Patterns in Analgesic and Hypnotic Use During the Last Year of Life

Abstract
Introduction: Pain and discomfort tend to increase as disease is overtaking the body, and death is imminent. To alleviate such symptoms, increasing amounts of analgesics, hypnotics or sedatives are prescribed. The pattern of use of such medications prior to death is not well known. Consequently, this study examines patterns of usage of opioids, and benzodiazepines and/or z-hypnotics (BZD-Z) during the last year of life.
Methods: The study population, aged 41-80 in 2010, is from the Norwegian Pharmaceutical Database. Between January and October 2010, 8,862 deaths occurred in the study population. Controls consisted of 770,280 persons alive by the end of 2010. Opioids and BZD-Z use was recorded in six 2-month-periods before the death/index date.
Results: Opioid use was found for 14% of controls per two month period regardless of age. BZD-Z use by controls increased with age from 15% per two month period for ages 41-50 to 30% for ages 71-80. Among prospective deaths, opioid use increased gradually with time, ending with a rate triple that of controls. BZD-Z use also increased in use with approaching death but to a lesser extent than opioid use. About 4-6% of controls received opioids and BZD-Z concurrently, which is about double that expected if opioids and BZD-Z were distributed independently. About 8% of prospective deaths took both opioids and BZD-Z already at 12 months before death, which increased to 10.6% shortly before death. Persons over 60 show smaller increases in opioid and BZD-Z use with approaching death than those younger.
Conclusion: The gradually increasing use of opioids and BZD-Z as death draws near is consistent with the increasing need for alleviation of pain and other discomfort related to approaching death. Of interest is the difference in patterns of opioid and BZD-Z use with age.