Opioids Can Be Continued in Cancer Patients With Nonmedical Stimulant Use

Regardless of prognosis, panel deemed it appropriate to continue opioids, increase monitoring, and avoid opioid tapering

By Elana Gotkine HealthDay Reporter

MONDAY, Sept. 11, 2023 (HealthDay News) — For patients with cancer-related pain and nonmedical stimulant use, opioids should be continued, monitoring increased, and tapering avoided, according to a study published online Sept. 11 in Cancer.

Katie Fitzgerald Jones, Ph.D., from the VA Boston Healthcare System, and colleagues conducted two modified Delphi panels with palliative care and addiction experts to identify consensus on opioid management strategies for an individual with advanced cancer and cancer-related pain with nonmedical stimulant use. In panels A and B, the patient’s prognosis was weeks to months and months to years, respectively. A three-step analytical approach was applied to determine consensus and levels of clinical appropriateness for the management strategies.

For all management strategies, consensus was achieved. The researchers found that it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering for a patient with cancer-related and nonmedical stimulant use, regardless of prognosis. For a patient with a short prognosis, buprenorphine/naloxone transition was inappropriate, while the appropriateness was uncertain for a patient with a longer prognosis.

“The study findings provide consensus-based guidance for clinicians who treat cancer-related pain and encounter stimulant use, and include management strategies they can bring immediately to their practice,” Jones said in a statement. “The results highlight a need for integrated care models to address substance use during cancer and create a research agenda that prioritizes substance use disorder as an important comorbidity in people with cancer.”

Several authors disclosed ties to industry.