Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-05-20T00:27:20.028Z Has data issue: false hasContentIssue false
  • English
  • Français

Nonmedical opioid use at the end of life: A tale of addiction and a last wish

Published online by Cambridge University Press:  22 December 2022

Michael Tang Open the ORCID record for Michael Tang [Opens in a new window] ,
Joseph Arthur ,
Alexandra Cooper ,
Matthew Clark  and
Eduardo Bruera
Michael Tang*
Affiliation:
Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Joseph Arthur
Affiliation:
Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Alexandra Cooper
Affiliation:
Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Matthew Clark
Affiliation:
Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Eduardo Bruera
Affiliation:
Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
*
Author for correspondence: Michael Tang, Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. Email: MJTang@mdanderson.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Nonmedical opioid use (NMOU) has been associated with opioid overdose deaths. This pattern of misuse can be seen in those using opioids for cancer-associated pain. We present a case that highlights the complexities associated with NMOU and a patient’s care at the end of life.

Cases Description

A patient with a metastatic solid tumor malignancy along with co-occurring history of polysubstance abuse was admitted to an acute palliative and supportive care unit (APSCU). The patient demonstrated behaviors concerning for NMOU during her hospital stay but had increased symptom expression concerning for worsening dyspnea while in the APSCU. Unfortunately, she used home opioids, which was unknown to the team at the time along with requesting for higher doses of opioids that were being prescribed. This caused a worsening respiratory status and affected her care. Using an interdisciplinary approach, the providers managed her symptoms and discharged her safely to see her child.

Conclusion

This highlights the complexities of the alleviation of suffering in those with NMOU. It is important to continue to manage NMOU at the end of life due to its effects on quality of life. A multimodal approach is recommended to identify and care for these patients.

Keywords

OpioidsNonmedical opioid useSubstance use disorderPalliative care unit
Type
Case Report
Information
Palliative & Supportive Care , Volume 21 , Issue 3 , June 2023 , pp. 561 - 563
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amaram-Davila, J, Mallipeddi, T and Reddy, A (2020) Opioid prescribing with take-home naloxone: Rationale and recommendations. Current Anesthesiology Reports 10(4), 428–435. doi:10.1007/s40140-020-00419-0CrossRefGoogle Scholar
Amaram-Davila, JS, Arthur, J, Reddy, A, et al. (2021) Managing nonmedical opioid use among patients with cancer pain during the COVID-19 pandemic using the CHAT model and telehealth. Journal of Pain and Symptom Management 62(1), 192–196. doi:10.1016/j.jpainsymman.2021.01.005CrossRefGoogle ScholarPubMed
Arthur, J and Bruera, E (2019) Balancing opioid analgesia with the risk of nonmedical opioid use in patients with cancer. Nature Reviews Clinical Oncology 16(4), 213–226. doi:10.1038/s41571-018-0143-7CrossRefGoogle ScholarPubMed
Arthur, J, Edwards, T, Reddy, S, et al. (2018) Outcomes of a specialized interdisciplinary approach for patients with cancer with aberrant opioid-related behavior. The Oncologist 23(2), 263–270. doi:10.1634/theoncologist.2017-0248CrossRefGoogle ScholarPubMed
Arthur, JA, Tang, M, Lu, Z, et al. (2021) Random urine drug testing among patients receiving opioid therapy for cancer pain. Cancer 127(6), 968–975. doi:10.1002/cncr.33326CrossRefGoogle ScholarPubMed
Bohnert, AS, Valenstein, M, Bair, MJ, et al. (2011) Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA 305(13), 1315–1321. doi:10.1001/jama.2011.370CrossRefGoogle ScholarPubMed
Brent, J and Weiss, ST (2022) The opioid crisis—not just opioids anymore. JAMA Network Open 5(6), e2215432–e2215432. doi:10.1001/jamanetworkopen.2022.15432CrossRefGoogle ScholarPubMed
Cagle, JG, McPherson, ML, Frey, JJ, et al. (2020) Estimates of medication diversion in hospice. JAMA 323(6), 566–568. doi:10.1001/jama.2019.20388CrossRefGoogle ScholarPubMed
Caraceni, A, Hanks, G, Kaasa, S, et al. (2012) Use of opioid analgesics in the treatment of cancer pain: Evidence-based recommendations from the EAPC. The Lancet Oncology 13(2), e58–e68. doi:10.1016/S1470-2045(12)70040-2CrossRefGoogle ScholarPubMed
Carmichael, A-N, Morgan, L and Del Fabbro, E (2016) Identifying and assessing the risk of opioid abuse in patients with cancer: An integrative review. Substance Abuse and Rehabilitation 7, 71–79. doi:10.2147/SAR.S85409Google ScholarPubMed
Case, AA, Walter, M, Pailler, M, et al. (2020) A practical approach to nonmedical opioid use in palliative care patients with cancer: Using the PARTNERS framework. Journal of Pain and Symptom Management 60(6), 1253–1259. doi:10.1016/j.jpainsymman.2020.08.031CrossRefGoogle ScholarPubMed
Dalal, S and Bruera, E (2019) Pain management for patients with advanced cancer in the opioid epidemic era. American Society of Clinical Oncology Educational Book 39, 24–35. doi:10.1200/EDBK_100020CrossRefGoogle ScholarPubMed
Gabbard, J, Jordan, A, Mitchell, J, et al. (2019) Dying on hospice in the midst of an opioid crisis: What should we do now? American Journal of Hospice and Palliative Medicine 36(4), 273–281. doi:10.1177/1049909118806664CrossRefGoogle ScholarPubMed
Hui, D and Bruera, E (2014) A personalized approach to assessing and managing pain in patients with cancer. Journal of Clinical Oncology 32(16), 1640–1646. doi:10.1200/JCO.2013.52.2508CrossRefGoogle ScholarPubMed
Kirsh, KL (2010) Differentiating and managing common psychiatric comorbidities seen in chronic pain patients. Journal of Pain & Palliative Care Pharmacotherapy 24(1), 39–47. doi:10.3109/15360280903583123CrossRefGoogle ScholarPubMed
Lipari, RN and Hughes, A (2013) How people obtain the prescription pain relievers they misuse. The CBHSQ Report. Rockville, MD: Substance Abuse and Mental Health Services Administration (US), 1–7.Google Scholar
U.S. Department of Health and Human Services (2021) Opioid crisis statistics. https://www.hhs.gov/opioids/about-the-epidemic/opioid-crisis-statistics/index.html (accessed 14  November 2022).Google Scholar
Passik, SD and Theobald, DE (2000) Managing addiction in advanced cancer patients: Why bother? Journal of Pain and Symptom Management 19(3), 229–234. doi:10.1016/S0885-3924(00)00109-3CrossRefGoogle ScholarPubMed
Reddy, A and de la Cruz, M (2019) Safe opioid use, storage, and disposal strategies in cancer pain management. Oncologist 24(11), 1410–1415. doi:10.1634/theoncologist.2019-0242CrossRefGoogle ScholarPubMed
Tang, M, Arthur, J, Reddy, A, et al. (2021) Deficiencies with the use of prescription drug monitoring program in cancer pain management: A report of two cases. Journal of Palliative Medicine 24(5), 751–754. doi:10.1089/jpm.2020.0537CrossRefGoogle ScholarPubMed
Tang, M and Reddy, A (2022) Telemedicine and its past, present, and future roles in providing palliative care to advanced cancer patients. Cancers (Basel) 14(8), . doi:10.3390/cancers14081884CrossRefGoogle ScholarPubMed
Yennurajalingam, S, Arthur, J, Reddy, S, et al. (2021) Frequency of and factors associated with nonmedical opioid use behavior among patients with cancer receiving opioids for cancer pain. JAMA Oncology 7(3), 404–411. doi:10.1001/jamaoncol.2020.6789CrossRefGoogle ScholarPubMed