A single center, retrospective analysis evaluating aberrant drug behavior stratification utilizing the opioid risk tool in patients with cancer.

Abstract

167 Background: Historically, it was believed that cancer patients could not have aberrant drug behaviors. However, clinical experience suggests otherwise. The prevalence of aberrant drug behaviors of cancer patients is unknown as screening is uncommon. Consequently, the UCSD Moores Cancer Center outpatient palliative care clinic initiated screening of aberrant drug behaviors utilizing the opioid risk tool (ORT) on new consultations. The purpose of this retrospective analysis was to identify key risk factors of aberrant behaviors of cancer patients and formulate a routine approach to follow-up and medications quantities. Methods: The treating oncologist referred new consultations to the outpatient palliative care clinic. A cohort of 93 cancer patients was evaluated from July 2012 to February 2013. Patients completed a 10-item, provider-administered, ORT during the consultation visit. Based on the ORT, patients were stratified into high-, moderate-, or low-risk for abarrent drug behavior and follow-up appointments and opioid quantities were adjusted accordingly. Results: Of the 93 patients, 48% were men and 52% women. Most patients had metastatic cancer (n=50; 54%) of gastrointestinal primary (n=27; 29%). Fifty-six (60%) patients were stratified as low-, 15 (16%) moderate-, and 22 (24%) high-risk based on ORT score. The most common risk factors for aberrant behaviors were a history of depression (women=25; men=17) and family history of alcohol abuse (women=22; men=18). There was no difference in the prevalence of depression (p=0.17) or family history of alcohol abuse (p=0.57). The least common risk factor was a personal history of prescription drug abuse (n=1) in women and history of preadolescent sexual abuse in men (n=0). Conclusions: Screening of cancer patients suggests risk factors for aberrant drug behavior exist. Stratifying patients based on a standard, routine tool can help identify cancer patients at risk for aberrant drug behaviors. Moderate and high-risk patients can then be followed closely with limited quantities of opioids until trust is established.