(372) Suboxone Therapy for Cancer Survivors with Opioid Use Disorder: A Case Report

Abstract

Research has identified cancer survivors as a growing demographic of patients with opioid use disorder. Providers of this group may continue opioid medications despite remission of cancer, as clinical findings may be complicated by difficulty identifying a clear pain generator. We present a 57-year-old man with history of retroperitoneal liposarcoma that presented to the emergency department at a Veterans Affairs Hospital fifteen times between March 2017 and October 2018 with abdominal pain, nausea, and vomiting. He had been in remission since 2016 after treatment with chemotherapy and radiation. Of the multiple hospital visits, he was admitted five times and seen by multiple specialists, including gastroenterology, hematology-oncology, palliative care, and pain management. Because of the severity of pain and recent cancer remission, he underwent multiple comprehensive evaluations, including multiple CT scans, esophagogastroduodenoscopy, and PET scan. No evidence of recurrence was found. The patient was provided intravenous opioid therapy with relief at each encounter. After review of his clinical course, Pain providers identified he was consistently presenting prior to the anticipated renewal date of his opioids. The patient's symptoms were felt to be consistent with opioid withdrawal. Given the severity of symptoms and lack of indication for continuing opioids, the patient was determined to be a candidate for medication assisted therapy. He was subsequently tapered off opioids and started on buprenorphine 4 mg BID. He was titrated to 8 mg TID by addiction psychiatry with significant improvement in abdominal pain, sleep, and appetite. Since starting MAT, the patient hasn't presented to the ED for care. This case report highlights the need for vigilance against the development of OUD in cancer survivors. It also demonstrates the healthcare costs and concerns of continuing opioid therapy without indication. Identifying opioid use disorder and utilizing MAT may be crucial to treating OUD in this population.