(125) When Patients Take Charge of Opioids: Self-Management and Safety of Prescribed Opioids for Cancer Pain in the Context of Opioid Crisis

Abstract

Among insured adults, patients with cancer have more pharmacy claims and claims for higher doses of opioids. Patients with cancer also remain exempt from most state legislation and policy initiatives on prescribing opioids, necessitating a critical understanding of opioid management and risks among this group. This multi-method study investigated pain and opioid self-management practices reported by adult cancer patients recruited from an outpatient oncology clinic of an NCI-designated cancer center (n=65; mean age 56.3, SD=12.3; pain 6.0, SD=2.8; >50% with metastatic disease; IRB approval, University of Pennsylvania). Using Freelisting analysis (Smith's salience index, ANTHROPAC), “pain relief” and “addiction” were the most salient concerns identified by the participants. In the qualitative interviews (n=32, ATLAS ti. 8.0), taking charge of the prescribed opioids emerged as a major theme. Patients described opioid self-management practices including using long-acting/extended-release opioids on an as-needed basis; increasing duration between opioid doses until pain is “pretty bad” or “unbearable”; reducing prescribed opioid dose by cutting pills into half or one-quarter; self-tapering of opioids; outsourcing opioid management decisions to a family member to minimize potential risk for addiction; combining acetaminophen and ibuprofen for pain relief in order to avoid prescription opioids; and use of licit and illicit marijuana to avoid having to go to prescribed opioids, which were considered “harder pills”. Many patients described knowing someone affected by opioid crisis, thought clinicians are quick to prescribe opioids without simultaneously providing alternatives; many preferred non-opioid treatments for pain but more commonly faced a variety of access barriers. While the recent HHS Pain Management Taskforce has identified self-management as one of the best practices for improving pain, function, and safety of prescribed opioids4, our findings point to potentially unsafe opioid self-management practices among cancer outpatients needing urgent attention to improve education and access to effective alternative treatments. Funding: American Cancer Society#128779-PEP-15-186-01.