Screening for substance abuse risk in cancer patients using the Opioid Risk Tool and urine drug screen

Barclay, Joshua; Owens, Justine E.; Blackhall, Leslie

doi:10.1007/s00520-014-2167-6

Cited by 99 publications

(115 citation statements)

References 20 publications

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“…Factors associated with increased risk of prescription opioid abuse in cross-sectional studies include younger age (18–25 years old), male gender, psychiatric disorders (e.g., depression, bipolar disorder), exposure to violence or sexual assault, a history of substance use disorders (in particular illegal drug use), and a family history of substance use disorder (2, 22). Men are more likely than women to use prescription opioids via alternative routes (e.g., crushing and snorting pills), and women are more likely than men to receive prescriptions for opioids combined with sedatives, an important risk factor for inadvertent overdose (23).…”

Section: Screening and Assessmentmentioning

confidence: 99%

Prescription Opioid Misuse, Abuse, and Treatment in the United States: An Update

Brady¹,

McCauley²,

Back³

2016

AJP

215

169

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Objective Prescription opioid abuse and dependence have escalated rapidly in the United States over the past 20 years, leading to high rates of overdose deaths and a dramatic increase in the number of people seeking treatment for opioid dependence. The authors review the scope of the abuse and overdose epidemic, prescription practices, and the assessment, treatment, and prevention of prescription opioid misuse and dependence. Method The authors provide an overview of the literature from 2006 to the present, with the twin goals of highlighting advances in prevention and treatment and identifying remaining gaps in the science. Results A number of policy and educational initiatives at the state and federal government level have been undertaken in the past 5 years to help providers and consumers, respectively, prescribe and use opioids more responsibly. Initial reports suggest that diversion and abuse levels have begun to plateau, likely as a result of these initiatives. While there is a large body of research suggesting that opioid substitution coupled with psychosocial interventions is the best treatment option for heroin dependence, there is limited research focusing specifically on the treatment of prescription opioid dependence. In particular, the treatment of chronic pain in individuals with prescription opioid use disorders is underexplored. Conclusions While policy and educational initiatives appear to be effective in decreasing prescription opioid abuse and misuse, research focusing on the development and evaluation of treatments specific to prescription opioid dependence and its common comorbidities (e.g., chronic pain, depression) is critically needed.

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Section: Screening and Assessmentmentioning

confidence: 99%

Prescription Opioid Misuse, Abuse, and Treatment in the United States: An Update

Brady¹,

McCauley²,

Back³

2016

AJP

215

169

View full text Add to dashboard Cite

show abstract

“…The urine drug test (UDT) is an important opioid risk‐management tool that is frequently used in patients with noncancer pain who are receiving COT . However, the published data are very limited on its use among patients with advanced cancer, and the frequency of aberrant drug‐related behavior in this patient population is not well known . A better understanding of the utility of the UDT in these patients may help clinicians to optimize safe opioid use and minimize misuse among cancer patients who receive COT.…”

Section: Introductionmentioning

confidence: 99%

Frequency, predictors, and outcomes of urine drug testing among patients with advanced cancer on chronic opioid therapy at an outpatient supportive care clinic

Arthur

Edwards

et al. 2016

Cancer

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UDTs were used infrequently among outpatients with advanced cancer who were receiving chronic opioid therapy. Younger age, positive CAGE questionnaire results, early stage cancer or no evidence of disease status, higher pain intensity, and lower fatigue scores were significant predictors of UDT ordering. More than 50% of UDT results were abnormal. More research is necessary to better characterize aberrant opioid use in patients with advanced cancer. Cancer 2016;122:3732-9. © 2016 American Cancer Society.

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“…Numerous screening tools are available to help identify those currently misusing, or at risk for misusing opioids, including the SOAPP‐SF (Screener and Opioid Assessment for Patients with Pain, Short Form) , the Opioid Risk Tool , and the Brief Risk Interview . One concern regarding the use of these tools is that many have not been widely tested in the oncology population.…”

Section: Risk Assessment and Monitoringmentioning

confidence: 99%

“…Universal precautions may include several strategies, including the use of urine toxicology , standardized contracts or agreements , and review of the data accessed from the state PDMP . More information is needed regarding which of these strategies are most beneficial, as well as cost and time effective, in the oncology setting.…”

Section: Risk Assessment and Monitoringmentioning

confidence: 99%

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Risk Assessment and Monitoring of Patients with Cancer Receiving Opioid Therapy

Paice

2019

The Oncologist

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The primary objective of this article is to assist oncologists and advanced practice prescribers to safely and effectively minimize risk when providing opioids for cancer pain relief. The majority of people with cancer are unlikely to misuse or divert opioid medications, yet the prescriber is often unaware of those who are at risk for these behaviors. To provide skillful pain management to each patient in the oncology setting, while limiting harm to the community, all prescribers must consider the potential for risk of misuse, addiction, or diversion. To minimize this risk to the greatest degree possible, it is imperative to include a thorough risk assessment when conducting a comprehensive pain evaluation. This information is then used to triage pain relief interventions based upon the degree of risk, including whether or not to incorporate opioids into the plan of care. Risk mitigation strategies, incorporating universal precautions, are implemented to assess, monitor, and reduce the potential for opioid misuse. Universal precautions include strategies such as the use of urine toxicology, state prescription drug monitoring programs, and agreements. Ongoing monitoring is conducted with the goal being to identify aberrant behaviors early so that they can be addressed and managed appropriately. Referral to addiction specialists may be warranted when substance use disorder precludes safe use of opioids. Implications for Practice Throughout the trajectory of cancer care, opioid use is often indicated, and, in fact, it may be unethical to limit or prohibit the use of opioids when pain is severe. Oncologists face the significant challenge of providing cancer pain control that is safe and effective, while limiting individual risk for abuse or overdose and keeping the community free of diverted substances. Most oncology providers report inadequate training in chronic pain principles and in managing addiction. Risk assessment and mitigation measures can be incorporated within oncology care to enhance effective pain management while reducing the potential for harm.

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Screening for substance abuse risk in cancer patients using the Opioid Risk Tool and urine drug screen

Abstract: Opioids are an effective treatment for cancer-related pain, yet substantial risk for substance abuse exits in the cancer population. Screening tools, such as the Opioid Risk Tool, should be used as part of a complete patient assessment to balance risk with appropriate relief of suffering.

Cited by 99 publications

References 20 publications

Prescription Opioid Misuse, Abuse, and Treatment in the United States: An Update

Prescription Opioid Misuse, Abuse, and Treatment in the United States: An Update

Frequency, predictors, and outcomes of urine drug testing among patients with advanced cancer on chronic opioid therapy at an outpatient supportive care clinic

Risk Assessment and Monitoring of Patients with Cancer Receiving Opioid Therapy

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