Compassion Inequities and Opioid Use Disorder: A Matched Case-Control Analysis Examining Inpatient Management of Cancer-Related Pain for Patients With Opioid Use Disorder

Sarah A. Singh, Rachel A. Moreland, Wei Fang, Parvez Shaikh, John Michael Perez, Ann M. Morris, Basem Dahshan, Rebecca F. Krc, Dilip Chandran, Monika Holbein

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Context: The opioid epidemic spurred guidelines intended to reduce inappropriate prescribing. Although acute cancer-related pain was excluded from these recommendations, studies demonstrate reduced opioid prescribing for patients hospitalized with advanced cancer. Objectives: We performed a matched case-control analysis to determine how a history of opioid use disorder (OUD) affects inpatient management of cancer pain. Methods: Charts of patients with OUD admitted for cancer pain from 2015-2020 were retrospectively reviewed. Hospitalizations were matched 1:1 by patient age and sex. Home milligram-morphine equivalent per day (MME/day) was calculated from the home medication list. Admission MME/day was the average MME/day administered during hospitalization. Results: A total of 80 hospitalizations (40:40) were matched for 25 patients with a history of OUD and 31 patients with no history of OUD. Cancer was metastatic/relapsed for 70% of admissions. The median overall survival was 2.3 months (95% CI 0-5.21, P = 0.13). Patients with OUD had a significantly lower change from Home to Admission MME/day (-3 vs. 37, P < 0.01) and were less likely to have any increase in Admission MME/day (OR 0.1, 95% CI 0.02-0.43, P < 0.01). When considering opioids administered after pain specialty consultation, there was no difference between groups. Conclusion: Our results suggest that patients with OUD receive lower quality inpatient management of cancer-related pain. Provider education and early involvement of pain specialists are crucial in delivering equitable and compassionate end-of-life care for patients with OUD.

Original languageEnglish (US)
Pages (from-to)e156-e163
JournalJournal of Pain and Symptom Management
Volume62
Issue number3
DOIs
StatePublished - Sep 2021

All Science Journal Classification (ASJC) codes

  • General Nursing
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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