Symposia
Addictive Behaviors
Miryam Yusufov, Ph.D.
Clinical Psychologist
Dana-Farber Cancer Institute
Boston, Massachusetts
Miryam Yusufov, Ph.D.
Clinical Psychologist
Dana-Farber Cancer Institute
Boston, Massachusetts
Kathryn I. Pollak, PhD
Professor
Duke Cancer Institute
Durham, North Carolina
Hanneke Poort, PhD
Affiliate Faculty
Dana-Farber Cancer Institute
Boston, Massachusetts
Yvan Beaussant, MD
Instructor in Medicine
Dana-Farber Cancer Institute
Boston, Massachusetts
Elise Tarbi, PhD
Postdoctoral Research Fellow
Dana-Farber Cancer Institute
Boston, Massachusetts
Richard E. Leiter, MD, MA
Palliative Care Physician and Researcher
Dana-Farber Cancer Institute
Boston, Massachusetts
James A. Tulsky, MD
Chair, Department of Psychosocial Oncology and Palliative Care
Dana-Farber Cancer Institute
Boston, Massachusetts
Background: Between 60% and 90% of patients with cancer receive opioid therapy for pain management. This high prescription rate occurs in the context of a widely known opioid epidemic. However, few studies describe substance use disorder risk in oncology, even though access to opioids increases substance use disorder risk by up to four times. Prior studies suggest a wide spectrum of opioid use behaviors, ranging from not taking prescription opioids to abusing them.
Methods: As part of a randomized clinical trial of oncology communication, five coders identified substance use-related content across 826 audio-recorded oncology clinician-patient encounters. The operational definition of “substance use content” was “mention of opioids or substance use related concerns during the clinician-patient encounter”.
Results: Of the 826 encounters, 147 (18%) contained content related to controlled substances. Content included general discussions of opioid efficacy and refill requests (n=116), inadequate pain management (n=12), concerns about addiction or the stigma of being on opioids (n=11), discussions about opioid safety, including taking opioids with alcohol or driving (n=6), and seeking early refills (n=2). Example clinician responses to concerns about addiction included: it not being possible to become addicted because the opioids were for “real pain” and it not being a concern in older age. However, clinicians also responded with boundary-setting related to requests for early refills and higher doses.
Conclusions: Despite routine prescribing of opioid medications in cancer care, there are insufficient conversations related to opioids during clinician-patient encounters. Further, oncology clinicians appear to inadequately respond to concerns about addiction. These data suggest the need for behavioral interventions that target substance use disorder risk in cancer care, as well as interventions for prescribing clinicians. Implications for clinicians and researchers will be discussed.