Best Practices in the Management of Nonmedical Opioid Use in Patients with Cancer-Related Pain

Abstract

Introduction Nonmedical opioid use (NMOU) in patients with cancer is a term covering a spectrum of nonprescribed opioid use. The extent to which an individual uses opioids in a nonprescribed manner will influence propensity for adverse effects such as neurotoxicity, substance use disorder, overdose, and death. Objectives The objectives of this study were to (A) evaluate current literature regarding management of NMOU in patients with cancer‐related pain; (B) provide best practice recommendations based on evidence; and (C) integrate practices derived from the management of noncancer pain, where clinically appropriate or when the oncology literature is limited. Methods This study is a narrative review. Implications Although harm from NMOU was thought to be rare among oncology patients, about one in five patients with cancer is at risk of adverse outcomes including prolonged opioid use, high opioid doses, and increased health care utilization. The management of NMOU can be challenging because pain is a multidimensional experience encompassing physical, psychological, and spiritual domains. An interdisciplinary team approach is most effective, and management strategies may include (A) education of patients and families; (B) harm reduction, including opioid switching, decreasing the overall daily dose, avoiding concurrent sedative use, and using adjuvant medications for their opioid‐sparing potential; (C) managing psychological and spiritual distress with an interdisciplinary team and techniques such as brief motivational interviewing; and (D) risk mitigation by pill counts, frequent clinic visits, and accessing statewide prescription drug monitoring plans. Conclusion Although many of the management strategies for NMOU in patients with cancer‐related pain are modeled on those for chronic non–cancer‐related pain, there is emerging evidence that education and harm‐reduction initiatives specifically for cancer‐related pain are effective. Implications for Practice Nonmedical opioid use (NMOU) in patients with cancer is a term covering a broad spectrum of nonprescribed opioid use. The extent to which an individual uses opioids in a nonprescribed manner will influence propensity for adverse effects such as neurotoxicity, substance use disorder, overdose, and death. This review evaluates the evidence for best practices in oncology and addresses limitations in the literature with supplemental evidence from noncancer chronic pain. Management recommendations for NMOU are provided, based on a combination of literature‐based evidence and best clinical practice. Effective management of NMOU in oncology has the potential to improve quality of life, decrease health utilization, and improve survival.

Effects of Animal-Assisted Therapy on Hospitalized Children and Teenagers: A Systematic Review and Meta-Analysis

“…This can increase the discomfort of children, affect their treatment processes, and lead to poor quality of life (Duran et al, 2020;Genik et al, 2020). To control cancer-related symptoms, pharmacotherapy has been widely used as a traditional treatment (Ulker & Del, 2020).…”

Pill Counting as an Intervention to Enhance Compliance and Reduce Adverse Outcomes with Analgesics Prescribed for Chronic Pain Conditions: A Systematic Review

“…Several studies mention the utility of pill counting as a component of opioid management; however, few include specific citations for these statements. Of the 24 full-text manuscripts assessed with potential eligibility and not included in the final analysis, only nine specifically reference the utility of pill counting [15][16][17][18][19][20][21][22][23]. Colasanti et al cited an article by Chou and colleagues, in which the authors state, "Because patient self-report may be unreliable for determining amount of opioid use, functionality, or aberrant drug-related behaviors, pill counts…can be useful supplements" (p. 123) [15,24].…”

When Management of Cancer-Related Pain Is Complicated by Coexisting Opioid Use Disorder

“…A harm reduction approach to the care of persons with SUDs includes a focus on reducing the negative impacts of the harmful behavior without a focus on abstinence 30 . Using a harm reduction approach in the setting of a terminal illness, health care clinicians provide ongoing medical care and counseling on how to reduce negative outcomes of the illness or SUD 31,32 . Han 33 recently proposed a model of using a geriatric medicine approach in combination with harm reduction to better care for aging patients with complex comorbid medical conditions occurring simultaneously with SUDs.…”

“…30 Using a harm reduction approach in the setting of a terminal illness, health care clinicians provide ongoing medical care and counseling on how to reduce negative outcomes of the illness or SUD. 31,32 Han 33 recently proposed a model of using a geriatric medicine approach in combination with harm reduction to better care for aging patients with complex comorbid medical conditions occurring simultaneously with SUDs. Oncology and palliative care clinicians may choose to pursue a harm reduction approach when caring for patients with painful terminal illness and active SUDs using a similar approach of focusing on individual counseling, supporting patient-specific goals, and risk reduction without a primary focus on fixing or curing the underlying problem, to help a person feel as well as they can for as long as they are alive, within the context of their illness.…”