Risk for Opioid Misuse Among Emergency Department Cancer Patients

Area of Science:

• Emergency Medicine
• Oncology
• Pain Management
• Addiction Medicine

Background:

• Managing severe and persistent pain, particularly cancer-related pain, presents significant challenges in emergency medicine.
• Emergency departments (EDs) increasingly care for cancer patients, raising concerns about potential opioid misuse within this population.
• Identifying risk factors for opioid misuse is crucial for effective patient management and harm reduction strategies.

Purpose of the Study:

• To determine the risk of opioid misuse among cancer patients presenting to the emergency department with pain.
• To assess demographic and clinical factors associated with an increased risk of opioid misuse in this patient group.
• To evaluate the feasibility of implementing screening tools for opioid misuse in the ED setting.

Main Methods:

• The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) was administered to assess misuse risk.
• Eligible participants were adult cancer patients presenting to a comprehensive cancer center's ED for chronic cancer-related pain.
• Patients were required to be on a Schedule II opioid for analgesia, English-speaking, and able to provide informed consent.

Main Results:

• Of 209 participants, 34% (71 patients) were categorized as high-risk for opioid misuse based on the SOAPP-R cutoff score.
• Factors significantly associated with high misuse risk included depression (OR=3.06), poor coping (OR=1.08), and illicit substance use (OR=28.30).
• The high-risk group had a significantly higher number of annual opioid prescriptions compared to the low-risk group (17.8 vs. 12.6, p=0.023).

Conclusions:

• The risk of opioid misuse among cancer patients seeking emergency care is substantial.
• Screening for opioid misuse in the emergency department is a feasible and important clinical practice.
• Identifying high-risk patients allows for targeted interventions to mitigate potential harm.