Specialized interventions involving counseling and goal setting reduced opioid utilization and aberrant opioid-related behavior (AB) among patients with cancer who receive chronic opioid therapy, according to a study published in The Oncologist.
Recent evidence shows that patients with cancer, who were assumed to be at lower risk for aberrant opioid use, may be more prone to AB than previously thought. Although the aberrant use of opioids leads to high rates of opioid-induced morbidity and mortality, no well-defined and evidence-based strategies for managing patients who exhibit AB currently exist.
For this study, researchers assigned 100 patients with a current or past diagnosis of cancer receiving chronic opioid therapy to 2 cohorts; cohort A included 30 patients with a history of AB who previously required intervention, and cohort B included 70 patients without evidence of AB. ABs were defined as any drug seeking actions or behaviors as predetermined by the researchers.
The intervention consisted of an interdisciplinary team of specialized healthcare professionals collectively creating a specific plan on identification of AB in a patient. The team would counsel and discuss goals, expectations, risks, and alternatives in regards to pain management with the patient.
At baseline, patients with AB had significantly higher pain intensity (P =.002) and opioid dose (P =.001) compared with patients without AB. Younger age (P <.0001) and higher levels of anxiety (P =.005) were independent predictors for AB.
There was a significant reduction in median number of ABs per month, from 3 to 0.4 (P <.0001), and the median morphine equivalent dose decreased from 165 mg/day at the first visit to 112 mg/day by the last follow-up (P =.018) even if the pain intensity did not (P =.984).
The most frequently reported AB prior to invention that also had the greatest improvement was drug seeking behavior by requesting earlier refills of opioid medications.
The authors conclude that the findings “offer a promising starting point for the creation of a standardized universal strategy for clinical teams dealing with patients on chronic opioid therapy. More research is needed to better characterize aberrant opioid use and further verify the effectiveness of this intervention in patients with cancer.”
Arthur J, Edwards T, Reddy S, et al. Outcomes of a specialized interdisciplinary approach for patients with cancer with aberrant opioid-related behavior [published online October 11, 2017]. Oncologist. doi: 10.1634/theoncologist.2017-0248