Opioid Use Disorder and Overdose in Older Adults With Breast, Colorectal, or Prostate Cancer

Roberts, Andrew W.; Eiffert, Samantha; Wulff‐Burchfield, Elizabeth; Dusetzina, Stacie B.; Check, Devon K.

doi:10.1093/jnci/djaa122

Cited by 9 publications

(8 citation statements)

References 45 publications

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“…Medicaid insurance and tumor type were significantly associated with higher odds of new persistent opioid use, as were Ewing sarcoma and osteosarcoma. Our study confirms the previously published finding that opioid use after cancer treatment warrants attention 15,16 . Our study is novel in that it provides a close examination of new persistent use in AYAs, a unique patient population diagnosed with cancer at the outset of their adult lives.…”

Section: Discussionsupporting

confidence: 89%

“…Recent studies have indicated that as many as 17% of older adults with cancer are at risk of becoming new persistent opioid users; this is commonly defined as receiving 2 or more opioid prescriptions after the completion of therapy 13,14 . In these studies, identified risk factors for new persistent use include surgery, a prior MH diagnosis, concomitant use of sedative‐hypnotics (eg, lorazepam), and noncommercial insurance 13‐17 . Whether these associations are observed in AYAs has not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

“…13,14 In these studies, identified risk factors for new persistent use include surgery, a prior MH diagnosis, concomitant use of sedative-hypnotics (eg, lorazepam), and noncommercial insurance. [13][14][15][16][17] Whether these associations are observed in AYAs has not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

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New persistent opioid use among adolescents and young adults with sarcoma

Beauchemin

Raghunathan

Accordino

et al. 2022

Cancer

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BACKGROUND: Adolescents and young adults (AYA) with sarcoma experience both acute and chronic pain related to their disease and treatment. Studies in older adults have reported a high risk of persistent opioid use after cancer therapy among previously opioid-naive patients; however, few studies have evaluated posttreatment opioid use among AYAs. This article describes patterns of new persistent opioid use among AYAs in the year after treatment for sarcoma. METHODS: Opioid-naive patients who were 10 to 26 years old and diagnosed with sarcoma (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) were identified with the IBM Marketscan Database. Included subjects had an International Classification of Diseases code for sarcoma (ninth or tenth revision), received anticancer therapy (chemotherapy, surgery, and/or radiation) within 30 days of the first diagnosis code, and had continuous insurance coverage (commercial or Medicaid) for more than 12 months both before the diagnosis and after the last therapy. The primary outcome was new persistent opioid use, which was defined as at least 2 opioid prescriptions in the 12 months following treatment completion. Covariates included age, sex, insurance, tumor type, surgical procedure, mental health (MH) or substance use diagnoses before or during therapy, and concomitant lorazepam use. RESULTS: In total, 938 patients met the inclusion criteria; 521 (56%) were male, and 578 (62%) were younger than 18 years. In total, 727 (78%) had commercial insurance, and 273 (29%) had an MH diagnosis either before or during the treatment period. Of the total group, 464 (49%) used opioids during treatment only. Of those who used opioids during treatment, 135 (23%) received at least 2 prescriptions in the year after therapy. In a multivariable analysis, Medicaid versus commercial insurance (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.15-2.64) and non-soft tissue sarcoma (OR for Ewing sarcoma, 3.23; 95% CI, 1.81-5.78; OR for osteosarcoma, 2.05; 95% CI, 1.36-3.09) conferred a higher likelihood of new persistent use. CONCLUSIONS: In this cohort of AYAs treated for sarcoma, 64% of the patients received opioid prescriptions during treatment, and 23% of these patients became new persistent users. Because of the risks associated with persistent opioid use, studies of novel pain management strategies along with age-appropriate education and anticipatory guidance are urgently needed.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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New persistent opioid use among adolescents and young adults with sarcoma

Beauchemin

Raghunathan

Accordino

et al. 2022

Cancer

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“…13 CRC, in particular, has been associated with a remarkably heightened risk of opioid overdose. 14 Managing pain among this population while minimizing the risk of opioid dependence or overdose thus presents a significant challenge. Nevertheless, despite the risk of overdose, patients in our study who received opioids for 90 consecutive days before admission demonstrated significantly decreased inpatient mortality as compared with short term and nonopioid users.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Inpatient Mortality and Length of Stay in Nonmetastatic Colorectal Cancer

Ulanja

Beutler

Antwi‐Amoabeng

et al. 2021

American Journal of Clinical Oncology

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Objective: The objective of this study was to assess the effect of opioid use and other factors on inpatient length of stay (LOS) and mortality among patients hospitalized with nonmetastatic colorectal cancer (NMCRC). Materials and Methods:We analyzed discharge encounters collected from the 2016 to 2017 National Inpatient Sample (NIS) to evaluate the effect of long-term opioid use (90 d or longer) and cancer-related complications on LOS and mortality among hospitalized patients with NMCRC.Results: A total of 94,535 patients with NMCRC were included in the analysis. Long-term opioid users had a shorter average LOS and reduced inpatient mortality as compared with nonopioid users (5.97 5.75 vs. 6.66 6.92 d, P < 0.01; and adjusted odds ratio = 0.72, 95% confidence interval: 0.56-0.93, respectively). Factors that significantly increased both LOS and mortality included infection, venous thromboembolism, and chemotherapy-induced neutropenia; the average LOS was 2.7, 2.6, and 0.7 days longer, and the adjusted odds ratio for risk of inpatient mortality was 3.7, 1.2, and 1.2, respectively (P < 0.05), for patients admitted with these cancer-related complications.Conclusions: Long-term opioid use is associated with decreased LOS and inpatient mortality among patients with NMCRC. Individuals admitted for cancer-related complications face a longer LOS and increased mortality as compared with those admitted without these morbidities.

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“…Third, our study design required that we exclude individuals who died within 24 months of cancer diagnosis. This includes individuals who may have experienced disease regression and died from their cancer and those who died of an opioid overdose [a rare event ( 35 )]. Fourth, it is unclear whether our results generalize to other states.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Chronic Opioid Use: A Population-Level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims

Check

Baggett

Kim

et al. 2021

JNCI: Journal of the National Cancer Institute

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Background No population-based studies have examined chronic opioid use among cancer survivors who are diverse with respect to diagnosis, age group, and insurance status. Methods We conducted a retrospective cohort study using North Carolina (NC) cancer registry data linked with claims from public and private insurance (2006–2016). We included adults with non-metastatic cancer who had no prior chronic opioid use (N = 38,366). We used modified Poisson regression to assess the adjusted relative risk of chronic opioid use in survivorship (>90-day continuous supply of opioids in the 13–24 months following diagnosis) associated with patient characteristics. Results Only 3.0% of cancer survivors in our cohort used opioids chronically in survivorship. Predictors included younger age (adjusted risk ratio [aRR], 50–59 vs 60–69 = 1.23, 95% confidence interval [CI] = 1.05–1.43), baseline depression (aRR = 1.22, 95% CI = 1.06–1.41) or substance use (aRR = 1.43, 95% CI = 1.15–1.78) and Medicaid (aRR vs Private = 1.93, 95% CI = 1.56–2.40). Survivors who used opioids intermittently (vs not at all) before diagnosis were twice as likely to use opioids chronically in early survivorship (aRR = 2.62, 95% CI = 2.28–3.02). Those who used opioids chronically (vs intermittently or not at all) during active treatment had a nearly 17-fold increased likelihood of chronic use in survivorship (aRR = 16.65, 95 CI = 14.30–19.40). Conclusions Younger and low-income survivors, those with baseline depression or substance use, and those who require chronic opioid therapy during treatment are at increased risk for chronic opioid use in survivorship. Our findings point to opportunities improve assessment of psychosocial histories and to engage patients in shared decision-making around long-term pain management, when chronic opioid therapy is required during treatment.

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Opioid Use Disorder and Overdose in Older Adults With Breast, Colorectal, or Prostate Cancer

Cited by 9 publications

References 45 publications

New persistent opioid use among adolescents and young adults with sarcoma

New persistent opioid use among adolescents and young adults with sarcoma

Factors Affecting Inpatient Mortality and Length of Stay in Nonmetastatic Colorectal Cancer

Predictors of Chronic Opioid Use: A Population-Level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims

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