Is opioid addiction a problem in Palliative Care? Definitions, assessment and clinical implications

Only 78 days to #EAPC2020 … The 11th World Research Congress of the European Association for Palliative Care which,  for the first time ever, will take place online with interactive online sessions 7 to 9 October 2020 and on-demand content available from 21 September.

Ahead of the congress, we’re delighted to give some highlights of what’s in store at #EAPC2020. Today, Professor Eduardo Bruera, MD, Chair, Department of Palliative, Rehabilitation, & Integrative Medicine at UT MD Anderson Cancer Center, Houston, Texas, gives a glimpse of the plenary lecture he will give at the congress followed by a live panel discussion.

Professor Eduardo Bruera.

Opioids are the most important drugs for the management of pain in palliative care patients. Opioids are mainly agonists of the mu receptor along nociceptive pathways and by that mechanism they reduce afferent input into the somatosensory cortex.

Unfortunately, these very old drugs (between 60 and 220 years old) are not targeted to the nociceptive pathway. (1) Opioids bind to mu receptors in multiple other areas of the brain, including the limbic system resulting in reward and reduced distress. A number of studies have found that a substantial minority of cancer patients receiving opioids for pain control develop behaviours consistent with non-medical opioid use (NMOU). These behaviours range in severity, from occasionally using more opioids than prescribed to obtaining prescriptions from multiple sources, buying street drugs, or diverting their opioid prescriptions. (2)

The underlying diagnosis for NMOU behaviours ranges from coping chemically with the distress of cancer to severe opioid use disorders. (2)

Several studies have found that some cancer patients are at a higher risk for developing NMOU: Positive screening in tests for alcohol/drugs, history of smoking, younger age, and male gender are independent predictors of higher risk for NMOU. (3)

Unfortunately, there are no reliable clinical or demographic predictors for NMOU. A practical, clinical approach includes ‘universal precautions’ with screening for risk factors before prescribing opioids for pain or dyspnea. Patients with low risk receive regular follow-up and those with increased risk (approximately 20 per cent) undergo more frequent follow-up and more intense opioid use education. All patients undergo regular monitoring and those who are diagnosed as having NMOU behaviour require a more specialised interdisciplinary palliative care management. This management has been found to successfully decrease NMOU and keep adherence to the team. (4)

More research is needed on better screening tools and management of palliative care patients with NMOU. Better analgesics, capable of much more specific reduction of spinothalamic nociceptive input without limbic system binding, are needed to replace the obsolete semisynthetic and synthetic opioids currently available. However, several promising target substances have been discarded so far due to safety concerns.


Join Professor Eduardo Bruera for his plenary presentation and live panel discussion, which will be one of the interactive online sessions during 7-9 October. Keep up to date at https://eapcresearchcongress2020.eu/

Prof Bruera’s lecture, Is opioid addiction a problem in Palliative Care? Definitions, assessment and clinical implications, will also be recorded and released for on-demand viewing by registered delegates until January 2021. Read the abstract of his lecture, and all other congress presentations and posters, in the Book of Abstracts for the 11th EAPC World Research Congress, to be published by ‘Palliative Medicine’ – available online from 21 September until January 2021.

References

1. Dalal S, Bruera E. Pain Management for Patients With Advanced Cancer in the Opioid Epidemic Era. Am Soc Clin Oncol Educ Book. 2019 Jan; 39:24-35. doi: 10.1200/EDBK_100020. Epub 2019 May 17. Review. PMID: 31099619.  Free Article

2. Arthur J, Bruera E. Balancing opioid analgesia with the risk of nonmedical opioid use in patients with cancer.Nat Rev Clin Oncol. 2019 Apr; 16(4):213-226. doi: 10.1038/s41571-018-0143-7. Review. PMID:30514978

3. Yennurajalingam, S. et al. Predicting the risk for aberrant opioid use behavior in patients receiving outpatient supportive care consultation at a comprehensive cancer center. Cancer 124, 3942–3949 (2018).

4. Arthur, J. et al. Outcomes of a specialized interdisciplinary approach for patients with cancer with aberrant opioid-related behavior. Oncologist 23, 263–270 (2017).

Links

JOIN PALLIATIVE CARE SPECIALISTS FROM ACROSS THE WORLD AT #EAPC2020 –11thEAPC WORLD RESEARCH CONGRESS ONLINE 2020 – Interactive online sessions 7 to 9 October 2020 with on-demand content available from 21 September. Be a part of the first-ever EAPC World Research Congress Online. Learn and interact with leading researchers and chat with other registered delegates from the global palliative care community – all in the safety of your own home or office.

LATE-BREAKING ABSTRACTS… Share your experience of COVID-19 and the Palliative Care Response. More information and how to submit your abstract here. Deadline: 31 July 2020.

This entry was posted in 11th EAPC World Research Congress Online, EAPC World Research Congresses, RESEARCH and tagged . Bookmark the permalink.

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