Opioid Misuse Behaviors in Adolescents and Young Adults in a Hematology/Oncology Setting

Ehrentraut, Jennifer Harman; Kern, Kathleen D.; Long, S. Alice; An, Angel Qi; Faughnan, Lane; Anghelescu, Doralina L.

doi:10.1093/jpepsy/jsu072

Cited by 39 publications

(32 citation statements)

References 48 publications

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“…The intensive nature of curative therapy and the consequent potential for symptomatic late sequelae results in a significant population of survivors who have either been exposed to opioids during therapy or may subsequently require them. A chart review of almost 400 patients aged 12–35 years from the St Jude Children's Research Centre documented opioid exposure in 94 cases . Aberrant opioid‐associated behaviour, as outlined in Table , was seen in 12%.…”

Section: Specific At Risk Groupsmentioning

confidence: 99%

“…In those patients with severe pain from advanced progressive disease, the primary aim of management with opioids should be to control pain, and concerns over the possibility of addiction become less relevant. Table 4 Aberrant opioid-associated behaviour in adolescents and young adults † Observable behaviour, for example requesting drugs specifically by 'street names', excess calls for repeats, reporting lost or stolen drugs, seeking multiple providers Medication non-compliance, for example use for non-pain indication, unauthorised dose increases Interpersonal behaviour, for example decreased functioning due to opioids, third-party concern Illegal behaviour, for example illicit drug use, stealing/selling, forgery †Adapted from Ehrentraut et al 14…”

Section: Summary and Recommendationsmentioning

confidence: 99%

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Opioid addiction and misuse in adult and adolescent patients with cancer

Pinkerton¹,

Hardy

2017

Internal Medicine Journal

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In the context of a therapeutic opioid epidemic, particularly in the USA, where increasingly stringent screening for ‘at risk’ individuals and close monitoring of opioid prescription and use is strongly recommended, the issue of misuse within the cancer population must be addressed. Most patients with advanced cancer will have pain requiring opioid therapy at some stage during their disease course. In the majority, this will provide good pain relief with no short‐ or longer‐term adverse sequelae. A subset will present with substance misuse issues that will influence management and prescribing practice. The potential ethical issues of limiting effective analgesia on the basis of addiction risk or history must be acknowledged. Both a judgemental or ‘relaxed’ approach to such patients is problematic. Ignoring the situation will not be in the patient's best interest, but an undue focus on this aspect may damage therapeutic relationships with clinicians and adversely affect a holistic approach to care. Clinical practitioners must be aware of the risk factors for opioid misuse and in patients who are not under palliative care consider screening prior to commencing opioids. Clinicians must be able to manage and monitor those identified as having an opioid misuse problem.

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Section: Specific At Risk Groupsmentioning

confidence: 99%

Section: Summary and Recommendationsmentioning

confidence: 99%

Opioid addiction and misuse in adult and adolescent patients with cancer

Pinkerton¹,

Hardy

2017

Internal Medicine Journal

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“…Finally, little is known about patterns of opioid use and misuse in the oncology setting because patients with cancer are also excluded from clinical trials that focus on chronic pain and analgesic use. However, given data suggesting potential for opioid misuse, particularly within the adolescent and young adult (AYA) oncology population, risk factors associated with opioid misuse have begun to be examined. Research in this area suggests that multidisciplinary care of AYA oncology patients is extremely important given the potential for psychiatric distress in this population that may place AYA patients at greater risk for misuse of opioids .…”

Section: Problem 2: Pain In Children With Cancermentioning

confidence: 99%

Children's cancer pain in a world of the opioid epidemic: Challenges and opportunities

Fortier

Yang

Phan

et al. 2019

Pediatric Blood & Cancer

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The opioid crisis in the United States has grown at an alarming rate. Children with cancer are at high risk for pain, and opioids are a first‐line treatment in this population. Accordingly, there is an urgent need to optimize pain management in children with cancer without contributing to the opioid crisis. This report details opportunities for this optimization, including clinical practice guidelines, comprehensive approaches to pain management, mobile health, and telemedicine. It is vital to balance appropriate use of analgesics with efforts to prevent misuse in order to reduce unnecessary suffering and minimize unintended harms.

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“…A study from a pediatric cancer center showed that more than 11% of adolescent and young adult cancer patients prescribed opioids demonstrated aberrant opioid misuse behaviors. 29 Te discussion of pre-existing substance abuse disorder or opioid misuse and aberrant behavior is a difcult but important conversation.…”

Section: Opioid Risk and Its Role In Palliative Medicinementioning

confidence: 99%

Opioid risk assessment in palliative medicine

Dale

Edwards

Ballantyne

2016

J Community Support Oncol

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Pain management with opioids is an integral part of palliative medicine. As the doses and durations of opioid therapy increase, the inherent risks of opioid therapy rise. Although opioids are effective analgesics, they bring with them complex medical and psychological side effects. Aberrant behavior is dangerous and can be diffcult to identify as it results in a splitting in the goals of treatment between the patient and providers. One effective strategy in preventing that situation is through the early identifcation of at-risk patients. There are several tools that can help identify patients at higher risk of addiction and aberrant behaviors during opioid therapy. Structured use of these tools in conjunction with the clinic exam, regular follow-up visits, and lab testing can further reduce patient risk and improve success in opioid therapy. This article will review the background behind a structured strategy for opioid risk assessment using the Opioid Risk Tool, SOAPP-R, and DIRE tools. In addition, example aberrant behaviors and followup strategies will be reviewed. It will be demonstrated that careful screening and follow-up allow risk factors to be recognized and addressed early.

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Opioid Misuse Behaviors in Adolescents and Young Adults in a Hematology/Oncology Setting

Abstract: Hematology/oncology AYA patients may exhibit AOB despite a legitimate clinical indication for opioid therapy. Clinicians should consider young patients' psychosocial risk factors when using opioid therapy.

Cited by 39 publications

References 48 publications

Opioid addiction and misuse in adult and adolescent patients with cancer

Opioid addiction and misuse in adult and adolescent patients with cancer

Children's cancer pain in a world of the opioid epidemic: Challenges and opportunities

Opioid risk assessment in palliative medicine

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