Early Posttherapy Opioid Prescription, Potential Misuse, and Substance Use Disorder Among Pediatric Cancer Survivors

Abstract

Background: Pediatric cancer survivors often have pain, which may be managed with opioids. We examined the prevalence of opioid prescriptions, potential misuse, and substance use disorders (SUDs) among pediatric cancer survivors during the first year posttherapy.

Methods: Using MarketScan Commercial Database, we identified 8969 survivors (aged 21 years or younger at diagnosis) who completed cancer therapy in 2009-2018 and remained continuously enrolled for at least 1 year posttherapy and 44 845 age-, sex-, and region-matched enrollees without cancer as a comparison group. Outcomes included opioid prescriptions, any indicator of potential prescription opioid misuse, and SUDs within 1 year posttherapy. Outcomes were compared between survivors and noncancer peers in bivariate and adjusted analyses, stratified by off-therapy age (children: 0-11 years; adolescents: 12-17 years; young adults: 18-28 years). All statistical tests were 2-sided.

Results: A higher proportion of survivors than noncancer peers filled opioid prescriptions (children: 12.7% vs 2.0%; adolescents: 22.9% vs 7.7%; young adults: 26.0% vs 11.9%). In models adjusting for sociodemographic factors and health status, survivors remained 74.4%-404.8% more likely than noncancer peer to fill opioid prescriptions (P < .001). The prevalence of potential misuse or SUDs was low, with 1.4% of child, 4.7% of adolescent, and 9.4% of young adult survivors fulfilling at least 1 criterion; however, it was higher than noncancer peers (0.1%, 1.4%, and 4.3%, respectively). In adjusted models, the likelihood of potential misuse among survivors remained at least 2 times higher than that among noncancer peers (P < .001), and the difference in SUDs became nonstatistically significant.

Conclusion: Statistically significantly higher rates of opioid prescriptions and potential misuse were found among pediatric cancer survivors within 1 year posttherapy as compared with peers without cancer.

Figure 1.

Adjusted percentage of any opioid prescription. The predicted percentages represented the model-adjusted likelihoods of specific outcomes among survivors vs noncancer peers, with other model covariates held at their observed values, estimated with logistic regressions. Partially adjusted models were regression models adjusting for sociodemographic factors and calendar year of the end of therapy. Fully adjusted models were regression models adjusting for sociodemographic factors, health status, and calendar year of the end of therapy. P values were calculated from logistic regression models and reflected 2-sided test of statistical significance.

Figure 2.

Adjusted percentages of (a) any indicator of potential misuse, (b) any substance use disorder (SUD), and (c) any indicator of potential misuse or SUD. The predicted percentages represent the model-adjusted likelihoods of specific outcomes among survivors vs noncancer peers, with other model covariates held at their observed values, estimated with logistic regressions. Partially adjusted models were regression models adjusting for sociodemographic factors and calendar year of the end of therapy. Fully adjusted models were regression models adjusting for sociodemographic factors, health status, and calendar year of the end of therapy. P values were calculated from logistic regression models and reflected 2-sided test of statistical significance.