Compliance with Opioid Therapy: Distinguishing Clinical Characteristics and Demographics Among Patients with Cancer Pain

• Published in: Pain medicine (Malden, Mass.) Mass.), 2018-07, Vol.19 (7), p.1469-1477
• Main Authors: Koyyalagunta, Dhanalakshmi, Bruera, Eduardo, Engle, Mitchell P, Driver, Larry, Dong, Wenli, Demaree, Chris, Novy, Diane M
• Format: Article
• Language: English
• Subjects: Adult; Age; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Analgesics, Opioid - urine; Anxiety; Cancer; CANCER PAIN & PALLIATIVE CARE SECTION; Cancer Pain - drug therapy; Cancer Pain - urine; Cohort Studies; Demographics; Demography; Drug use; Editor's Choice; Ethanol; Female; Follow-Up Studies; Humans; Male; Medication Adherence; Middle Aged; Morphine; Narcotics; Opioids; Pain; Pain Clinics - standards; Pain management; Pain Management - methods; Pain Management - standards; Patient compliance; Patients; Prescriptions; Quantitative analysis; Retrospective Studies; Self Report; Smoking; Statistical analysis; Substance Abuse Detection - methods; Substance Abuse Detection - standards; Urine
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnx178

Abstract Background Because an increase of patients who misuse opioids has been identified in our cancer clinical setting through urine drug testing (UDT) and the Screener and Opioid Assessment for Patient’s with Pain–Short Form (SOAPP-SF), we conducted this retrospective cohort study to identify patient characteristics that are associated with UDT that indicates noncompliance. Methods Over a two-year period, 167 of 8,727 patients (2.4%) seen in the pain clinic and who underwent UDT were evaluated to determine compliance with prescribed opioid regimens. Descriptive clinical and demographic data were collected, and group differences based on compliance with opioid therapy were evaluated. Results Fifty-eight percent of the patients were noncompliant with their prescribed opioid therapy. Noncompliant patients were younger than compliant patients, with a median age of 46 vs 49 years (P = 0.0408). Noncompliant patients were more likely to have higher morphine equivalent daily doses; however, the difference was not statistically significant. Patients with a history of alcohol (ETOH) (P = 0.0332), illicit drug use (P = 0.1014), and smoking (P = 0.4184) were more likely noncompliant. Univariate regression analysis showed that a history of ETOH use (P = 0.034), a history of anxiety (P = 0.027), younger age (P = 0.07), and a SOAPP-SF score of 4 or higher (P = 0.05) were associated with an abnormal UDT. Conclusions History of ETOH use, anxiety, high SOAPP-SF score, and younger age were associated with UDT that indicates noncompliance. Given the very small percentage of UDT testing, it is quite likely that a significant number of patients who did not undergo UDT were also nonadherent with treatment recommendations.