Experts Address Managing Cancer-Related Pain in Setting of Opioid Abuse, Misuse

WEDNESDAY, July 6, 2022 — In a qualitative study published online June 30 in JAMA Oncology, consensus-based guidance is provided for managing advanced cancer-related pain in patients with opioid use disorder (OUD) or opioid misuse.

Katie Fitzgerald Jones, M.S.N., from Boston College in Chestnut Hill, and colleagues conducted two modified Delphi panels to examine the perspectives of palliative and addiction clinicians on three common clinical scenarios involving patients with advanced cancer-related pain and opioid misuse or OUD. A total of 120 palliative or addiction medicine specialists participated in at least one round and 84 participated in all three rounds.

The authors deemed it appropriate to begin treatment with buprenorphine/naloxone and inappropriate to refer to a methadone clinic for a patient with untreated OUD, regardless of prognosis. For patients with shorter prognoses, beginning split-dose methadone was deemed appropriate, while appropriateness was uncertain for those with longer prognoses. Appropriateness was uncertain for initiating a full opioid agonist for those with a short prognosis and was inappropriate for those with a longer prognosis. For those with no medical history of OUD taking more opioids than prescribed, it was deemed appropriate to increase monitoring, inappropriate to taper opioids, and of uncertain appropriateness to increase the patient’s opioids or transition to buprenorphine/naloxone, regardless of prognosis. It was deemed appropriate to increase monitoring and inappropriate to taper opioids and prescribe buprenorphine/naloxone for a patient with a urine drug test positive for nonprescribed benzodiazepines, regardless of prognosis.

“This qualitative study provides consensus-based management strategies that can be used to guide clinicians caring for patients with cancer-related pain and opioid misuse/OUD,” the authors write.

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Posted July 2022