Prescription Monitoring Program Review Among Patients with Cancer Receiving Opioids at a Safety-Net Palliative...

Prescription monitoring programs (PMPs) are commonly used to monitor non-medical opioid use (NMOU); however, the effectiveness of PMPs for identifying cancer patients with risk factors is not well known.

This study assessed the frequency and predictors of concerning PMP findings among cancer patients in a palliative care clinic and examined the ability of PMPs, clinical review, and urine drug testing to identify NMOU behaviors. This was a retrospective analysis of consecutive cancer patients seen by palliative care at a safety-net hospital over four years. Demographic, clinical, and psychosocial risk factors for NMOU were extracted from the medical record. Concerning PMP findings were based on prescriber documentation. Logistic regression models identified predictors of documented PMP concerns.

Among 906 patients, 844 (93%) had PMP reviews at either consultation or a follow-up visit. Of these, 31/844 (4%) demonstrated documented PMP concern. Predictors of documented PMP irregularities included a history of illicit drug use (OR 6.30, 95% CI: 2.35-17.06), opioid use for non-malignant pain (OR 19.49, 95% CI: 6.24-60.90), and a family history of illicit drug use (OR 5.42, 95% CI: 0.96-25.04).

A total of 166 patients (20%) were identified as having NMOU behaviors based on clinical review; in contrast, PMP review identified only 31 (4%) patients with NMOU behaviors, and two (6%) were missed by clinical review. Documented PMP concern was low in cancer patients. Clinical review identified most patients with NMOU behaviors, with limited contribution from PMP review. Our findings suggest that PMP should not be used in isolation when assessing opioid-related risk in this population.