Study Evaluates Risk Factors for Nonmedical Opioid Use Behavior Among Patients With Cancer

Some patients with cancer may receive opioids to help manage pain associated with their disease. But according to a study, about one in five of these patients may eventually take part in nonmedical opioid use (NMOU) behavior.

“One of the main aims of research on NMOU is to reduce the frequency of NMOU behaviors through interventions such as universal screening, reduced opioid exposure, and more intense follow-up of patients with elevated risk. The absence of data on the frequency of NMOU behavior is the major barrier to conducting research on NMOU,” the researchers explained.

Between March 18, 2016, and June 6, 2018, 3,615 patients with cancer were referred to the supportive care center at MD Anderson Cancer Center. Patients who had been taking opioids for cancer-related pain for at least one week were eligible for inclusion. Those who did not have follow-up within three months of their initial consultation, did not fill out the required questionnaire, or did not have scheduled opioid treatments. A total of 1,554 patients were ultimately eligible for inclusion. The Edmonton Symptom Assessment Scale, the Screener and Opioid Assessment for Patients with Pain (SOAPP), and the Cut Down, Annoyed, Guilty, Eye Opener–Adapted to Include Drugs (CAGE-AID) survey were used to evaluate patients.

Among the 1,554 patients evaluated in the study, the median age was 61 years (interquartile range [IQR], 52-69 years), 816 were female, and 1,124 were white. Overall, 299 patients (19.2%) had at least one NMOU behavior; the median number of NMOU behaviors per patient was one (IQR, 1-3). Three-quarters of NMOU behaviors (n=576/745) were observed by the first two follow-up visits. The most common NMOU behavior was unscheduled clinic visits for inappropriate refills, which was the case in almost a third of NMOU behaviors (n=218). Close to a third of patients (n=88/299) scored ≥7 on SOAPP, while 48 patients scored ≥2 on the CAGE-AID survey.

Factors associated with NMOU behavior were marital status single (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.15-2.18; P=0.005) or divorced (HR, 1.43; 95% CI, 1.01-2.03; P=0.04), SOAPP score (positive vs. negative, HR, 1.35; 95% CI, 1.04-1.74; P=0.02), morphine equivalent daily dose (MEDD) (HR, 1.003; 95% CI, 1.002-1.004; P<0.001), and Edmonton Symptom Assessment Scale pain level (HR, 1.11; 95% CI, 1.06-1.16; P<0.001), according to multivariate analysis. Single marital status, MEDD >50 mg, and SOAPP score >7 were risk factors for NMOU behavior, according to recursive partition analysis.

The study was published in JAMA Oncology.

“This prognostic study of patients with cancer taking opioids for cancer pain found that 19% of patients developed NMOU behavior within a median duration of 8 weeks after initial supportive care clinic consultation,” the study authors concluded, adding, “This information will assist clinicians and investigators designing clinical and research programs in this important field.”