Health Care Provider Attitudes and Beliefs Toward Nonmedical Opioid Use in Patients with Cancer Pain

Amaram‐Davila, Jaya; Kim, Min Ji; Reddy, Akhila; Edwards, Tonya; Dai, Jianliang; Urbauer, Diana L.; Shelal, Zeena; Ross, Yvette; Hosain, Monawar; Bruera, Éduardo; Arthur, Joseph

doi:10.1089/jpm.2022.0293

Cited by 5 publications

(2 citation statements)

References 19 publications

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“…10 Without special training, clinicians either "use opioids sparingly," resulting in poor pain management, or believe it is not necessary to address comorbid OUD while prescribing opioids to patients with cancer. 11,12 Without evidence-based clinical pathways or validated screening tools, identification of aberrant opioid use is based on individual practitioners' personal biases, previous experience, and various education backgrounds. 13,14 The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain recommend use of the Current Opioid Misuse Measure (COMM), a self-assessment risk tool to screen for OUD during opioid treatment.…”

Section: Introductionmentioning

confidence: 99%

Should We Use COMM (Current Opioid Misuse Measure) to Screen for Opioid Abuse in Patients With Cancer Pain?

Moryl,

Mendoza,

Horn

et al. 2023

Journal of the National Comprehensive Cancer Network

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Background: Growing concerns about opioid use disorder (OUD) and the resulting decrease in opioid availability for patients with cancer pain highlight the need for reliable screening tools to identify the subset of patients at increased risk for aberrant opioid use. Our study examines the utility of Current Opioid Misuse Measure (COMM) recommended by the NCCN Clinical Practice Guidelines in Oncology for Adult Cancer Pain. Patients and Methods: We analyzed prospectively collected patient-reported outcomes of 444 consecutive patients with cancer seen in pain clinics of a cancer center at 2 time points within 100 days. The relationship of COMM to other OUD screening tools, pain, opioid doses, patient demographics, and mortality was examined using univariate and multivariable logistic regression. We also examined individual items of COMM for face validity. Results: Among 444 patients who completed pain surveys at 2 time points, 157 (35.4%) did not complete COMM surveys. Using a COMM cutoff of ≥13, a total of 84 patients (29.3%; 84/287) scored positive for aberrant drug use. As patients remained on opioids for 49 to 100 days, the likelihood of improving COMM score (turning from positive to negative) was 6.1 times greater than the reverse. The number of patients with COMM ≥13 was 3.8 times higher than the number of patients with CPT diagnostic codes for OUD, 5.3 times higher than those with a positive urine drug screening, and 21 times higher than those with a positive CAGE (Cut Down, Annoyed, Guilty, Eye-Opener Questionnaire) score. COMM ≥13 was not associated with pain relief response (worst pain intensity score ≥2 points on the Brief Pain Inventory), opioid doses, gender, or age. Contrary to the intended use of COMM to identify aberrant opioid use, COMM ≥13 predicted mortality: patients with COMM ≥13 were 1.9 times more likely to die within 12 months. Conclusions: Our study found that using COMM in a cancer population may significantly overestimate the risk of opioid misuse. Using COMM without modifications can create an additional barrier to cancer pain management, such as limiting appropriate opioid use.

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Section: Introductionmentioning

confidence: 99%

Should We Use COMM (Current Opioid Misuse Measure) to Screen for Opioid Abuse in Patients With Cancer Pain?

Moryl,

Mendoza,

Horn

et al. 2023

Journal of the National Comprehensive Cancer Network

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show abstract

“…In a recent study, palliative medicine physicians reported that aberrant opioid use was underdiagnosed, challenging to manage, time-consuming, and stressful. 3,6 A recent meta-analysis estimated the prevalence of opioid use disorder (OUD) among patients with cancer-related pain to be 8% and the risk for OUD to be 23.5%. 7 This is consistent with another report that determined that at least 1 in 5 patients with cancer are at increased risk for OUD.…”

mentioning

confidence: 99%

Mitigating the Risk of Aberrant Use of Opioids in Patients With Cancer Pain

Chwistek

2023

Journal of the National Comprehensive Cancer Network

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Healthcare provider perceptions and reported practices regarding opioid prescription for patients with chronic cancer pain

Arthur,

Edwards,

et al. 2024

Support Care Cancer

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Health Care Provider Attitudes and Beliefs Toward Nonmedical Opioid Use in Patients with Cancer Pain

Cited by 5 publications

References 19 publications

Should We Use COMM (Current Opioid Misuse Measure) to Screen for Opioid Abuse in Patients With Cancer Pain?

Should We Use COMM (Current Opioid Misuse Measure) to Screen for Opioid Abuse in Patients With Cancer Pain?

Mitigating the Risk of Aberrant Use of Opioids in Patients With Cancer Pain

Healthcare provider perceptions and reported practices regarding opioid prescription for patients with chronic cancer pain

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