Navigating Challenging Conversations About Nonmedical Opioid Use in the Context of Oncology

Opioids are commonly used in the context of oncology to treat cancer-related pain. In the context of increased awareness of nonmedical use of opioids, including misuse and opioid use disorder among individuals with cancer, oncologists may find themselves having difficult conversations with patients regarding the use of opioids. We offer a review of pertinent literature and a conversation framework for providers to use, as well as key communication strategies for clinicians. Building on the therapeutic alliance between provider and patient, emphasizing the importance of nonabandonment, and using a benefit-to-harm framework, we hope clinicians find they are more able to navigate these challenging but important conversations with patients. IMPLICATIONS FOR PRACTICE: Providers may find it difficult and uncomfortable to discuss nonmedical use of opioids with patients. To the authors' knowledge, no previous articles discuss ways to communicate about nonmedical use of opioids in the oncology setting. This work borrows from other specialties and offers a communication framework and key communication strategies to help clinications communicate more effectively with patients who may have an opioid use disorder or may be using their prescribed opioids for reasons other than their pain.