Study Highlights Challenges of Opioid Use Disorder in Patients with Cancer Pain

PainRelief.com:  What are the main findings?

Response: What we found was buprenorphine/naloxone (suboxone) was a first-line treatment for people with cancer-related pain and Opioid use disorder. Alternatively, in some instances of a short prognosis of weeks to months, addiction and palliative care clinicians would prescribe methadone three times a day for dual indication of Opioid Use Disorder. This is an important finding because existing federal policies do not allow methadone to be prescribed outside of opioid treatment programs for addiction. 

For opioid misuse, the use of buprenorphine/naloxone was less clear and there is a knowledge and research gap on the efficacy of buprenorphine/naloxone for cancer-related pain. It is critical that more research and training be provided to clinicians working in cancer care since buprenorphine may improve safety in people at risk for opioid-related harms.

PainRelief.com: What should readers take away from your report?

Response: Cancer, Opioid Misuse/Use Disorder are important comorbid conditions and clinicians must be equipped to provide compassionate safe evidence-based care.

This study provides important information that existing policies isolating addiction care from the rest of health care is problematic for all including people with cancer. As a result, clinicians are circumventing the system and perhaps putting themselves and their patients at risk for harm. Policy innovation is sorely needed. 

Both methadone and buprenorphine can be used to address cancer related-pain and OUD, our study highlights that there is a knowledge and research gap on how to optimize both conditions.

Clinicians also need more training on using buprenorphine/naloxone and more evidence to implement for opioid misuse behaviors.

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: Integration of addiction treatment as an aspect of cancer treatment was important to our participants, more work is needed to understand the best patient-centered strategies to provide care.

Disclosures: The study was funded by the Cambia Health Foundation to Dr. Jessica Merlin and Katie Fitzgerald Jones is a Jonas Mental Health and Policy Scholar and funded by 

Ruth L. Kirschstein National Service Award (F31NR019929-01)

Citation:

Merlin JS, Khodyakov D, Arnold R, et al. Expert Panel Consensus on Management of Advanced Cancer–Related Pain in Individuals With Opioid Use Disorder. JAMA Netw Open. 2021;4(12):e2139968. doi:10.1001/jamanetworkopen.2021.39968

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2787463

[last-modified]

The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.