Opioid Abuse in Cancer Pain: Report of Two Cases and Presentation of an Algorithm of Multidisciplinary Care

Background: The growing awareness of opioid abuse and addiction in the chronicpain population, along with increasing cancer survivorship, has heightened ourawareness of this potential problem in the cancer patient. An increasing number ofpatients who abuse opioids have been identified in our clinical setting.Objective: We present an algorithm of multidisciplinary care for the treatment ofcancer patients at risk for abusing opioids.Setting: Two illustrative patient examples were identified recently from our clinic.Results: These 2 patient examples demonstrate our multidisciplinary approach totreatment. A discussion of safe prescribing principles adapted from the literature ispresented. Also, a brief point of added complexity is introduced; specifically, ethicalconsiderations due to the unique nature of cancer pain.Limitations: Although validation studies exist for the use of screening tools inpatients with chronic noncancer pain, there have been no instrument validationstudies on patients with cancer pain. The educational treatment model that we referto regarding facilitating safe use of opioids also has not been studied on patients withcancer pain. Lastly, we express caution in generalizing our guidelines to patients withnoncancer pain. Our patient population differs in the multiple co-existing stressorsand symptom burden associated with cancer. Conclusions: We have become increasingly aware of the problem of opioid abusein the cancer pain population. With an approach to using safe prescribing principlesadapted from chronic pain literature, and an ethically based multidisciplinaryapproach, clinicians can continue to treat pain successfully in the opioid-misusingcancer patient. We outline our approach in this article.Key words: opioids, opioid abuse and addiction, substance abuse and addiction,multidisciplinary care