Opioid Epidemic Negatively Influences Opioid Use for Pain Management in Advanced Cancer

The opioid epidemic in the U.S. has negatively impacted the use of opioids and weakened the use of pain management in patients with advanced cancer, according to a study published in Cancer.

“Addiction fears have long been identified as a barrier to cancer pain management, yet most knowledge of this subject predates the opioid epidemic,” the study authors wrote. “Our findings suggest that the epidemic has amplified these fears and caused shame that permeates numerous aspects of patients’ pain management efforts.”

Opioids is typically the standard treatment for patients with cancer who experience significant pain, as over two-thirds of patients report having this type of pain, according to the study’s introduction. The epidemic of opioid abuse has been occurring in the U.S. over the past 20 years, and although regulations on controlled substances have been implemented, there may be evidence that they have substantially reduced access to opioids for patients with cancer.

“Although the risk of de novo opioid misuse disorder is likely low on the context of advanced cancer, patients’ addiction worries operate as substantial barriers to pain control and therefore deserve thorough conversations that acknowledge the current climate around opioid use,” the study authors wrote.

To look deeper into this, researchers assessed responses from 26 patients (mean age, 60 years; 69% women) with advanced cancers who underwent semi-structured interviews between May 2019 and April 2020. The most common cancer type among patients in this study was breast cancer, followed by gastrointestinal cancer and genitourinary cancer. Questions during the interview focused on several areas: challenges using opioids, opioid experience, nonpharmaceutical self-management and patient-provider communication and the opioid epidemic.

Patients reported that their ability to manage pain on their own has been negatively impacted by the opioid epidemic. In addition, many patients attributed personal experiences with the opioid epidemic and negative media coverage to the stigma, guilt and fear around the use of opioids.

“Interestingly, nearly every patient in our study referenced media coverage of the opioid epidemic — typically using highly charged words such as ‘addict,’ ‘oxy,’ ‘pill-seeker,’ ‘junkies’ and ‘narcotics,’” the study authors wrote. “Sensationalized stories and stigmatizing language are a hallmark of the media’s coverage of the epidemic, which appears to be directly influencing the way in which patients with advanced cancer view their own analgesic medications.”

This stigma resulted in many patients delaying their use of opioids and felt that taking them was “caving in.” Patients also reported that they controlled this internal conflict with opioids by taking lower doses or skipping doses altogether, for example.

As a result of the opioid epidemic, some patients described a stigma around speaking with their clinicians about opioid use for pain management. This led to patients avoiding the discussions or purposely seem like they plan on underusing opioids to avoid being a “pill seeker.”

Structural barriers also persisted among these patients’ access to opioids including delays in refills, prior authorizations or being questions by a pharmacist about their use of the drug. Patients reported that these barriers amplified the stigma of opioids, were stressful and interfered with controlling their pain, in addition to supporting their uncertainty about this class of drug.

One limitation to this study includes a lack of racial/ethnic diversity because racial/ethnic minorities are more likely to be affected by the opioid stigma and are known to face greater barriers to opioid access, the study authors wrote. Another limitation is the fact that this study was limited to one center in Massachusetts because that state has the seventh highest per capita opioid mortality rate in the U.S.

“Future research with larger, more diverse populations is needed to determine the extent to which opioid stigma influences cancer pain outcomes and to identify modifiable targets for intervention,” the study authors wrote. “Awareness and proactive communication regarding the opioid stigma may be an important strategy to better supporting patients coping with advanced cancer pain.”

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