Paul D Tan1,2, Joshua S Barclay1, Leslie J Blackhall1. 1. 1 Department of Medicine, Division of General Medicine, Geriatrics, and Palliative Care, University of Virginia , Charlottesville, Virginia. 2. 2 Department of Medicine, Eastern Maine Medical Center , Veazie, Maine.
Abstract
BACKGROUND: Opioids are the mainstay of treatment of cancer pain. With increased use there have been concerns about rising rates of prescription drug abuse and diversion. Although there has been an increase in research and practice guidelines about the scope of the problem for chronic, nonmalignant pain, less information is available about both the frequency of the problem and current practices regarding screening for substance abuse and diversion in patients and family members seen in palliative care clinics. OBJECTIVE: The aim of this study was to evaluate the degree to which palliative programs felt that substance abuse and diversion was an issue, and to identify practices regarding care of patients with potential substance misuse issues. METHODS: We sent a survey regarding substance abuse perception, policies, training, and screening to 94 accredited palliative medicine fellowship program directors as obtained by the Accreditation Council for Graduate Medical Education (ACGME) directory. RESULTS: We received usable responses from 38 (40.4%) programs. Policies for screening patients (40.5%) or family members (16.2%), dealing with diversion (27%), and use of a screening tool (32.4%) were reported infrequently. Despite this, one-half of respondents indicated that substance abuse and diversion was an issue for their clinics, with only 25% indicating substance abuse was not an issue. Additionally, the majority of fellows (83%) and about half (47%) of staff received mandatory training for dealing with substance misuse. All programs provided some screening of patients, with 48.7% screening all patients for abuse. Screening of family members was relatively rare, as was routine use of the urine drug screen (UDS). CONCLUSION: Despite increased concerns about substance abuse, the majority of programs did not have substance abuse and diversion policies or report screening all patients, with screening of caregivers rarely reported. Consensus guidelines addressing substance abuse and diversion for palliative patients are needed to address this growing problem.
BACKGROUND: Opioids are the mainstay of treatment of cancer pain. With increased use there have been concerns about rising rates of prescription drug abuse and diversion. Although there has been an increase in research and practice guidelines about the scope of the problem for chronic, nonmalignant pain, less information is available about both the frequency of the problem and current practices regarding screening for substance abuse and diversion in patients and family members seen in palliative care clinics. OBJECTIVE: The aim of this study was to evaluate the degree to which palliative programs felt that substance abuse and diversion was an issue, and to identify practices regarding care of patients with potential substance misuse issues. METHODS: We sent a survey regarding substance abuse perception, policies, training, and screening to 94 accredited palliative medicine fellowship program directors as obtained by the Accreditation Council for Graduate Medical Education (ACGME) directory. RESULTS: We received usable responses from 38 (40.4%) programs. Policies for screening patients (40.5%) or family members (16.2%), dealing with diversion (27%), and use of a screening tool (32.4%) were reported infrequently. Despite this, one-half of respondents indicated that substance abuse and diversion was an issue for their clinics, with only 25% indicating substance abuse was not an issue. Additionally, the majority of fellows (83%) and about half (47%) of staff received mandatory training for dealing with substance misuse. All programs provided some screening of patients, with 48.7% screening all patients for abuse. Screening of family members was relatively rare, as was routine use of the urine drug screen (UDS). CONCLUSION: Despite increased concerns about substance abuse, the majority of programs did not have substance abuse and diversion policies or report screening all patients, with screening of caregivers rarely reported. Consensus guidelines addressing substance abuse and diversion for palliative patients are needed to address this growing problem.
Authors: Jay Soong-Jin Lee; Hsou Mei Hu; Anthony L Edelman; Chad M Brummett; Michael J Englesbe; Jennifer F Waljee; Jeffrey B Smerage; Jennifer J Griggs; Hari Nathan; Jacqueline S Jeruss; Lesly A Dossett Journal: J Clin Oncol Date: 2017-10-19 Impact factor: 44.544
Authors: Sherri Rauenzahn; Adam Sima; Brian Cassel; Danielle Noreika; Teny Henry Gomez; Lynn Ryan; Carl E Wolf; Luke Legakis; Egidio Del Fabbro Journal: Support Care Cancer Date: 2017-01-25 Impact factor: 3.603
Authors: Dhanalakshmi Koyyalagunta; Eduardo Bruera; Mitchell P Engle; Larry Driver; Wenli Dong; Chris Demaree; Diane M Novy Journal: Pain Med Date: 2018-07-01 Impact factor: 3.750
Authors: Anne Ebenau; Boukje Dijkstra; Marianne Stal-Klapwijk; Chantal Ter Huurne; Ans Blom; Kris Vissers; Marieke Groot Journal: BMC Palliat Care Date: 2018-08-03 Impact factor: 3.234