Patients' Opioid Self-Management Poses Risks

While opioids are the most commonly prescribed agent to combat cancer-related pain, more is needed to ensure proper patient use and to reduce the stigma around the drugs, according to a study conducted by a team of researchers from the University of Pennsylvania, Emory University, and Memorial Sloan Kettering Cancer Center.

“Currently there is a disproportionate policy and clinical focus on prescribers’ opioid prescription patterns and misuse of opioids. This focus omits the important other side, i.e. patients’ opioid self-management practices,” said study author Salimah Meghani, PhD, associate professor at the University of Pennsylvania School of Nursing, in an interview with Oncology Nursing News.

The researchers used open-structure interviews and free listing (where participants list items related to the topic) to gather data from 97 adults being treated for solid malignancies or multiple myeloma and pain at an NCI-designated cancer center in Philadelphia.

For those who free listed, “pain relief” was the primary term used in relation to pain medicine, trumping “addiction.” However, interviews revealed many potentially unsafe practices when it came to patients managing their opioids. This included:

• reducing the dose by cutting pills
• self-tapering of opioids
• using extended release/long-acting opioids on an “as-needed” basis
• mixing non-opioid drugs, over-the-counter medicines, and illicit drugs to avoid taking opioids

The researchers wrote, “Some described assuming stewardship of their prescribed opioids and felt that oncology clinicians are quick to prescribe opioids without providing workable alternatives.”

But using these practices to avoid opioid use can also be dangerous, Meghani explained.

“Our study uncovered that under-use and dose-conserving practices of prescribed opioids can be also be problematic as the overuse and misuse of opioids,” she said.

Potential dangers of this kind of self-management can include a decreased tolerance and increased risk when returning to opioids after gaps in taking them. And, a previous study conducted by Meghani and others found a strong association between inconsistent opioid use and healthcare utilization.

Patients also noted that they would go on and off the drugs in attempt to mitigate stigma, side effects, and addiction.

“Our findings suggest that clinical tools to systematically elicit patient’s self-management practices, specially scheduled opioids are lacking and need to be employed in clinical practice,” Meghani said.

Meghani explained that nurses can use a patient counseling guide to help guide the discussion with patients regarding opioid use. Practitioners should also discuss opioid use with every oncology visit.

And while oncology nurses can do their part to help, there are still unanswered questions and more to be done in this field.

“Clinical interventions are needed to reduce opioid stigma for patients who need opioids to manage pain and daily function,” Meghani said.

Read more: Nurses Can Change the Direction of the Opioid Crisis