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Researchers Develop a Risk Score for Opioid Misuse

Score could help prevent misuse among cancer patients

A new study of US veterans has found an overall incidence of persistent post-cancer treatment opioid use of 8.3%.

Research has shown that 10% of cancer patients who had surgery were still filling opioid prescriptions one year after that surgery, with daily opioid doses similar to those in long-term opioid users.

"Our study attempts to create an objective clinical tool that can help give providers a better understanding of a patient's risk of opioid-related toxicity," says study author Lucas K. Vitzthum, MD, of the Department of Radiation Medicine and Applied Science at the University of California San Diego.

Vitzthum and colleagues sought to identify clinical risk factors as well as create a risk score that could help identify patients with cancer who might be at risk of persistent opioid use and abuse. Using the Veterans Affairs Informatics and Computing Infrastructure (VINCI) database, the researchers selected a cohort of 106,732 cancer survivors who received a diagnosis between 2000 and 2015. The population included patients with cancer who were treated with definitive local therapy and who were alive without recurrence two years after they began treatment.

The primary endpoint was persistent opioid use, defined as having filled 120 or more days' supply or 10 or more opioid prescriptions from 1 to 2 years following the initiation of curative treatment.

Rates were lowest for those who had never used opioids (3.5%) and highest among prior chronic users (72.2%). Among patients who were opioid naïve, the variation in rates was associated with whether opioids were given during the diagnostic and treatment period. Patients who received opioid drugs during that time had rates of persistent posttreatment use of 6.2% vs 1.5% for patients who did not receive a prescription.

Opioid abuse or dependence occurred in 2.9% of patients and opioid-related admissions occurred in 2.1%.

The authors identified several factors associated with the risk of persistent opioid use, including younger age, white race, increased comorbidity, being unemployed at the time of diagnosis, lower median income, and current or prior tobacco use. A previous diagnosis of alcohol or non-opioid drug abuse, opioid abuse, and depression was also associated with higher odds of persistent opioid use.

“The VA population is unique, and may differ from the general population," says David Hui, MD, University of Texas MD Anderson Cancer Center in Houston, in a comment. But overall, even in cancer patients there is a risk of opioid misuse, which this study demonstrates, he added.

“[This tool] allows providers to understand the potential long-term risks of our treatments and factor this into their current management," says Fumiko Chino, MD, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York City. "Some of my own patients worry that if they face more restrictions on their medications that they will not be able to work as they do now or complete their normal daily activities. They know there is a problem with opioid use in America today, but they also know that, for them, it's the right medication. It's not 'one size fits all' treatment, and each patient needs to have a pain management plan that is appropriate for their unique situation."

Source: Medscape, December 2, 2019

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