Gaps in the Use of Long-Acting Opioids Within Intervals of Consecutive Days Among Cancer Outpatients Using Electronic Pill Caps

Abstract

Objective This study describes individual cancer patients’ nonuse of extended-release or long-acting (ER/LA) opioids, including periods of gap between opioid doses taken. Design Secondary analysis of a three-month observational study of prescribed ER/LA opioids monitored using electronic pill caps. Setting Two outpatient oncology clinics of a large health system in the Mid-Atlantic region. Participants Inclusion was based on self-identified African Americans and whites, at least 18 years old, diagnosed with solid tumors or multiple myeloma. For the current analysis, the additional inclusion criterion was prescription of an oral ER/LA opioid for cancer pain to be taken around the clock. Methods The electronic monitoring period for each study participant was partitioned into intervals of days between days with one or more openings (using medication event monitoring systems) representing rates of ER/LA opioid nonuse over consecutive days and over time. Results Of the sample (N = 109), two-thirds of the cancer patients had some nonuse of prescribed ER/LA opioids, with one in four having nonuse during 31.5–87.5% of their electronic-monitoring periods. Nonuse over periods of five or more, six or more, and seven or more consecutive days occurred for 37.6%, 34.9%, and 30.3% of the participants, respectively. Conclusions About one in three ambulatory cancer patients in this study had substantial gaps between days of ER/LA opioid use, potentially resulting in risk of overdose depending upon the prescribed ER/LA opioid type, dose, and length of the time the opioid was stopped and resumed at the previous dose. This phenomenon has received little to no attention in the opioid safety discourse.

Trajectories and predictors of high-occurrence pain flares in ambulatory cancer patients on opioids

“…In contrast to an opioid use disorder, opioid misuse may or may not be related to overuse of opioids ( 63 ). Indeed among patients with cancer, underuse of opioids, rather than overuse of opioids, has been found to be the main concern ( 20 , 64-66 ). Underuse of opioids in patients with cancer occurs due to opioid stigma, heightened fears of addiction, and lack of patient education on correct use of opioids ( 64 , 65 ).…”

“…Indeed among patients with cancer, underuse of opioids, rather than overuse of opioids, has been found to be the main concern ( 20 , 64-66 ). Underuse of opioids in patients with cancer occurs due to opioid stigma, heightened fears of addiction, and lack of patient education on correct use of opioids ( 64 , 65 ). In fact, a significant number of cancer patients may have considerable gaps in opioid use, which may lead to both opioid safety risks and poor baseline pain control ( 64 , 65 , 67 , 68 ).…”

“…Underuse of opioids in patients with cancer occurs due to opioid stigma, heightened fears of addiction, and lack of patient education on correct use of opioids ( 64 , 65 ). In fact, a significant number of cancer patients may have considerable gaps in opioid use, which may lead to both opioid safety risks and poor baseline pain control ( 64 , 65 , 67 , 68 ). Further studies are needed to understand how opioid prescription patterns may be associated with cancer pain control and trajectories of pain flares to generate an evidence base to inform clinical practice and cancer pain guidelines.…”

Modeling Individual Patient Count/Rate Data over Time with Applications to Cancer Pain Flares and Cancer Pain Medication Usage

“…Adherence data for around the clock pain medications were collected using pill bottles equipped with Medication Event Monitoring System (MEMS) devices (AARDEX North America, Boulder, CO) that recorded the date and time of each pill bottle opening and presumably of the taking of the pain medication [ 13 ] [ 14 ]. Cancer Patient 3 was monitored for a period of 91 days.…”