Treating cancer-related symptoms in patients exhibiting nonmedical opioid use behaviours: a retrospective chart review study.

PURPOSE: Although opioids are essential for treating symptoms in patients with advanced cancer, non-medical opioid use (NMOU, defined as patients using opioids differently, or in excess of, their prescription) is becoming more common and challenging to manage. We aimed to characterize the practice patterns and challenges documented by physicians treating cancer-related symptoms in patients exhibiting NMOU behaviours in an oncology palliative care clinic. METHODS: We purposively sampled patients who received care in the clinic in 2023 and who exhibited NMOU. We conducted a mixed methods retrospective chart review of all palliative care notes from initial consultation to six months of follow-up. RESULTS: Patients exhibiting NMOU (n = 12; median age 51; 67% male; 92% with stage 3 or 4 cancer) were younger and had higher symptom burden compared to other patients seen in the clinic. Commonly documented NMOU behaviours included increasing opioid doses without medical guidance (9, 75%), unscheduled visits for early refills (7, 58%), and missed appointments and emergency department visits for opioids (6, 50%). Safety interventions included prescribing lower quantities of opioids (9, 75%), frequent follow-up (8, 67%), and initiating opioid treatment agreements (8, 67%). Qualitative analysis revealed four themes: addressing social determinants of health; instituting harm reduction strategies; managing complex pain; and increased healthcare utilization. CONCLUSION: This study provides real-world insights into the complex needs of patients with cancer and NMOU and of the clinicians who care for them. Targets for quality improvement were identified including naloxone co-prescription and developing collaborative models with addiction specialists integrated with cancer care.