{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T18:32:01Z","timestamp":1775500321227,"version":"3.50.1"},"reference-count":52,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T00:00:00Z","timestamp":1742342400000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Public Health Challenges"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Palliative care aims to alleviate suffering and improve the quality of life for patients with life\u2010limiting illnesses through effective pain management with opioids. Despite its global importance, opioid use in palliative care faces significant challenges, particularly in resource\u2010poor settings like Bangladesh. In Bangladesh, opioid use is notably low, with disparities between urban and rural areas. Cultural stigmas, strict regulations, and inadequate healthcare provider training further obstruct effective pain management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aims to explore the challenges healthcare providers face regarding opioid use in both hospital and home\u2010based palliative care settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A descriptive cross\u2010sectional study was conducted using face\u2010to\u2010face semistructured interviews with 135 licensed healthcare providers from August to September 2022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The respondents, predominantly young (57% aged 20\u201339) and female (68.9%), primarily manage late\u2010stage cancer patients (98.5%), with pain (100%) being the primary symptom treated. Morphine syrup is commonly used (68.1%), whereas oxycodone and buprenorphine are unavailable. Side effects such as deep sedation (43.7%) and addiction (34.1%) highlight the need for careful monitoring. Limited awareness (10.4%) of national opioid policies results in inconsistent practices (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.001) and (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.004). Prescribing restrictions (60.7%) and dispensing rights issues contribute to operational challenges, affecting patient access to pain management. Misconceptions about palliative care (32.6%) and inter\u2010departmental non\u2010cooperation (38.5%) hinder patient referrals (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.001) and continuity of care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Inconsistent awareness of opioid policies causes varied practices and attitudes. Addressing referral challenges and prescribing restrictions requires interdisciplinary solutions, enhanced education, better policy dissemination, and standardized guidelines for effective palliative care opioid management.<\/jats:p><\/jats:sec>","DOI":"10.1002\/puh2.70013","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T08:45:42Z","timestamp":1742373942000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Opioid\u2010Related Challenges Faced by Palliative Healthcare Providers in Both Hospital and Home Care Settings: A Multi\u2010Center\u2010Based Descriptive Cross\u2010Sectional Study"],"prefix":"10.1002","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4664-6761","authenticated-orcid":false,"given":"Mastura","family":"Kashmeeri","sequence":"first","affiliation":[{"name":"Department of Public Health &amp; Hospital Administration NIPSOM  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6234-2207","authenticated-orcid":false,"given":"A. N. M. Shamsul","family":"Islam","sequence":"additional","affiliation":[{"name":"Department of Public Health &amp; Hospital Administration NIPSOM  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2395-9049","authenticated-orcid":false,"given":"Palash Chandra","family":"Banik","sequence":"additional","affiliation":[{"name":"Department of Noncommunicable Diseases Bangladesh University of Health Sciences (BUHS)  Dhaka Bangladesh"},{"name":"Center for Higher Studies and Research Bangladesh University of Professionals  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,19]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Pain Policy Studies Group.Achieving Balance in State Pain Policy: A Progress Report. 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H.England.The Controlled Drugs (Supervision of Management and Use) Regulations 2013 Single Operating Model accessed March 10 2025 https:\/\/www.cdreporting.co.uk\/documents\/som-cont-drugs.pdf."},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/082585979801400405"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0304\u20103959(00)00361\u20104"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(05)66666\u20104"},{"key":"e_1_2_11_34_1","volume-title":"Opioid Availability and Accessibility for the Relief of Cancer Pain in Africa, Asia, India, the Middle East, Latin America and the Caribbean: Final Report of the International Collaborative Project","author":"Cherny N. 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