Safety of opioid prescribing among older cancer survivors

Role of primary care in opioid prescribing for older head and neck cancer survivors

BACKGROUND

Older head and neck cancer (HNC) survivors have concerning rates of potentially unsafe opioid prescribing. Identifying the specialties of opioid prescribers for HNC survivors is critical for targeting the settings for opioid safety interventions. This study hypothesized that oncology and surgery providers are primarily responsible for opioid prescriptions in the year after treatment but that primary care providers (PCPs) are increasingly involved in prescribing over time.

METHODS

Using linked Surveillance, Epidemiology, and End Results-Medicare data, a retrospective analysis was conducted of adults aged >65 years diagnosed between 2014 and 2017 with stage I-III HNC and who had ≥6 months of treatment-free follow-up through 2019. Starting at treatment completion, opioid fills were assigned to a prescriber specialty: oncology, surgery, primary care, pain management, or other. Prescriber patterns were summarized for each year of follow-up. Multinomial logistic regression models captured the likelihood of opioids being prescribed by each specialty.

RESULTS

Among 5135 HNC survivors, 2547 (50%) had ≥1 opioid fill (median, 2.1-year follow-up). PCPs prescribed 47% of all fills (42%-55% each year). PCPs prescribed opioids to 45% of survivors with ≥1 opioid fill, which was a greater share than other specialties. PCPs prescribed longer supplies of opioids (median, 20 days/fill; median, 30 days/year) than oncologists or surgeons. The likelihood of an opioid being prescribed by an oncology provider was four times lower than that of it being prescribed by a PCP.

CONCLUSIONS

PCP involvement in opioid prescribing remains high throughout HNC survivorship. Interventions to improve the safety of opioid prescribing should target primary care, as is typical for opioid reduction efforts in the noncancer population.

Patterns and predictors of opioid dispensing among older cancer patients from 2008 to 2015

BACKGROUND

Understanding factors associated with opioid dispensing in cancer patients is important for developing tailored guidelines and ensuring equitable access to pain management. We examined patterns and predictors of opioid dispensing among older cancer patients from 2008 to 2015.

METHODS

We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database linked to Medicare claims. We included the most common cancer types among patients aged 66-95 years. Opioids dispensed within 30 days before and 120 days after cancer diagnosis were assessed. We used logistic regression models to examine trends, adjusted odds ratios (aORs), and 95% confidence intervals (CIs) for opioid dispensing, considering patient demographics, geography, cancer stage, comorbidities, and treatment options. Models were stratified by sex.

RESULTS

A total of 211,759 cancer patients aged 66-95 years were included in the study. For cancers combined, non-Hispanic Black men had a significantly lower odds of receiving opioids during the 120 days post-diagnosis (aOR = 0.89, 95% CI = 0.84-0.94) compared to non-Hispanic White men. Factors such as pre-diagnosis opioid dispensing, age, geography, cancer stage, comorbidities, and type of cancer treatment were associated with opioid dispensing during the 120 days post-diagnosis. Surgery had the strongest association, with men undergoing surgery being 4.4 times more likely to receive opioids within 120 days post-diagnosis (aOR = 4.41, 95% CI = 4.23-4.60), while women had an odds ratio of 2.72 (95% CI = 2.62-2.83). Chemotherapy and radiotherapy were also positively associated with opioid dispensing, with less pronounced estimates.

CONCLUSIONS

We observed significant variations in opioid dispensing among cancer patients aged 66-95 years across cancer types and demographic and clinical factors.

Pain management for post-treatment survivors of complex cancers: a qualitative study of opioids and cannabis

Aim: We aimed to understand experiences with opioids and cannabis for post-treatment cancer survivors. Patients & methods: We conducted seven focus groups among head and neck and lung cancer survivors, using standard qualitative methodology to explore themes around 1) post-treatment pain and 2) utilization, perceived benefits and perceived harms of cannabis and opioids. Results & conclusion: Survivors (N = 25) experienced addiction fears, stigma and access challenges for both products. Opioids were often perceived as critical for severe pain. Cannabis reduced pain and anxiety for many survivors, suggesting that anxiety screening, as recommended in guidelines, would improve traditional pain assessment. Opioids and cannabis present complex harms and benefits for post-treatment survivors who must balance pain management and minimizing side effects.

Safe use of opioids

Background: Opioids are effective analgesics for cancer pain and refractory non-cancer pain. Although they are essential medication, problematic issues on aberrant behavior and adverse events have rapidly emerged as social problems in Korea. This study aimed to describe the mechanisms, efficacy, and adverse events, especially how to deal with opioid dependency.Current Concepts: Opioid-induced aberrant behavior includes physical and psychological dependences (addiction), abuse, and diversion (giving prescribed opioids to another person). Most physicians are unfamiliar with how to handle patients presenting these problematic issues. Physical and psychological dependences develop through different pathophysiologic mechanisms, i.e., noradrenergic and dopaminergic pathways, respectively. Motivational enhancement therapy, psychosocial support, substitution therapy with buprenorphine, and adjunctive medications, including alpha-2 adrenergic agonist, antidepressants, and non-steroidal antiinflammatory drugs, are the mainstay of treatment for opioid dependency. Constipation, nausea/vomiting, drowsiness/sedation, delirium, itching sensation, voiding difficulty, dry mouth, opioid-induced hyperalgesia, and respiratory depression are well-known physical side effects of opioid consumption.Discussion and Conclusion: Research on the development history, epidemiology of opioid dependency, and its treatment are warranted to avoid an opioid crisis in Korea. Above all, thorough knowledge for physicians and patients is urgently needed.