Salimah H Meghani1, Jesse Wool2, Jessica Davis3, Katherine A Yeager4, Jun J Mao5, Frances K Barg6. 1. Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: meghanis@nursing.upenn.edu. 2. Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 3. School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 4. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. 5. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. 6. School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Family and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Abstract
CONTEXT: With concerns about opioid prescribing practices prominent in the professional and lay literature, there is less focus on patients' self-management of opioids for cancer pain and potential safety risks. OBJECTIVES: To investigate reports of opioid self-management practices and concerns among patients undergoing active cancer treatments-a group excluded from the scope of most policy initiatives on prescription opioids. METHODS: This sequential multimethod study used freelisting (n = 65) and open-ended semistructured interviews with a racially diverse subgroup (n = 32). Adult ambulatory patients with solid malignancies or multiple myeloma and pain (≥4 on a scale of 0-10) were recruited from an urban National Cancer Institute-designated cancer center in Philadelphia. Freelists were analyzed using consensus analysis and semistructured interview data were analyzed using thematic analysis. RESULTS: In freelisting, "pain relief" emerged as the primary term in relation to taking pain medications preceding "addiction" concerns. In interviews, patients described several heuristics and some potentially unsafe practices to minimize opioid use to a self-defined "normal." These included reducing opioid dose by cutting pills; self-tapering off opioids; using extended-release/long-acting opioids on an as-needed basis; mixing over-the-counter, nonopioid analgesics; and using illicit drugs to avoid "harder medicines" (opioids). Many patients preferred nonopioid treatments for pain but invariably faced access barriers. Some described assuming stewardship of their prescribed opioids and felt that oncology clinicians are quick to prescribe opioids without providing workable alternatives. CONCLUSIONS: Risks related to self-management of opioids among cancer outpatients, including potential overdose risks, need urgent attention. Interventions are needed for improving clinician-patient communication, patient education, safety, and access to effective nonopioid alternatives.
CONTEXT: With concerns about opioid prescribing practices prominent in the professional and lay literature, there is less focus on patients' self-management of opioids for cancer pain and potential safety risks. OBJECTIVES: To investigate reports of opioid self-management practices and concerns among patients undergoing active cancer treatments-a group excluded from the scope of most policy initiatives on prescription opioids. METHODS: This sequential multimethod study used freelisting (n = 65) and open-ended semistructured interviews with a racially diverse subgroup (n = 32). Adult ambulatory patients with solid malignancies or multiple myeloma and pain (≥4 on a scale of 0-10) were recruited from an urban National Cancer Institute-designated cancer center in Philadelphia. Freelists were analyzed using consensus analysis and semistructured interview data were analyzed using thematic analysis. RESULTS: In freelisting, "pain relief" emerged as the primary term in relation to taking pain medications preceding "addiction" concerns. In interviews, patients described several heuristics and some potentially unsafe practices to minimize opioid use to a self-defined "normal." These included reducing opioid dose by cutting pills; self-tapering off opioids; using extended-release/long-acting opioids on an as-needed basis; mixing over-the-counter, nonopioid analgesics; and using illicit drugs to avoid "harder medicines" (opioids). Many patients preferred nonopioid treatments for pain but invariably faced access barriers. Some described assuming stewardship of their prescribed opioids and felt that oncology clinicians are quick to prescribe opioids without providing workable alternatives. CONCLUSIONS: Risks related to self-management of opioids among cancer outpatients, including potential overdose risks, need urgent attention. Interventions are needed for improving clinician-patient communication, patient education, safety, and access to effective nonopioid alternatives.
Authors: William E Rosa; Barbara Riegel; Connie M Ulrich; Jesse Chittams; Ryan Quinn; Salimah H Meghani Journal: Oncol Nurs Forum Date: 2021-01-04 Impact factor: 2.172
Authors: Katie Fitzgerald Jones; Esther Laury; Justin J Sanders; Lauren T Starr; William E Rosa; Staja Q Booker; Melissa Wachterman; Christopher A Jones; Susan Hickman; Jessica S Merlin; Salimah H Meghani Journal: J Palliat Med Date: 2021-11-16 Impact factor: 2.947
Authors: Elise C Tarbi; Robert Gramling; Christine Bradway; Elizabeth G Broden; Salimah H Meghani Journal: J Palliat Med Date: 2021-02-02 Impact factor: 2.947
Authors: Pete Wegier; Jaymie Varenbut; Mark Bernstein; Peter G Lawlor; Sarina R Isenberg Journal: BMC Palliat Care Date: 2020-11-29 Impact factor: 3.234