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    Original Investigation
    Substance Use and Addiction
    August 17, 2020

    National Patterns in Prescription Opioid Use and Misuse Among Cancer Survivors in the United States

    Author Affiliations
    • 1Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
    • 2Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, Pennsylvania
    • 3Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
    JAMA Netw Open. 2020;3(8):e2013605. doi:10.1001/jamanetworkopen.2020.13605
    Key Points español 中文 (chinese)

    Question  How do patterns in prescription opioid use and misuse among cancer survivors compare with those among populations without cancer?

    Findings  In this cross-sectional study of 169 162 adult respondents, cancer survivors with an incidence of cancer or cancer treatment in the past year had a nearly 2-fold higher likelihood of prescription opioid use compared with respondents without cancer; prescription opioid use decreased among long-term cancer survivors but remained higher compared with the cohort without cancer. Prescription opioid misuse was similar among cancer survivors compared with respondents without cancer.

    Meaning  In this study, cancer survivors reported higher rates of prescription opioid use compared with respondents without cancer, but this finding may not translate to increased opioid misuse at a given time.

    Abstract

    Importance  Prescription opioids are frequently prescribed to treat cancer-related pain. However, limited information exists regarding rates of prescription opioid use and misuse in populations with cancer.

    Objectives  To estimate the prevalence and likelihood of prescription opioid use and misuse in adult cancer survivors compared with respondents without cancer and to identify characteristics associated with prescription opioid use and misuse in adult cancer survivors.

    Design, Setting, and Participants  This cross-sectional study is a retrospective, population-based study using data from 169 162 respondents to the National Survey on Drug Use and Health from January 2015 to December 2018. Survey data sets were queried for all respondents aged 18 years or older. Those with a reported history of cancer were termed cancer survivors and further divided into more recent (had cancer within 12 months of survey) and less recent (had cancer more than 12 months prior to survey) cohorts. Respondents with nonmelanoma skin cancer were excluded.

    Main Outcomes and Measures  Prescription opioid use and misuse within the past 12 months.

    Results  Among 169 162 respondents, 5139 (5.2%) were cancer survivors, with 1243 (1.2%) and 3896 (4.0%) reporting having more recent and less recent cancer histories, respectively. Higher rates of prescription opioid use were observed among more recent cancer survivors (54.3%; 95% CI, 50.2%-58.4%; odds ratio [OR], 1.86; 95% CI, 1.57-2.20; P < .001) and less recent cancer survivors (39.2%; 95% CI, 37.3%-41.2%; OR, 1.18; 95% CI, 1.08-1.28; P < .001) compared with respondents without cancer (30.5%, reference group). Rates of prescription opioid misuse were similar among more recent (3.5%; 95% CI, 2.4%-5.2%; OR, 1.27; 95% CI, 0.82-1.96; P = .36) and less recent (3.0%; 95% CI, 2.4%-3.6%; OR, 1.03; 95% CI, 0.83-1.28; P = .76) survivors compared with respondents without cancer (4.3%, reference group). Younger age (aged 18-34 years vs ≥65 years: OR, 7.06; 95% CI, 3.03-16.41; P < .001), alcohol use disorder (OR, 3.22; 95% CI, 1.45-7.14; P = .005), and nonopioid drug use disorder (OR, 14.76; 95% CI, 7.40-29.44; P < .001) were associated with prescription opioid misuse among cancer survivors.

    Conclusions and Relevance  In this study, prescription opioid use was higher among more and less recent cancer survivors compared with the population without a history of cancer. Rates of prescription opioid misuse were low and similar among all 3 cohorts. These findings suggest that higher prescription opioid use among cancer survivors may not correspond to increased short-term or long-term misuse.

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