Opioid stigma can create barriers to effective pain management for patients with cancer, despite that prescription opioids are considered standard for pain care and patients with cancer are typically exempt from state laws restricting opioid use. These findings were published in JCO Oncology Practice.

A group of researchers affiliated with the University of Pittsburgh and the University of Alabama at Birmingham conducted in-depth qualitative interviews with 20 patients with advanced cancer and 11 support providers to explore how opioid stigma manifests in the lives of the patients with cancer.

The research team conducted the interviews with patients with stage III or IV cancer by phone, making certain to cover issues such as their experiences with pain and pain treatment, cancer pain, and their friends’ and family’s opinions on opioid use for cancer-related pain, as well as their general thoughts on the opioid epidemic.


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Several themes were identified that illustrated how opioid stigma affects patients with advanced cancer:

  • Participants had direct experience with opioid stigma and opioid-related discrimination in healthcare settings.
  • Participants had concerns about opioid stigma affecting patient care in the future.
  • Patients expressed opioid-restricting attitudes and behaviors that may reflect internalized stigma and fear of addiction.

The attitudes didn’t reflect an overt stereotype about opioid misuse; rather, they illustrated a more subtle, internalized kind of stigma. “Left unaddressed, internalized stigma can lead to worsening shame and guilt when cancer progresses, pain worsens, and opioid dosages increase,” the researchers wrote.

“The results also reflected a pervasive unease with perceptions of addiction, which may influence patient coping strategies (eg, distancing and opioid restricting behaviors) and efforts to maintain a positive image with their clinicians,” they added.

The researchers also noted that additional work is necessary to further explore how systemic influences such as racism may interact with opioid stigma to create particular challenges for people of color. Future research could focus on how opioid stigma manifests in diverse populations, they suggested.

Limitations did exist for the study. For example, three-fifth of the patients had their cancer-related pain managed by their oncologists, but that trend is on the decline, so their experiences may not be applicable to any other patients with advanced cancer pain.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Bulls HW, Hamm M, Wasilko R, et al. Manifestations of opioid stigma in patients with advanced cancer: perspectives from patients and their support providers. JCO Oncol Pract. 2022;18(10):e1594-e1602. doi:10.1200/OP.22.00251