Abstract| Volume 63, ISSUE 6, P1076, June 2022

Manifestations of Opioid Stigma in Patients with Advanced Cancer (RP316)

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      1. Conceptualize stigma surrounding prescription opioids by using the Opioid Stigma Framework
      2. Describe manifestations of opioid stigma in patients with advanced cancer
      3. Describe potential management approaches to mitigate the impact of opioid stigma in patients with advanced cancer


      Patients with advanced cancer are routinely prescribed opioids for pain management. However, high-profile efforts to address the opioid epidemic contribute to a widespread negative view of opioids. As a consequence, emerging evidence suggests that stigma surrounding prescription opioids, or opioid stigma, may complicate cancer pain management. However, little is known about how opioid stigma manifests in the experiences of patients with advanced cancer.


      Explore manifestations of opioid stigma in patients with advanced cancer.


      Our study took a qualitative description approach. Qualitative interviews were conducted between 02/2020 and 05/2021. Participants were patients with advanced cancer and pain, prescribed or recommended opioids for their pain, identified by their oncologist; and patient-identified support people (family member or friend). Interviews were coded by two experienced qualitative analysts, using a codebook developed inductively from the content of the interviews, and content and thematic analyses were conducted.


      A total of 20 patients and 11 support people participated. Three themes emerged. First, participants described direct experiences with opioid stigma and opioid-related discrimination in healthcare settings, generally in settings outside of their oncology clinic (e.g., pain clinics, pharmacies). Second, participants endorsed concerns about opioid stigma impacting patient care in the future. Finally, patients displayed opioid-restricting attitudes and behaviors that may reflect internalized stigma and fear of addiction.


      These results suggest that opioid stigma is a central challenge for patients with advanced cancer. Participants described specific, addressable manifestations of opioid stigma, including internalized and anticipated stigma and experiences of discrimination. Interventions to address opioid stigma at the clinician/systems level and mitigate the consequences of opioid stigma for patients with advanced cancer are needed to improve cancer pain treatment.