Reducing Cancer Patients’ Risk of Opioid Addiction, Harm

Eric Roeland, MD, of Massachusetts General Hospital in Boston, explains how oncologists can seek balance when prescribing opioids to patients with cancer and how to mitigate risks of addiction and other opioid-related harms.

Following is a transcript of his remarks:

We had the opportunity to discuss the use of opioids at ASCO this year. Given the high aberrancy of opioid use across the United States, this is a very important topic for oncologists to be aware of. I think the first thing that we all need to be focused on is maintaining access to opioids for our cancer patients, those who are most at risk and who need access to these very important drugs. At the same time, it’s very important that we now recognize the importance of assessing risk, risk of aberrant use.

For the busy oncologist, it might feel overwhelming to add yet another thing that they need to do day-to-day in their busy clinical practice, but there’s some real simple things that you can do to assess opioid aberrancy risk. The first is to complete a prescription drug monitoring program report. This is now available in most states across the United States and even available online. In some institutions, like mine, it’s integrated into the electronic medical record. Prior to prescribing any opioid or benzodiazepine, it’s important to see the number of other prescribers and pharmacies that a patient is having those medications filled and to really engage the patient and ask if there’s anything that’s unclear.

The second thing I think we all need to make sure that we’re doing is having discussions about safety and safe storage of opioids because even a patient who has legitimate cancer pain at home might have relatives or loved ones that may be taking these medications and using them inappropriately. There’s just some of us out there that are at higher risk of using or misusing opioids for inappropriate reasons.

Then the last is to really start thinking about universal precautions. In the same way that we look at the prevention of spreading infectious diseases in the hospital, we also need to start thinking of universal ways that we can prevent yet another issue for our patients in terms of developing addiction to opioids. Balancing and seeking, and ensuring that we have access to opioids for our cancer patients, but we’re assessing risk, and then instituting practices in our day-to-day clinical care to ensure that we’re not causing more issues or problems for the patient and/or their family.

https://www.medpagetoday.com/meetingcoverage/ascovideopearls/80768