STANFORD, CA — How has pain management for cancer patients been affected by the opioid epidemic and related risk reduction policies?
A new study from Stanford University researchers and colleagues, including representatives from several VAMCs, sought to answer that question. To do that, they analyzed how an Opioid Safety Initiative (OSI) implemented at the VHA affected opioid prescribing patterns and opioid-related toxicity.
The study team performed an interrupted time series analysis of 42,064 opioid-naïve patients treated at the VHA for prostate, lung, breast and colorectal cancer from 2011-2016. Researchers, including teams from the Palo Alto, CA; San Diego, Ann Arbor, MI and Portland, OR, VAMCs, evaluated the impact of the OSI on the incidence of any new opioid prescriptions, high-risk prescriptions, persistent use and pain-related ED visits.
Results published in the Journal of the National Cancer Institute indicate the incidence of new opioid prescriptions was 26.7% (95% CI = 25.0-28.4%) in 2011 and increased to 50.6% (95% CI = 48.3-53.0%) by 2013 prior to OSI implementation (monthly rate of change: +3.3%, 95% CI = 1.3-4.2%, p <0.001). After the OSI, however, the monthly rate of change for new prescriptions decreased (-3.4%, 95% CI = -3.9 – -2.9%, p < 0.001).1
Researchers report that the implementation of the OSI was associated with:
- A decrease in the monthly rate of change of concomitant benzodiazepines and opioid prescriptions (-2.5%, 95% CI = -3.2 – -1.8%, p < .001),
- No statistically significant change in high-dose opioids (-1.2%, 95% CI = -3.2-0.9%, p = 0.26),
- A decrease in persistent opioid use (-5.7%, 95% CI = -6.8 – -4.7%, p <0.001), and
- An increase in pain-related ED visits (+3.0%, 95% CI = 1.0-5.0%, p = 0.003).
In addition, they report that the OSI was associated with a decreased incidence of opioid-related admissions (3-year cumulative incidence: 0.9% [95% CI = 0.7-1.0%] vs. 0.5% [95% CI = 0.4-0.6%], p < 0.001) and no statistically significant change in the incidence of opioid misuse (3-year cumulative incidence: 1.2% [95% CI = 1.0-1.3%] vs. 1.2% [1.1-1.4%], p = 0.77).
“The OSI was associated with a relative decline in the rate of new, persistent, and certain high-risk opioid prescribing as well as a slight increase in the rate of pain-related ED visits,” the authors concluded. “Further research on patient-centered outcomes is required to optimize opioid prescribing policies for patients with cancer.”
- Vitzthum LK, Nalawade V, Riviere P, Marar M, Furnish T, Lin LA, Thompson R, Murphy JD. Impacts of an Opioid Safety Initiative on United States Veterans Undergoing Cancer Treatment. J Natl Cancer Inst. 2022 Jan 25:djac017. doi: 10.1093/jnci/djac017. Epub ahead of print. PMID: 35078240.