Skip to main content

Advertisement

SpringerLink
Log in

Healthcare provider perceptions and reported practices regarding opioid prescription for patients with chronic cancer pain

  • Research
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Data indicates that clinicians might be under-prescribing opioids for patients with chronic cancer pain, and this could impact adequate pain management. Few studies have sought to understand healthcare provider (HCP) perceptions and practices regarding the prescription of opioids for chronic cancer pain. We assessed HCP perceptions and practices regarding opioid prescription for patients with chronic cancer pain since the onset of the COVID-19 pandemic.

Methods

An anonymous cross-sectional survey was conducted among 186 HCPs who attended an opioid educational event in April 2021 and 2022.

Results

Sixty-one out of 143 (44%) opioid prescribers reported reluctance to prescribe opioids for chronic cancer pain. In a multivariate logistic model, younger participants (log OR − 0.04, 95% CI − 0.085, − 0.004; p = 0.033) and pain medicine clinicians (log OR − 1.89, CI − 3.931, − 0.286; p = 0.034) were less reluctant, whereas providers who worry about non-medical opioid use were more reluctant to prescribe opioids (log OR 1.58 95% CI 0.77–2.43; p < 0.001). Fifty-three out of 143 (37%) prescribers had experienced increased challenges regarding opioid dispensing at pharmacies, and 84/179 (47%) of all respondents reported similar experience by their patients. Fifty-four out of 178(30%) were aware of opioid-related harmful incidents to patients or their families, including incidents attributed to opioid misuse by a household or family member.

Conclusion

A considerable number of opioid prescribers were reluctant to prescribe opioids for patients with chronic cancer pain. Many reported challenges regarding dispensing of opioids at the pharmacies. These may be unintended consequences of policies to address the opioid crisis. Future measures should focus on addressing regulatory barriers without undermining the gains already made to combat the opioid crisis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data is stored and can be accessed from password-protected institution computers at MD Anderson Cancer Center, behind the institution firewall.

References

  1. Caraceni A et al (2012) Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 13(2):e58-68

    CAS  PubMed  Google Scholar 

  2. Han B et al (2015) Nonmedical prescription opioid use and use disorders among adults aged 18 through 64 years in the United States, 2003–2013. JAMA 314(14):1468–1478

    CAS  PubMed  Google Scholar 

  3. Voon P, Kerr T (2013) “Nonmedical” prescription opioid use in North America: a call for priority action. Subst Abuse Treat Prev Policy 8:39

    PubMed  PubMed Central  Google Scholar 

  4. Seth P et al (2018) Overdose deaths involving opioids, cocaine, and psychostimulants - United States, 2015–2016. MMWR Morb Mortal Wkly Rep 67(12):349–358

    PubMed  PubMed Central  Google Scholar 

  5. Lipari RN, Hughes A (2017) How people obtain the prescription pain relievers they misuse. In: The CBHSQ Report. Rockville (MD): Substanvce Abuse and Mental Health Service Administration (US);2013

  6. Compton WM, Jones CM, Baldwin GT (2016) Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med 374(2):154–163

    CAS  PubMed  Google Scholar 

  7. Wainwright JJ et al (2020) Analysis of drug test results before and after the US declaration of a national emergency concerning the COVID-19 outbreak. JAMA 324(16):1674–1677

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Niles JK et al (2021) The opioid epidemic within the COVID-19 pandemic: drug testing in 2020. Popul Health Manag 24(S1):S43-s51

    PubMed  Google Scholar 

  9. Rosic T, Naji L, Sanger N, Marsh DC, Worster A, Thabane L, Samaan Z (2022) Factors associated with increased opioid use during the COVID-19 pandemic: A prospective study of patients enrolled in opioid agonist treatment. J Addict Med 16(4):e257–e264. https://doi.org/10.1097/ADM.0000000000000939

  10. Zhang H et al (2021) Prescription opioids dispensed to patients with cancer with bone metastasis: 2011–2017. Oncologist 26(10):e1890–e1892

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Haider A et al (2017) Opioid prescription trends among patients with cancer referred to outpatient palliative care over a 6-year period. J Oncol Pract 13(12):e972–e981

    PubMed  PubMed Central  Google Scholar 

  12. Greco MT et al (2014) Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol 32(36):4149–4154

    PubMed  Google Scholar 

  13. Enzinger AC et al (2021) US trends in opioid access among patients with poor prognosis cancer near the end-of-life. J Clin Oncol 39(26):2948–2958

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Townsend TN et al (2022) Has declining opioid dispensing to cancer patients been tailored to risk of opioid harms? J Pain Symptom Manag 63(2):179–188

    Google Scholar 

  15. Jamison RN et al (2014) Beliefs and attitudes about opioid prescribing and chronic pain management: survey of primary care providers. J Opioid Manag 10(6):375–382

    PubMed  Google Scholar 

  16. McCracken LM, Velleman SC, Eccleston C (2008) Patterns of prescription and concern about opioid analgesics for chronic non-malignant pain in general practice. Primary Health Care Res Dev 9(2):146–156

    Google Scholar 

  17. Blake H et al (2015) Prescribing opioid analgesics for chronic non-malignant pain in general practice - a survey of attitudes and practice. Br J Pain 9(4):225–232

    MathSciNet  PubMed  PubMed Central  Google Scholar 

  18. Rosic T et al (2022) Factors associated with increased opioid use during the COVID-19 pandemic: a prospective study of patients enrolled in opioid agonist treatment. J Addict Med 16(4):e257–e264

    CAS  PubMed  Google Scholar 

  19. Spencer MR, Miniño AM, Warner M (2022) Drug overdose deaths in the United States, 2001–2021. NCHS Data Brief, no 457. Hyattsville, MD: National Center for Health Statistics. https://doi.org/10.15620/cdc:122556, https://doi.org/10.15585/mmwr.mm7006a4

  20. Schroeder AR et al (2019) Association of opioid prescriptions from dental clinicians for US adolescents and young adults with subsequent opioid use and abuse. JAMA Intern Med 179(2):145–152

    PubMed  Google Scholar 

  21. Howard R et al (2019) Association of opioid prescribing with opioid consumption after surgery in Michigan. JAMA Surg 154(1):e184234

    PubMed  Google Scholar 

  22. Barnett ML (2020) Opioid prescribing in the midst of crisis - myths and realities. N Engl J Med 382(12):1086–1088

    PubMed  Google Scholar 

  23. Blendon RJ, Benson JM (2018) The public and the opioid-abuse epidemic. N Engl J Med 378(5):407–411

    PubMed  Google Scholar 

  24. Kwon JH (2014) Overcoming barriers in cancer pain management. J Clin Oncol 32(16):1727–1733

    PubMed  Google Scholar 

  25. Ziegler L et al (2016) Opioid prescribing for patients with cancer in the last year of life: a longitudinal population cohort study. Pain 157(11):2445–2451

    CAS  PubMed  Google Scholar 

  26. Enzinger AC et al (2023) Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life. J Clin Oncol 41(14):2511–2522

    PubMed  Google Scholar 

  27. Amaram-Davila J et al (2023) Health care provider attitudes and beliefs toward nonmedical opioid use in patients with cancer pain. J Palliat Med 26(2):248–252

    PubMed  PubMed Central  Google Scholar 

  28. Arthur J, Bruera E (2022) Managing cancer pain in patients with opioid use disorder or nonmedical opioid use. JAMA Oncol 8(8):1104–1105

    PubMed  PubMed Central  Google Scholar 

  29. Arthur JA et al (2022) Interdisciplinary intervention for the management of nonmedical opioid use among patients with cancer pain. Cancer 128(20):3718–3726

    PubMed  Google Scholar 

  30. Arthur J et al (2021) Health care provider attitudes, beliefs, and perceived confidence in managing patients with cancer pain and nonmedical opioid use. J Pain Symptom Manag 61(1):128-135 e6

    Google Scholar 

  31. Hill MV et al (2018) An educational intervention decreases opioid prescribing after general surgical operations. Ann Surg 267(3):468–472

    PubMed  Google Scholar 

  32. Hopkins RE et al (2019) Prescriber education interventions to optimize opioid prescribing in acute care: a systematic review. Pain Physician 22(6):E551–E562

    PubMed  Google Scholar 

  33. Feter N et al (2021) Sharp increase in depression and anxiety among Brazilian adults during the COVID-19 pandemic: findings from the PAMPA cohort. Public Health 190:101–107

    CAS  PubMed  Google Scholar 

  34. Bäuerle A et al (2020) Increased generalized anxiety, depression and distress during the COVID-19 pandemic: a cross-sectional study in Germany. J Public Health (Oxf) 42(4):672–678

    PubMed  Google Scholar 

  35. Barnett ML et al (2018) A health plan’s formulary led to reduced use of extended-release opioids but did not lower overall opioid use. Health Aff (Millwood) 37(9):1509–1516

    PubMed  Google Scholar 

  36. Bao Y et al (2022) Medicare part D coverage restrictions and patient cost-sharing for opioids commonly used for cancer pain, 2015–2021. JCO Oncol Pract 18(10):e1574–e1586

    PubMed  PubMed Central  Google Scholar 

  37. Bennett K (2019) When opioid prescriptions are denied. Pract Pain Manag 19(3)

  38. Davis CS et al (2019) Laws limiting the prescribing or dispensing of opioids for acute pain in the United States: a national systematic legal review. Drug Alcohol Depend 194:166–172

    PubMed  Google Scholar 

  39. Webster LR (2013) New policing role for pharmacists undermines partnership with prescribers. Pain Med 14(11):1619–1620

    PubMed  Google Scholar 

  40. Hartung DM et al (2018) Pharmacists’ role in opioid safety: a focus group investigation. Pain Med 19(9):1799–1806

    PubMed  Google Scholar 

  41. Cook AK, Worcman N (2019) Confronting the opioid epidemic: public opinion toward the expansion of treatment services in Virginia. Health Justice 7(1):13

    PubMed  PubMed Central  Google Scholar 

  42. de la Cruz M et al (2017) The impact of an educational program on patient practices for safe use, storage, and disposal of opioids at a comprehensive cancer center. Oncologist 22(1):115–121

    PubMed  Google Scholar 

  43. Reddy A, de la Cruz M (2019) Safe opioid use, storage, and disposal strategies in cancer pain management. Oncologist 24(11):1410–1415

    PubMed  PubMed Central  Google Scholar 

  44. Bandieri E et al (2016) Randomized trial of low-dose morphine versus weak opioids in moderate cancer pain. J Clin Oncol 34(5):436–442

    CAS  PubMed  Google Scholar 

  45. Beyaz SG et al (2016) Seizures associated with low-dose tramadol for chronic pain treatment. Anesth Essays Res 10(2):376–378

    PubMed  PubMed Central  Google Scholar 

  46. Beakley BD, Kaye AM, Kaye AD (2015) Tramadol, pharmacology, side effects, and serotonin syndrome: a review. Pain Physician 18(4):395–400

    PubMed  Google Scholar 

Download references

Funding

This work was supported by the National Institutes of Health through Award Number 1UL1TR003167.

Author information

Authors and Affiliations

  1. Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    Joseph Arthur, Tonya Edwards, Zhanni Lu, Magdelene Doris Amoateng & Eduardo Bruera

  2. Department of Hospital Medicine, The University of Texas MD Anderson Cancer, Houston, TX, USA

    Kwame Koom-Dadzie

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, TX, USA

    Hongxu Zhu, James Long & Kim-Anh Do

Authors
  1. Joseph Arthur
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tonya Edwards
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhanni Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Magdelene Doris Amoateng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kwame Koom-Dadzie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hongxu Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. James Long
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kim-Anh Do
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Eduardo Bruera
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design: JA, TE, EB.

Material preparation: JA, TE, ZL.

Data Collection: JA, ZL.

Data analysis and interpretation: JA, HZ, KD, JL, EB.

Manuscript writing and revision: JA, MDA, KK, EB.

Final approval of manuscript: JA, TE, ZL, MDA, KK, HZ, JL, KD, EB.

Corresponding author

Correspondence to Joseph Arthur.

Ethics declarations

Ethical approval

The MD Anderson Institutional Review Board approved this study and granted waiver of informed consent because subjects were at no more than minimal risk because of the retrospective nature of this study. This study was conducted in accordance with the Declaration of Helsinki.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arthur, J., Edwards, T., Lu, Z. et al. Healthcare provider perceptions and reported practices regarding opioid prescription for patients with chronic cancer pain. Support Care Cancer 32, 121 (2024). https://doi.org/10.1007/s00520-024-08323-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00520-024-08323-7

Keywords

Search

Navigation