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. 2021 Sep;62(3):e156-e163.
doi: 10.1016/j.jpainsymman.2021.05.002. Epub 2021 May 11.

Compassion Inequities and Opioid Use Disorder: A Matched Case-Control Analysis Examining Inpatient Management of Cancer-Related Pain for Patients With Opioid Use Disorder

Sarah A Singh  1 , Rachel A Moreland  2 , Wei Fang  3 , Parvez Shaikh  4 , John Michael Perez  2 , Ann M Morris  4 , Basem Dahshan  4 , Rebecca F Krc  4 , Dilip Chandran  2 , Monika Holbein  5
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Compassion Inequities and Opioid Use Disorder: A Matched Case-Control Analysis Examining Inpatient Management of Cancer-Related Pain for Patients With Opioid Use Disorder

Sarah A Singh et al. J Pain Symptom Manage. 2021 Sep.

Abstract

Context: The opioid epidemic spurred guidelines intended to reduce inappropriate prescribing. Although acute cancer-related pain was excluded from these recommendations, studies demonstrate reduced opioid prescribing for patients hospitalized with advanced cancer.

Objectives: We performed a matched case-control analysis to determine how a history of opioid use disorder (OUD) affects inpatient management of cancer pain.

Methods: Charts of patients with OUD admitted for cancer pain from 2015-2020 were retrospectively reviewed. Hospitalizations were matched 1:1 by patient age and sex. Home milligram-morphine equivalent per day (MME/day) was calculated from the home medication list. Admission MME/day was the average MME/day administered during hospitalization.

Results: A total of 80 hospitalizations (40:40) were matched for 25 patients with a history of OUD and 31 patients with no history of OUD. Cancer was metastatic/relapsed for 70% of admissions. The median overall survival was 2.3 months (95% CI 0-5.21, P = 0.13). Patients with OUD had a significantly lower change from Home to Admission MME/day (-3 vs. 37, P < 0.01) and were less likely to have any increase in Admission MME/day (OR 0.1, 95% CI 0.02-0.43, P < 0.01). When considering opioids administered after pain specialty consultation, there was no difference between groups.

Conclusion: Our results suggest that patients with OUD receive lower quality inpatient management of cancer-related pain. Provider education and early involvement of pain specialists are crucial in delivering equitable and compassionate end-of-life care for patients with OUD.

Keywords: Opioid use disorder; health disparities; palliative care.

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