Grant: Project Grant

The opioid crisis is a major public health problem. With the recent increase in overdose-related deaths from prescription opioids in the general population, the potential dangers of these medications are further underscored. In 2017, over 10 million adults in the United States reported misusing prescription opioids and close to 2 million met the diagnostic criteria for an opioid use disorder. Patients with cancer represent a particularly vulnerable population that may be at high risk for chronic opioid use because of distress from their illness, multiple invasive procedures, pain from their underlying cancer or treatment, and poor coordination in prescribing due to the large number of healthcare providers involved in their care. Patients with no prior opioid use are at risk of becoming chronic opioid users, and chronic opioid users are at risk of misusing opioids, both of which can result in substantial morbidity and mortality. Little is known about the patterns of chronic opioid use in the cancer setting. There is also a lack of information on the experiences and attitudes of patients and prescribers about the risks of opioids. Policies have been proposed to guide safer prescribing of opioids to cancer patients, but little evidence is available to support the implementation of these policies. Our aim is to better understand the risk of chronic opioid use in the cancer population, its associated outcomes, physicians' decision-making process when prescribing, and specific patient factors. We will conduct a retrospective cohort study of non-metastatic cancer patients undergoing cancer therapy in Alberta. We aim to describe the burden of chronic opioid use, identify patients who are at high risk of chronic opioid use, and estimate the effects of preventing chronic opioid use on hospitalizations and survival. We will also explore prescribers' and patients' views and experiences with opioids. This information can be used to inform safer opioid prescribing practices.