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Opioid Self-management Practices and Potential Safety Risks Among Patients with Cancer

Despite a national opioid crisis, prescribed opioid analgesics remain a viable option for pain management for patients with cancer.  In effect, patients with cancer represent one of the few groups excluded from most state legislation and policy initiatives on prescribing opioids as well as from opioid stewardship programs of many health systems. However, little is understood about oncology patients’ opioid self-management practices and potential safety risk that may stem from these practices.

In new research from the University of Pennsylvania School of Nursing (Penn Nursing), investigators found that pain was the top concern identified by cancer patients in this study. However, they often could not take advantage of their prescribed opioid medications due to societal stigma and other opioid-related concerns. Patients with cancer in this study described using a number of practices to limit opioids, which they considered “hard pills”. These reported practices included self-stopping and resuming opioids, increasing duration between prescribed opioid doses, using a concoction of over-the-counter analgesics, and importantly cutting pills to reduce dose and self-tapering of opioids.

“Our findings point to unsafe opioid self-management practices among cancer outpatients that need urgent attention, including improving patients’ access to effective alternative treatments for pain and patient education on safe opioid use” said the lead-investigator Salimah H. Meghani, PhD, MBE, RN, FAAN, Associate Professor of Nursing, Term Chair of Palliative Care, and Associate Director of the NewCourtland Center for Transitions.   

“Most often opioid safety efforts have focused on overuse of opioids among patients. However, underuse and variable patterns of opioid use is equally important and can also expose patients to underappreciated safety risks.”

The researchers recommend that patients with cancer be included in the opioid stewardship programs being developed as part of the many healthcare systems in the U.S. These programs should also work to reduce stigma for oncology patients who continue to need opioids to relieve moderate to severe pain, the study recommended.  

The study’s findings have been published in the Journal of Pain and Symptom Management in an  article titled “When Patients Take Charge of Opioids: Self-Management and Safety of Prescribed Opioids for Cancer Pain in the Context of Opioid Crisis.” This study was funded by the American Cancer Society grant to Meghani (ACS #128779-PEP-15-186-01). Co-authors of the study include Jesse Wool, BSN, of Penn Nursing; Jessica Davis, BA and Frances K. Barg, PhD, both of the University of Pennsylvania School of Arts and Sciences; Katherine A. Yeager, PhD, RN, of Emory University; and Jun J. Mao, MD, MSCE, of Memorial Sloan Kettering Cancer Center.