Some patients receiving opioids to treat cancer-related pain may be more susceptible than others to engage in non-medical opioid use.
While opioids can be an effective tool in managing cancer-related pain, some patients may be more susceptible to non-medical opioid use (NMOU) – which can become dangerous, according to data recently published in JAMA Oncology.
“The majority of patients with cancer who have pain are receiving opioids. Now that there is an epidemic of opioid misuse and addiction, it’s a very important thing to learn about: how these patients have pain but are also at risk for opioid misuse. What are the complications? What are the consequences? How can we help them?” said lead study author Dr. Sriram Yennu, a professor in the department of palliative care and rehabilitation medicine at The University of Texas MD Anderson Cancer Center.
The study was conducted at The University of Texas MD Anderson Cancer Center and involved 1,554 patients with cancer who were referred to the supportive care center and were prescribed opioids for cancer pain at least once a week.
Multiple scales and factors were considered in analyzing patients’ opioid usage, including the Screener and Opioid Assessment to Patients with Pain (SOAPP) scale, which consists of 14 items regarding patients antisocial behavior, substance abuse history, doctor-patient relationship, medication-related behaviors, and psychiatric and neurologic need for medicine. Participants answer questions on a scale of 0 (never) to 4 (very often).
Ultimately, the researchers found that 19% of patients had at least one NMOU behavior. Higher SOAPP scores were correlated with a greater risk of NMOU. Additionally, marital status, daily opioid dose or morphine daily dose, and pain severity were also associated with NMOU.
The most common NMOU behavior was frequent unscheduled clinic visits or phone calls for refills, which occurred in 49.2% of the NMOU group and 29.3% of the general population.
“It is very difficult to assess other behaviors (that were studied), because sometimes (patients) may not self-report,” Yennu said. “This is a more objective behavior – (asking for) inappropriate refills – that we can really see them doing. So, this is definitely something we need to investigate further.”
Other NMOU behaviors included self-escalation of opioid dose for excessive increase in the opioid dosage not consistent with patient’s pain syndrome; use of nonprescribed restricted medications or illicit drugs; and reports of impaired functioning in daily activities due to opioid use.
Looking forward, the study authors state that their findings lay the groundwork for new policies when it comes to cancer-related pain, such as universal screening, setting limits on opioid use, and implementing more intense follow-up with an interdisciplinary team to ensure that patients are safely managing their symptoms.
For now, Yennu said that opioids still have an important role in treating cancer-related pain.
“It is so important to optimize pain in patients with cancer. And the best way to currently do this is opioids. But how can we reduce the risk?” he concluded.
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