Cancer Care and the Opioid Crisis

The vast majority of patients diagnosed with cancer will have episodes of moderate to severe pain related to their underlying malignancy and/or painful procedures such as surgery, radiation and chemotherapy-induced mucositis, or from stem cell transplantation. Opioids remain the most important pharmacologic agents for the management of these distressing symptoms. In recent years, the opioid overdose epidemic has created considerable concern among numerous stakeholders including healthcare providers, patients, pharmaceutical agencies, as well as federal, state, and local government agencies. This special series presents highly informative scholarly articles on opioid therapy in cancer pain management within the context of the recent national guidelines and policies related to the use of opioids.

In “The Other Opioid Crisis: Just Another Drug Shortage?” Soumerai al. share their candid perspectives on the effect of the intravenous opioid shortage in the US on patient care and describe a key opioid conservation strategy that their team utilized during those challenging times.

In “Safe Opioid Use, Storage and Disposal Strategies in Cancer Pain Management”, Akhila Reddy and Maxine de la Cruz describe how patient and provider education can help improve safe opioid use, storage, and disposal in cancer patients

In “Navigating Challenging Conversations About Nonmedical Opioid Use in the Context of

Oncology”, Zachary Sager and Julie Childers provide an excellent conversation framework and key communication strategies for clinicians to use when communicating with patients with nonmedical opioid use behaviors.

In “Risk Assessment and Monitoring of Cancer Patients Receiving Opioid Therapy”, Judith Paice discusses key risk evaluation strategies that clinicians should utilize in order to effectively and safely manage pain while minimizing the risk for nonmedical opioid use during chronic opioid therapy

In “Best Practices in the Managing Nonmedical Opioid Use in Patients with Cancer-

Related Pain” Esad Ulker and Egidio Del Fabbro conduct a comprehensive review of the literature and provide best practice recommendations regarding management of patients with nonmedical opioid use.

In “Dancing with Deterrents: Understanding the Role of Abuse Deterrent Opioid Formulations and Naloxone in Managing Cancer Pain” Megan Mitchell discusses the advantages and limitations of abuse-deterrent opioid formulations as harm-reduction mechanisms in cancer patients receiving chronic opioid therapy

In “Opioid Prescribing Trends in Women Following Mastectomy or Breast Conserving

Surgery Before and After the 2014 Federal Reclassification of Hydrocodone”, Gibson et al. examined the changes in opioid prescribing practices of oncology clinicians following the reclassification of hydrocodone as a scheduled II medication by the DEA.

In “Urine Drug Testing in Cancer Pain Management”, Joseph Arthur reviews the types, interpretation and application of urine drug testing in cancer pain management and how they can be used to support therapeutic decision making.

In summary we believe this series will be helpful in providing the much needed awareness and education for practicing oncologists regarding safe and judicious use of opioids. Our ultimate goal is that all oncologists improve their opioid prescribing practices through the adoption of universal precautions approach when caring for patients receiving chronic opioid therapy.

Articles


Opioid Prescribing Trends in Women Following Mastectomy or Breast‐Conserving Surgery Before and After the 2014 Federal Reclassification of Hydrocodone
Derrick C. Gibson, Lin‐Na Chou, Mukaila A. Raji, Jacques G. Baillargeon, Yong‐Fang Kuo
The Oncologist first published on December 4, 2019; doi:10.1634/theoncologist.2019-0758

 

Urine Drug Testing in Cancer Pain Management
Joseph A. Arthur
The Oncologist first published on October 11, 2019; doi:10.1634/theoncologist.2019-0525

 

Navigating Challenging Conversations About Nonmedical Opioid Use in the Context of Oncology
Zachary Sager, Julie Childers
The Oncologist first published on May 31, 2019; doi:10.1634/theoncologist.2019-0277

 

Dancing with Deterrents: Understanding the Role of Abuse-Deterrent Opioid Formulations and Naloxone in Managing Cancer Pain
Megan T. Mitchell
The Oncologist first published on May 31, 2019; doi:10.1634/theoncologist.2019-0340

 

Risk Assessment and Monitoring of Patients with Cancer Receiving Opioid Therapy
Judith A. Paice
The Oncologist first published on May 22, 2019; doi:10.1634/theoncologist.2019-0301

 

Safe Opioid Use, Storage, and Disposal Strategies in Cancer Pain Management
Akhila Reddy, Maxine de la Cruz
The Oncologist first published on May 16, 2019; doi:10.1634/theoncologist.2019-0242

 

The Other Opioid Crisis: Just Another Drug Shortage?
Tara E. Soumerai, Mihir M. Kamdar, Bruce A. Chabner
The Oncologist 2019; 24:574-575; first published on February 28, 2019; doi:10.1634/theoncologist.2018-0514