Opioid Misuse and Abuse: Risk Assessment and Management in Patients with Cancer Pain

Abstract

The FDA's 2012 risk evaluation and mitigation strategy is a major step toward systematically reducing the inherent risks of chronic opioid therapy for pain, but does not distinguish between risks related to sources of pain. This article discusses the effect of risk mitigation in the treatment of cancer pain, with a focus on pretreatment screening and ongoing monitoring in this patient population that often requires pain management at some time during cancer treatment. Experience with screening, risk stratification, and interventions at one cancer center is shared, along with some recommendations for practice. A new screening checklist is proposed that summarizes known risk factors. Patients with cancer are not protected from the problems of opioid abuse/misuse, and the multidisciplinary cancer treatment team should coordinate an evaluation of risk and the monitoring of aberrant behaviors as part of the comprehensive care plan.

A Pilot Study To Define Chemical Coping in Cancer Patients Using the Delphi Method

“…Psychiatric disease, which was identified as a warning sign for chemical coping in our study, also has been consistently reported as a warning sign for opioid-related problems in noncancer and cancer patients. 14,16,[20][21][22][23] Warning signs identified in our study may support further research to screen for chemical coping and develop appropriate interventions.…”

Opioid risk assessment in palliative medicine

“…More frequent visits and short-term prescriptions may also help decrease risk in high-risk patients by reducing the amount of medication the patient has on hand at any given time [68]. Often, the decision for the provider is not a binary choice between prescribing opioids or not, but involves obtaining additional support, changing prescribing schedules, getting a family member to help with dispensing medications, or other techniques to reduce risk and enhance safety [69,70].…”

Opioid risk assessment in palliative medicine

“…When a patient shows aberrant behavior, the palliative medicine clinician has a responsibility to ensure that additional support and alternative methods are used to reduce risk and increase patient safety. 36 Opioid risk assessment: a process algorithm Te high risk of opioid medications must be considered when treating patients with pain in the setting of palliative medicine. However, with careful screening and information gathering, safe and efective pain control can be achieved in this complex population of patients (Figure).…”