Interdisciplinary intervention for the management of nonmedical opioid use among patients with cancer pain

Abstract

BACKGROUND: Few studies have assessed interventions aimed at managing nonmedical opioid use (NMOU) behavior among patients with cancer. The authors developed the Compassionate High-Alert Team (CHAT) intervention to manage patients receiving opioids for cancer pain who demonstrate NMOU behavior. The objective of this study was to determine the change in frequency of NMOU behaviors, pain intensity, and opioid requirements among those who received the intervention. METHODS: A total of 130 patients receiving opioids for cancer pain that had documented evidence of NMOU and received the CHAT intervention were reviewed. Demographic and clinical information such as NMOU behaviors, pain scores, and morphine equivalent daily dose at baseline, 3, and 6 months post-intervention was obtained. RESULTS: NMOU behaviors significantly decreased from a median (interquartile range) of 2 (1-3) at baseline to 0 (0-1) at both 3 and 6 months post-intervention (p < .001). A total of 45 of 75 (60%) and 31 of 50 (62%) of CHAT recipients achieved complete response to the intervention at 3 and 6 months, respectively. Higher baseline number of NMOU behaviors was independently associated with patient response to the intervention (odds ratio [OR], 1.97; 95% confidence interval [CI],1.09-4.28, p = .049 at 3 months; OR, 2.5; 95% CI, 1.20-6.47, p = .03 at 6 months). The median pain score decreased from 7 at baseline to 6 at both 3 and 6 months (p = .01). Morphine equivalent daily dose did not significantly change during that same period (143 mg/day vs. 139 mg/day, p = .13). CONCLUSIONS: Most patients who received the CHAT intervention improved in their NMOU behaviors and pain intensity scores 3 and 6 months post-intervention. These preliminary findings support the efficacy of CHAT in managing patients receiving opioids for cancer pain who demonstrate NMOU behavior.

Empowering Oncologists to Successfully Address Non-Medical Opioid Use During Cancer Treatment: A Review of Best Practices

“…Patients with cancer however, are not excluded from universal safe opioid prescribing (Table 1) [18]. While there has been documented evidence that urine drug screens and pill counts affect cancer disease trajectories they do help with identifying patients in need of more support [7,19,20]. Insurance companies have broadly applied the CDC guideline principles to all patients receiving opioid therapy in varying degrees, such as requiring prior authorizations for long-acting opioids [21], documentation of opioid agreements, and regular urine drug screens and risk assessments.…”

“…Please see Table 3 for further detail [38]. Communication strategies in patients with NMOU/SUD: Few interventions have been dedicated to the intersection of cancer and NMOU in the medical literature, with all based in larger clinical centers [7,19,32]. Guidance for clinicians on how to approach these conversations with concomitant NMOU and cancer care is lacking and not easily extrapolated from the chronic non-cancer pain literature.…”

“…In this review, NMOU refers to the range of situations from isolated instances of misuse to patterns of problematic use in SUD. Management of NMOU can be challenging and may benefit from a dedicated team approach [7]. Oncologists, who often are primary opioid prescribers with their patients, can facilitate care of patients who develop NMOU, by identifying when specialist management is indicated.…”