Expert Consensus-based Guidance on Approaches to Opioid Management in Individuals with Advanced Cancer-related Pain and Nonmedical Stimulant Use

Overview

Journal Cancer

Publisher Wiley

Specialty Oncology

Date 2023 Sep 11

PMID 37691479

Authors

Katie Fitzgerald Jones

Dmitry Khodyakov

Benjamin H Han

Robert M Arnold

Emily Dao

Jeni Morrison

Jennifer Kapo

Diane E Meier

Judith A Paice

Jane M Liebschutz

Christine S Ritchie

Jessica S Merlin

Hailey W Bulls

Affiliations

Soon will be listed here.

Abstract

Background: Clinicians treating cancer-related pain with opioids regularly encounter nonmedical stimulant use (i.e., methamphetamine, cocaine), yet there is little evidence-based management guidance. The aim of the study is to identify expert consensus on opioid management strategies for an individual with advanced cancer and cancer-related pain with nonmedical stimulant use according to prognosis.

Methods: The authors conducted two modified Delphi panels with palliative care and addiction experts. In Panel A, the patient's prognosis was weeks to months and in Panel B the prognosis was months to years. Experts reviewed, rated, and commented on the case using a 9-point Likert scale from 1 (very inappropriate) to 9 (very appropriate) and explained their responses. The authors applied the three-step analytical approach outlined in the RAND/UCLA to determine consensus and level of clinical appropriateness of management strategies. To better conceptualize the quantitative results, they thematically analyzed and coded participant comments.

Results: Consensus was achieved for all management strategies. The 120 Experts were mostly women (47 [62%]), White (94 [78%]), and physicians (115 [96%]). For a patient with cancer-related and nonmedical stimulant use, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering. Buprenorphine/naloxone transition was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis.

Conclusion: Study findings provide urgently needed consensus-based guidance for clinicians managing cancer-related pain in the context of stimulant use and highlight a critical need to develop management strategies to address stimulant use disorder in people with cancer.

Plain Language Summary: Among palliative care and addiction experts, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering in the context of cancer-related pain and nonmedical stimulant use. Buprenorphine/naloxone transition as a harm reduction measure was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis.

Citing Articles

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Dangerous Variation or Patient-Centered Care? Palliative Care and Pain Providers' Comfort, Experiences, and Approaches when Treating Cancer Pain With Coexisting Aberrant Behaviors.

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Creating a Palliative Care Clinic for Patients with Cancer Pain and Substance Use Disorder.

Kale S, Tosto G, Rush L, Kullgren J, Russell D, Fried M J Pain Symptom Manage. 2024; 68(2):e138-e145.

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