Psychiatric or Drug Hospitalizations in Older Cancer Survivors on Long-Term Opioids

Abstract

Non-cancer patients prescribed chronic courses of opioids are at high risk of psychiatric or drug overdose particularly during the post-tapering period, but data are limited on this effect in cancer survivors. This study quantified emergency room visits or hospital admissions for psychiatric or drug/alcohol overdose/withdrawal (henceforth "events") in cancer survivors prescribed opioids related to their cancer diagnoses. We identified 15,002 cancer survivors in SEER-Medicare diagnosed between 2010 and 2017 with bladder, breast, colon/rectal, kidney, lung, head/neck, or prostate cancer who were prescribed at least 6 months of stable opioids following their cancer diagnosis. The post-tapering interval was defined as a 3-month period following monthly oral morphine equivalent (OME) reduction of at least 15%. Outcomes were studied with logistic regression and time-dependent analysis was performed using a generalized estimating equation (GEE) using an auto-regressive correlation matrix; all reported p-values are two-sided. The study had a median follow up of 24 months; in this time, 8,311 patients (55%) initiated a taper at some point. The mean daily OME in non-tapering patients was 33.4 mg compared to 47.4 mg in tapering patients (p < 0.001); both groups had a low rate of any prior events in the baseline period (7.5% versus 8%, respectively p = 0.686). Patients attempting a taper also tended to be younger (40.3% versus 35.2% age 66-70, p <0.001). There was no difference by race. Opioid tapering was not associated with a higher rate of events in the 3-month post-taper period (p = 0.81) when correcting for sex, primary care site, baseline event rate, comorbidity, and age. Many older cancer survivors who are prescribed chronic opioids remain on high doses of opioids after completing therapy. These patients are at risk of acute psychiatric and drug-related emergencies. Unlike the general population, this risk does not appear to be exacerbated in the months following opioid tapering. Oncologists should be mindful of psychiatric and drug-related events in long-term cancer survivors prescribed chronic opioids, and these data should reassure physicians deciding whether or not to initiate an opioid taper. Future research should explore risk mitigation in these patients.