Massey researcher finds better risk management of opioid abuse needed among cancer patients
Opioid addiction is an epidemic in the U.S. and other developed nations, and cancer patients are at even greater risk. Opioids are commonly prescribed to control cancer pain, and VCU Massey Cancer Center Palliative Care Director Egidio Del Fabbro, M.D., says more should be done to identify the potential for abuse and addiction among cancer patients.
“We should be doing everything we can to ensure the best possible quality of life for cancer patients during and after treatment, and that includes preventing opioid addiction,” says Del Fabbro. He recently reviewed research relating to opioid addiction in cancer patients in order to identify risk factors for opioid misuse and abuse, provide evidence of best clinical practices for addiction prevention and suggest future directions for research. “We have more cancer survivors than ever before thanks to advancements in medicine, but we need to develop guidelines and other tools to ensure they do not become dependent upon opioids.”
Of 691 research articles on opioid addiction, Del Fabbro found 34 that related to cancer. The studies were categorized into screening questionnaires for opioid abuse or alcohol, urine drug screens to identify opioid misuse or abuse, prescription drug-monitoring programs and the use of universal precautions – a set of guidelines – that help physicians determine if opioid use is appropriate.
Studies involving urine drug screens indicated that at least one in five cancer patients may be at risk of opioid abuse. In addition, several studies demonstrated associations between high-risk patients and clinical outcomes such as aberrant behavior, prolonged opioid use, higher morphine-equivalent daily dose, greater health care utilization and symptom burden.
While the literature review did uncover helpful research, Del Fabbro concluded there was not enough data to develop clear guidelines and that additional studies are needed to better determine the effectiveness of various opioid abuse risk assessments. Additionally, he suggests that reimbursement policies and incentives should be considered to ensure health care providers comply with best practices.
“I believe that we can combine good clinical practice with standardized guidelines for assessing opioid abuse risk to help prevent addiction while effectively managing pain,” says Del Fabbro. “Doing so will not only ensure that fewer patients become addicted to opioids, it also has the potential to reduce health care costs and address a serious public health concern.”