Higher Prescription Opioid Use Is Not Linked to Misuse Among Cancer Survivors, According to Recent Study

Opioids are an effective tool in treating cancer-related pain, which previous research has found to be experienced by as many as 60% of patients and 33% of survivors. However, these drugs are also at the center of a nationwide epidemic, making them a dangerous yet indispensable option when it comes to pain management.

While opioid use in the general public is a topic of national concern, not much is known about the rates of opioid use and misuse in patients with cancer and survivors. To better understand how these populations use opioids to manage pain, and to gauge their misuse, researchers performed a cross-sectional, retrospective, population-based study, the results of which were recently published in JAMA Oncology.

After analyzing the data from 169,162 respondents to the National Survey on Drug Use and Health between January 2015 and December 2018, researchers identified 5,139 individuals (52%) with a history of cancer as survivors, and then broke this group into two smaller groups:

• more recent survivors (1,243 or 1.2%), who had cancer within 12 months of taking the survey, and
• less recentsurvivors (3,896 or 4%), who had cancer more than 12 months prior to survey completion.

Because of their low likelihood of needing opioids for cancer-related pain, individuals with non-melanoma skin cancer were excluded from the analysis, and all respondents were at least 18 years or older. The most common types of cancer among the 5,139 survivors included breast (1,118), prostate (621) and melanoma (502).

Within the survey, prescription opioid use was defined as the use of any prescription opioid within the last 12 months as directed by a doctor, while misuse was defined as the use of these drugs in any way not directed by a doctor (taking higher doses than directed, using opioids for a longer period of time than prescribed, taking opioids prescribed to someone else, etc).

Overall, prescription opioid use was found to be higher among respondents with a more recent (54.3%) and less recent (39.2%) cancer history versus respondents without cancer (30.5%).

Upon multivariable analysis, while individuals who had a history of cancer were more likely to use prescription opioids compared with those without a history of the disease, this did not correlate to a significant difference in rates of opioid misuse.

Among cancer survivors, those who used prescription opioids were more likely to be between 35 and 64 years of age, in poorer health, and having experienced a major depressive episode within the past year.

Of the respondents who had cancer, the highest rates of prescription opioid use were reported by those with gallbladder, liver or pancreatic cancer (72.2%), larynx, windpipe, or lung cancer (53.5%), and cervical cancer (48.4%). The lowest rates of opioid use were reported by individuals with prostate or testis cancer (37.9%) and uterine cancer (37.6%).

When evaluating prescription opioid misuse, lower rates were seen in respondents with a less recent cancer history (3%) and more recent cancer history (3.5%) compared with participants without cancer (4.3%).

Factors associated with prescription opioid misuse included younger age (age 18-34), alcohol use disorder and nonopioid drug use disorder.

Additionally, misuse was highest among respondents with esophagus or stomach cancer (10.1%) and gallbladder, liver, or pancreatic cancer (7.3%) and lowest among those with breast cancer (1.7%).

Ultimately, the researchers noted, while their study had multiple limitations — a major one being the fact that respondents may be unwilling to accurately self-report opioid misuse — they did note that the consistency in their findings compared with other similar studies led them to be confident that increased prescription opioid use among cancer survivors does not necessarily translate to a higher risk of misuse.

“It is imperative that opioid legislation and policies recognize that cancer survivors will have a higher rate of prescription opioid use and that restrictions on prescription opioid access for cancer survivors are incongruent with their opioid utilization patterns,” the authors concluded.

“Our analysis supports continued access to opioid medications for cancer survivors who may benefit from such therapy.”