Persistent opioid use is associated with a shorter myeloma survival

Overuse of opioids has been associated with a significant public health crisis, yet remain critical as adjunctive treatment in multiple myeloma (MM). Questions remain about the balance between the benefits to risks of ongoing opioid use, especially when the patient's myeloma is in remission. This retrospective review focuses on the association of chronic opioid use (COU) in a patient population predominantly people of color.

A cohort of 174 MM patients who received autologous stem cell transplant (ASCT) at an urban medical center were studied.

Baseline COU was observed in 52.9% of patients. COU rates and average morphine milligram equivalents (MME) per day were similar in those with and without bone disease. Previous illicit drug use was associated with a higher baseline COU. 142 (81.6%) patients received opioids during ASCT admission, while 105 (60.3%) were discharged on opioids and 72 (41.4%) met criteria for COU at 6 months. Opioid use at hospital discharge was associated with a higher 6-month COU (p = 0.008). COU at 6 months was independently associated with worse overall survival (p = 0.006).

We describe high rates of baseline COU in MM unrelated to bone disease. A number of patients started opioids during ASCT and were still taking them at 6-month follow-up visit. We demonstrate a negative association of 6-month COU on OS but not on PFS suggesting that opioid-related morbidity may play a role. These data highlight the need to test causality of opioid use on survival while simultaneously improving the management of pain in MM.