Abstract
Context
Opioid prescribing to cancer patients is declining, but it is unknown whether reductions
have been tailored to those at highest risk of opioid-related harms.
Objectives
Examine whether declines in opioid dispensing to patients receiving active cancer
treatment are sharper in patients with substance use disorder (SUD) or mental health
diagnoses.
Methods
We used 2008–2018 national, commercial healthcare claims data to examine adjusted
and unadjusted trends in opioid dispensing (receipt of ≥1 fill; average daily dosage;
receipt of high-dose opioids; receipt of concurrent opioids and benzodiazepines) to
patients ages ≥18 receiving treatment for one of four cancer types (breast; colorectal;
head and neck; sarcoma; N = 324,789 patients). To compare declines across subgroups with varying risk of opioid-related
harms, we stratified by SUD and mental health diagnosis. To address potential confounding,
we estimated subgroup-specific trends using generalized estimating equations, adjusting
for covariates.
Results
Across groups, rate of ≥1 opioid fill per quarter fell 32.5% (95% CI: 31.8%–33.2%)
from 2008 to 2018; daily dose among those receiving opioids fell 37.6% (95% CI: 36.7%–38.6%).
In most cases, these declines were not sharper in subgroups at greater risk of opioid-related
harms. For example, patients with opioid use disorder experienced the smallest declines
in dispensing frequency, and there was no evidence that declines were sharper in patients
with mental health diagnoses.
Conclusion
Sharp declines in opioid prescribing during the drug overdose crisis have affected
a wide range of patients undergoing cancer treatment and may not have been sufficiently
tailored to patient characteristics. Research on implications for opioid-related harms
and pain management is needed.
Key Words
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Article info
Publication history
Published online: October 14, 2021
Accepted:
September 18,
2021
Footnotes
ORCID: Tarlise Townsend: 0000-0001-7459-9798
ORCID: Amy Bohnert: 0000-0002-0864-2900
ORCID: Talya Salz: 0000-0002-4515-6004
ORCID: Rebecca Haffajee: 0000-0003-0123-1516
ORCID: Fumiko Chino: 0000-0003-0498-488X
ORCID: Megan Caram: 0000-0003-1597-5428
Identification
Copyright
© 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
