Cancer pain self-management in the context of a national opioid epidemic: Experiences of patients with advanced cancer using opioids

Background: The U.S. opioid epidemic has prompted dramatic changes in public attitudes and regulations governing opioid prescribing. Little is known about advanced cancer patients’ experiences using opioids in the context of the epidemic.
Methods: We conducted semi-structured interviews with patients with advanced cancer and evaluated their experiences self-managing chronic pain with opioids. Two authors coded the interview transcripts; the larger team used thematic and framework analytic methods for qualitative analysis.
Results: We interviewed 26 patients between May 2019-April 2020. Patients consistently described the negative impact of the opioid epidemic on their ability to self-manage pain.
Negative media coverage and personal experiences with the epidemic promoted stigma, fear, and guilt surrounding opioid use. As a result, many patients delayed initiating opioids and often viewed their decision to take opioids as a moral failure, describing this as “caving in.” Patients frequently managed this internal conflict through opioid-restricting behaviors (e.g. skipping or taking lower doses). Stigma also impeded patient-clinician communication; patients often avoided discussing opioids, or purposely conveyed underusing them to avoid being labeled a “pill seeker.” Patients experienced structural barriers to obtaining opioids such as prior authorizations, delays in refills, or being questioned by pharmacists about their opioid-use. Barriers were stressful, amplified stigma, interfered with pain control, and reinforced ambivalence about opioids.
Conclusion: The U.S. opioid epidemic has stigmatized opioid use and undermined pain
management in individuals with advanced cancer. Interventions seeking to alleviate cancer pain should attend to the multiple, negative influences of the opioid crisis on patients’ ability to selfmanage.