Managing the Opioid Epidemic in Oncology

Opioids continue to pose a significant concern in multiple healthcare spheres, and the oncology setting is not immune. A poster presentation featured during the Oncology Nursing Society 44th Annual Congress sought to clarify perceptions held by advance practice providers (APPs) pertaining to harm reduction strategies for addiction specifically in a cancer hospital’s hematology department. Armed with the appropriate knowledge and tools, APPs can help navigate the complex world of addiction and may be able to implement a program aimed at harm reduction.

Addiction is multi-faceted and goes beyond just the drugs—rather, it pertains to what is happening in the patient’s brain. Harm reduction, therefore, has several focuses as well. Notably, harm reduction does not refer to abstinence, and it is not an active way to treat addiction. The poster details three interventional harm reduction strategies: universal precautions, warning signs, and safer prescribing practices.

The first strategy, universal precautions, emphasizes that harm reduction is not about opioid therapy but about quality medical care. Here, the goal is to improve treatment outcomes and reduce the stigma associated with addiction. All patients should be assessed for their risk, through screening questionnaires, direct observation, patient/family history, clinical judgment, and urine toxicology screens.

Even with these precautions in place, it is still important to be on the lookout for red flags that something may be wrong. These could include missing pills and/or requiring early refills, having numerous prescribers and emergency room visits, sharing medications, refusing to undergo urine toxicology screens, making specific drug requests at increasing doses, and more.

The final facet of harm reduction interventions is practicing safer prescribing. It is important to ask all patients about their substance use/addiction history. Other useful strategies may include a pain diary, a prescription drug monitoring program, a controlled medicine management form, and placing a limit on prescription quantity.

McNally GA. Harm Reduction: Reframing perceptions and informing practices of hematology/oncology Advance Practice Providers.