CANCER PAIN SELF-MANAGEMENT IN THE CONTEXT OF A NATIONAL OPIOID EPIDEMIC: EXPERIENCES OF PATIENTS WITH ADVANCED CANCER

Desiree R. Azizoddin* (Corresponding Author), Rober Knoerl, Rosalind Adam, Daniela Kessler, Andrea C. Enzinger, James A. Tulsky

*Corresponding author for this work

Research output: Contribution to journalAbstractpeer-review

Abstract

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 opioid analgesics in the context of the epidemic.
Methods: We conducted semi-structured interviews with patients with advanced incurable malignancies from a large academic cancer center regarding
their experiences self-managing chronic pain with opioids. Thematic and Framework analysis were used to identify themes. Two investigators doublecoded all interview transcripts and analyzed themes with the larger research team.
Results: We interviewed 26 patients between May 2019-April 2020. The dominant theme across all interviews was the negative impact of the opioid epidemic on patients’ ability to self-manage pain. The epidemic, related media coverage, and personal experiences promoted stigma, fear, and guilt surrounding opioid use. As a result, patients often delayed initiating opioids until they were in a pain crisis, or even admitted to the hospital for pain.
Many patients specifically avoided using long-acting opioids, which were perceived as particularly dangerous or addictive. While most patients acknowledged their need for opioids in the content of cancer, many still viewed their decision to take opioids as a moral failure, or “caving in.” Most patients frequently expressed their ambivalence about using opioids. Many described managing their internal conflict through opioid-restricting behaviors such as skipping or taking lower doses than prescribed. Stigma also negatively affected patient-clinician communication. Patients avoided asking questions about opioid pain medications and their addiction concerns in an effort to “fly under the radar.” Several patients described purposely underusing their opioids and communicating this underuse to providers so as not to be labeled a “pill seeker.” Patients also experienced many structural barriers to obtaining opioids such as requests for prior authorizations, delays in receiving refills, or being questions by pharmacists about the legitimacy of their opioid needs. These barriers were stressful, reinforced stigma, and amplified patients’ fears and inner conflict about using opioids.
Conclusion: The opioid epidemic and stigma associated with opioid use have a negative influence on advanced cancer patients’ efforts to self-manage pain. Future interventions should target patients’ tainted experiences of opioids while addressing clinicians’ barriers to managing cancer pain within the context of the U.S. opioid crisis.
Original languageEnglish
Pages (from-to)S90-S90
Number of pages1
JournalAnnals of Behavioral Medicine
Volume55
Issue numberS1
DOIs
Publication statusPublished - 12 Apr 2021

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