For patients with cancer-related pain and nonmedical stimulant use, opioids should be continued, monitoring increased, and tapering avoided, according to a study published online Sept. 11 in Cancer.
Katie Fitzgerald Jones, Ph.D., from the VA Boston Healthcare System, and colleagues conducted two modified Delphi panels with palliative care and addiction experts to identify consensus on opioid management strategies for an individual with advanced cancer and cancer-related pain with nonmedical stimulant use. In panels A and B, the patient’s prognosis was weeks to months and months to years, respectively. A three-step analytical approach was applied to determine consensus and levels of clinical appropriateness for the management strategies.
For all management strategies, consensus was achieved. The researchers found that it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering for a patient with cancer-related and nonmedical stimulant use, regardless of prognosis. For a patient with a short prognosis, buprenorphine/naloxone transition was inappropriate, while the appropriateness was uncertain for a patient with a longer prognosis.