Adherence to Opioid Patient Prescriber Agreements at a Safety Net Hospital

Area of Science:

• Oncology
• Palliative Care
• Addiction Medicine

Background:

• Patient prescriber agreements (PPAs), or opioid contracts, are recommended to reduce non-medical opioid use (NMOU).
• Understanding PPA completion and adherence rates is crucial for effective opioid management in cancer patients.

Purpose of the Study:

• To determine the proportion of cancer patients with PPAs.
• To assess the rate of non-adherence to PPAs.
• To identify clinical predictors of PPA completion and non-adherence.

Main Methods:

• Retrospective study of consecutive cancer patients receiving opioids at a palliative care clinic (2015-2019).
• Data collected included patient demographics, cancer details, and PPA information.
• Multivariable logistic regression analysis was used to identify predictors.

Main Results:

• Of 905 patients, 54% had a PPA, and 10% of those with PPAs were non-adherent.
• PPAs were associated with younger age and alcohol use.
• Non-adherence predictors included male gender, single status, tobacco/alcohol use, criminal associations, non-malignant pain indication, and higher pain scores.

Conclusions:

• A significant minority of cancer patients on opioids do not adhere to PPAs.
• Non-adherence is more common in patients with identified NMOU risk factors.
• Universal PPAs and systematic NMOU risk screening can improve patient care and safety.