With the opioid crisis claiming so many lives, physicians need to be especially careful prescribing these drugs. However, for many patients with cancer who are in a lot of pain, opioids can be a necessary part of treatment. So how can physicians determine predictors and frequency of opioid abuse in this population? A study now published in JAMA Oncology found that marital status, higher levels of pain, high scores on the Screener and Opioid Assessment for Patients with Pain (SOAPP), and morphine milligram equivalent daily dose (MEDD) all influence a patient's likelihood of developing nonmedical opioid use (NMOU) behavior.
This trial enrolled 1,554 patients with cancer who received supportive care at MD Anderson Cancer Center between March 18, 2016, and June 6, 2018, were taking opioids for cancer pain for at least one week and had follow-up within three months of the initial consultation. Patients completed questionnaires and had scheduled opioid treatments. Patients' NMOU behavior was assessed using the Edmonton Symptom Assessment Scale, SOAPP, and the Cut Down, Annoyed, Guilty, Eye-Opener-Adapted to Include Drugs (CAGE-AID) survey.
The researchers found one or more NMOU behaviors in 299 patients (19% of the study population). By the first two follow-up visits, 576 of 745 NMOU behaviors had already occurred. Going to unscheduled appointments to get untimely refills was the most common NMOU behavior. Of the 299 patients exhibiting NMOU behaviors, 88 scored a 7 or higher on the SOAPP assessment, and 48 scored at least 2 out of 4 points on the CAGE-AID survey. Being unmarried, having a MEDD greater than 50 mg, and having SOAPP scores greater than 7 were all linked to having a 56% higher risk for NMOU behaviors.
"Based on these findings, a universal screening, setting limits on opioid use by limiting supply, more intense follow-up with an interdisciplinary team to provide optimal use of medications for pain and symptom management, and the provision of counseling and support to patients and their family members may help prevent the development of these NMOU behaviors. However, further studies in this patient population are needed, " conclude the study authors, led by Sriram Yennurajalingam, MD, MS, FAAHPM, Professor in the Department of Palliative Care and Rehabilitation Medicine, Division of Cancer Medicine, at The University of Texas MD Anderson Cancer Center.
For More Information
Yennurajalingam S, Arthur J, Reddy S, et al (2021). Frequency of and factors associated with non-medical opioid use behavior among patients with cancer receiving opioids for cancer pain. JAMA Oncol. [Epub ahead of print] DOI:10.1001/jamaoncol.2020.6789
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