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Objectives Trans-mucosal administration is considered when a patient is unable to swallow or enteral absorption is poor. It provides a safe, non-invasive alternative for rapid symptom control, as medications are absorbed rapidly through mucus membranes bypassing first pass metabolism. 1 A paediatric randomised control trial found similar absorption of buccal and sublingual oxycodone.2 Oxycodone has increased bioavailability and half-life and fewer side effects compared to morphine.3 The APPM formulary doesn’t include dosing recommendations for buccal oxycodone but there is data suggesting IV/oral oxycodone solutions can be administered buccally.4 Method Our specialist tertiary palliative care team have evaluated the use of buccal oxycodone using the oral solution available.A retrospective case notes review was undertaken of all patients having received buccal oxycodone as part of usual clinical practice by a specialist tertiary palliative care team from March 2024 to September 2024.Results Four children aged 6 to 16 years prescribed buccal oxycodone were identified.Starting doses varied between 50–100 micrograms/kg. Only 1 child was opioid naïve when commenced on oxycodone. For two children, the medication was commenced at the hospice and for two children, it was commenced at home.Both the concentrations of oral solution were used (10 mg/ml and 5 mg/5 ml) with good effect.The table 1 listed below gives details regarding the starting doses and the indication for commencing buccal oxycodone.Abstract 7770 Table 1 Age(Years) Weight(Kg) Diagnosis Reason for Commencing Buccal Oxycodone STARTING DOSESTRENGTH OF ORAL SOLUTION USED 6 18 Neurological condition with orofacial dystonia Rapid acting analgesia required when patient unable to swallow 1 mg prn (can be used 4 hourly)10 mg/ml solution used 16 25 Chromosomal abnormality, neurological condition End of life care for pain 0.8 mg – every 4 hours for pain0.3 mg for breathlessness5 mg/5 ml solution used 16 49.5 Genetic syndrome, gut failure (PN dependant) Rapid acting analgesia, enteral route not appropriate 0.5 mg (prn – can be used hourly)5 mg/5 ml solution used 12 31.6 Chromosomal condition, gut related problems Pain – as an alternative to paracetamol due to central line 2 mg 6 hourly – can be used every 4 hours is needed.10 mg/ml solution used Dose escalation was not required for any of the children. All the children were on other symptom management medications including gabapentin (n=1), clonidine (n=1), Midazolam (n=2), Chloral (n=1), diazepam (n=1), PCAS Oxycodone (n=1). Although no adverse effects were reported one child discontinued the use of the medication due to bitter taste.A 5th child was identified where buccal oxycodone would have been clinically appropriate but it could not be given due to challenges experienced in an inpatient hospital setting.Conclusion Oxycodone can safely be given via the buccal route for alleviation of symptoms such as moderate to severe pain.We found in this small case series that administering the oral solution buccally was effective. No adverse effects were noted although one child discontinued the treatment due to a bitter taste of the oral solution. The oral solution is a needle free buccal opioid option meaning this is easier to draw up and administer especially by parents/carers.Further studies are needed using the oral formulation to evaluate the feasibility of using buccal oxycodone over a longer period of time.References Sutherland AE, Presland M, Harrop E, et al- BMJ Supportive & Palliative Care 2022;12:305–315.Kokki H, Rasanen I, Lasalmi M, et al- Comparison of Oxycodone Pharmacokinetics after Buccal and Sublingual Administration in Children. Clin Pharmacokinet 45, 745–754 (2006).Huddart R, Clarke M, Altman, et al. Pharmacogenetics and Genomics 2018 October;28(10):230–237.Sutherland AE, Presland M, Harrop E, et al. Orodispersible and transmucosal alternative medications for symptom control in adults. BMJ Supportive & Palliative Care 2022;12:305–315.