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One in Five Cancer Patients on Long-Term Opioids Misuse Them

Among cancer patients receiving long-term opioid treatment for pain, 19% developed behaviors of nonmedical opioid use (NMOU), researchers reported.

In a study of more than 1,500 patients being treated at a comprehensive cancer center’s supportive care clinic, the most common NMOU behavior was an early refill request, in 29%, followed by self-directed dose escalation in 15%, co-use of illicit or non-prescribed drugs in 13%, and impaired daily function due to opioids in 11%, among others, according to a team led by Sriram Yennurajalingam, MD, MS, of MD Anderson Cancer Center in Houston.

“This finding highlights the need for continuous vigilance and careful use of these opioids in this population,” the authors wrote in JAMA Oncology.

On multivariate analysis, several factors were independently associated with an increased risk of NMOU behaviors, including single (HR 1.58, 95% CI 1.15-2.18, P=0.005) or divorced marital status (HR 1.43, 95% CI 1.01-2.03, P=0.04), Edmonton Symptom Assessment Scale (ESAS) pain level (HR 1.11, 95% CI 1.06-1.16, P<0.001), Screener and Opioid Assessment for Patients with Pain (SOAPP) score (positive vs negative HR 1.35, 95% CI 1.04-1.74, P=0.02), and morphine equivalent daily dose (HR 1.003, 95% CI 1.002-1.004, P<0.001).

In a recursive partition analysis, a morphine equivalent daily dose >50 mg, being single, and a SOAPP score of 7 or higher were associated with a 56% higher risk for NMOU behavior.

“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,” wrote Yennurajalingam and co-authors.

The study examined NMOU behaviors in 1,554 consecutive cancer patients on opioids for their pain who were referred to MD Anderson Cancer Center’s supportive care clinic from 2016 to 2018. Patients were assessed using SOAPP score; the Cut Down, Annoyed, Guilty, Eye Opener-Adapted to Include Drugs (CAGE-AID) survey; and ESAS pain level.

In all, 29.4% of patients had a SOAPP score of 7 or above. On the CAGE-AID survey, 16.6% scored at least 2 of 4 points. Median age in the cohort was 61 years, 52.5% were women, 72.3% were white, and 19.2% had one or more NMOU behaviors, with 745 behaviors recorded among these 299 patients.

Other NMOU behaviors included resistance to change in an opioid prescription (7%), request for a specific opioid (6%), doctor shopping (6%), reports of lost medication (4%), frequent emergency department visits for opioids (3%), a concerned family member (3%), requesting opioids for reasons other than pain (2%), and obtaining opioids from nonmedical sources (1%).

  • Ian Ingram joined MedPage Today in 2018 as Deputy Managing Editor, and covers oncology for the site.


Yennurajalingam reported grants from the Helsinn Healthcare Fatigue and Cachexia Study and the Genentech Patient Experience Study. Co-authors reported grants from or relationships with Teva Pharmaceutical, Insys Therapeutics, and Helsinn Healthcare.