Long-Term Opioid Therapy and Overdose in Patients With and Without Cancer (CO203A)

Abstract

Outcomes 1. Describe opioid trajectories in patients with and without cancer and their implications 2. Explain findings related to overdose risk and cancer status Importance Pain is experienced by most patients with cancer, and opioids are a cornerstone of cancer pain management. Prominent guidelines reflect the prevalent belief that benefits of palliating pain in cancer with opioids nearly always outweigh potential harms, including opioid overdose, despite limited evidence. Objective(s) Among patients with and without cancer: identify patterns of long-term opioid therapy (LTOT) and their correlates and assess the association between prescribing patterns and risk for opioid overdose, considering the potential moderating role of cancer. Method(s) A 2010-2017 retrospective cohort study using latent growth mixture modeling and Cox proportional hazards modeling. Setting included the Veterans Health Administration electronic health record database. Participants included patients with incident LTOT with and without cancer (N = 44,351; N = 285,772, respectively). Veterans in the cohort were ≥18 years of age at the time of incident LTOT; engaged in VHA care, defined as ≥2 outpatient visits or ≥1 inpatient admissions within the year prior to cohort entry; and received LTOT, defined as receipt of 90 consecutive days’ opioid prescription. Exposure included the pattern of opioid prescription received. Main outcomes included all accidental and intentional opioid-related overdose events. Results Patterns of opioid receipt observed in patients without cancer and replicated in patients with cancer were low-dose, low-dose/de-escalating trend, moderate-dose, moderate-dose/escalating trend, and high-dose/escalating trend. Controlling for covariates, time to first overdose was significantly predicted by higher-dose and escalating trajectories; the two low-dose patterns conferred similar, lower risk. Effects of trajectories on time to overdose did not differ by cancer group status. Conclusion(s) Patients with cancer face opioid overdose risks like those of patients without cancer. Impact Clinicians and researchers should consider these findings when counseling patients and developing inclusion criteria for LTOT studies. Future studies should seek to expand knowledge about opioid risk in patients with cancer.