2086P - Management of opioids use disorder in cancer survivors

Background

Management of opioids use disorder in cancer survivors The morbidity and mortality associated with opioid use disorder is a public health concern in many countries. However, opioids are a cornerstone in the management of cancer pain. The problem of opioid use disorders is an emerging concern in cancer survivors.

Methods

Over 10 months, we evaluated at the Gustave Roussy Pain Management Unit survivors of cancer who were on long-term prescription opioid therapy. A thorough evaluation involving an addiction specialist doctor, a psychologist or a psychiatrist, and the pain team was conducted to answer the following questions: - What is the current painful complaint and are opioids the adequate treatment for it? - Is the patient dependent on prescription opioids and does he/she have prescription opioid misuse? - Does the patient have an addiction to opioids (according to DSMV criteria) A personalized therapeutic project was then proposed for each patient.

Results

All patients accepted the project. Thirteen patients with a prescription opioid use disorder were enrolled for an opioid withdrawal program. Nine patients were misusing step-3 analgesics as defined by the WHO analgesic ladder, including one patient misusing fast-acting fentanyl, and 4 were misusing step-2 analgesics as monotherapy or in combination with another step-2 analgesic. The mean oral morphine equivalent doses were 150 mg daily [40-480 mg]. Nine patients had an opioid prescription renewal for more than 5 years. The fear of the pain rebound was the main obstacle to stopping opioid use. Seven patients could be withdrawn as outpatients six required hospitalizations for withdrawal under strict medical supervision. Five patients were put on Medications for Opioid Use Disorder (MOUD). None of the residual pain complaints warranted an opioid prescription.

Conclusions

Prescription opioids use disorder in cancer survivors requires the intervention of a specialized multidisciplinary team, trained in the identification and treatment of opioid withdrawal, in the handling of MOUD and in the management of chronic pain diseases. Close and regular collaboration with oncologists is necessary, to reconsider the need for prescription opioids in every patient as soon as he/she is in remission.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Gustave Roussy Cancer Campus Grand Paris.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.