New guidance for cancer pain and opioid use disorder or opioid misuse

 Opioids are a cornerstone of cancer pain management, but there is a lack of consensus on how to treat pain in cancer patients who also have struggled with opioid use disorder or prescription opioid misuse. In a study published today in JAMA Oncology, researchers outline guidance for treating such patients and highlight obstacles and opportunities for better integration of addiction treatment in cancer care.

"There is no standard of care for treating cancer pain and managing opioids in people who come into their cancer diagnosis with a history of substance use, or who are at increased risk for adverse events due to prescription opioid misuse behaviors, such as taking more opioids than prescribed," said first author Katie Fitzgerald Jones, M.S.N., a palliative and addiction nurse practitioner at VA Boston Healthcare System and Ph.D. candidate at Boston College. "As a first step towards improving care of these patients, our study surveyed clinicians to understand how they treat patients with opioid complexity."

The study was led by Jones and study principal investigator and senior author Jessica Merlin, M.D., Ph.D., associate professor of general internal medicine at the University of Pittsburgh School of Medicine and co-director of the Palliative Recovery Engagement Program at UPMC, a clinic that serves patients with serious illnesses, like cancer, who also struggle with opioid use disorder or prescription opioid misuse. In collaboration with colleagues at RAND, the investigators used an online Delphi study platform to explore consensus among 120 palliative care and addiction experts about how they would approach treatment of a hypothetical 50-year-old patient with advanced cancer who has cancer-related pain and either a history of opioid use disorder or prescription opioid misuse.

Participants were asked to rate and comment on various management strategies, such as prescribing methadone and buprenorphine. Experts indicated that both of these medications are an appropriate approach to treating cancer pain in a patient with a history of an opioid use disorder.

source:science daily