Compassion Inequities and Opioid Use Disorder: A Matched Case-Control Analysis Examining Inpatient Management of Cancer-Related Pain for Patients With Opioid Use Disorder

Sarah A. Singh; Rachel A. Moreland; Wei Fang; Parvez Shaikh; John Michael Perez; Ann M. Morris; Basem Dahshan; Rebecca F. Krc; Dilip Chandran; Monika Holbein

doi:10.1016/j.jpainsymman.2021.05.002

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Compassion Inequities and Opioid Use Disorder: A Matched Case-Control Analysis Examining Inpatient Management of Cancer-Related Pain for Patients With Opioid Use Disorder

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Compassion Inequities and Opioid Use Disorder: A Matched Case-Control Analysis Examining Inpatient Management of Cancer-Related Pain for Patients With Opioid Use Disorder

Sarah A. Singh, Rachel A. Moreland, Wei Fang, Parvez Shaikh, John Michael Perez, Ann M. Morris, Basem Dahshan, Rebecca F. Krc, Dilip Chandran and Monika Holbein

Journal of pain and symptom management, Vol.62(3), pp.e156-e163

09/01/2021

DOI: 10.1016/j.jpainsymman.2021.05.002

PMCID: PMC8416788

PMID: 33984461

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Abstract

The opioid epidemic spurred guidelines intended to reduce inappropriate prescribing. Although acute cancer-related pain was excluded from these recommendations, studies demonstrate reduced opioid prescribing for patients hospitalized with advanced cancer. We performed a matched case-control analysis to determine how a history of opioid use disorder (OUD) affects inpatient management of cancer pain. Charts of patients with OUD admitted for cancer pain from 2015-2020 were retrospectively reviewed. Hospitalizations were matched 1:1 by patient age and sex. Home milligram-morphine equivalent per day (MME/day) was calculated from the home medication list. Admission MME/day was the average MME/day administered during hospitalization. A total of 80 hospitalizations (40:40) were matched for 25 patients with a history of OUD and 31 patients with no history of OUD. Cancer was metastatic/relapsed for 70% of admissions. The median overall survival was 2.3 months (95% CI 0-5.21, P = 0.13). Patients with OUD had a significantly lower change from Home to Admission MME/day (-3 vs. 37, P < 0.01) and were less likely to have any increase in Admission MME/day (OR 0.1, 95% CI 0.02-0.43, P < 0.01). When considering opioids administered after pain specialty consultation, there was no difference between groups. Our results suggest that patients with OUD receive lower quality inpatient management of cancer-related pain. Provider education and early involvement of pain specialists are crucial in delivering equitable and compassionate end-of-life care for patients with OUD.

health disparities

Opioid use disorder

palliative care

Details

Title: Subtitle: Compassion Inequities and Opioid Use Disorder: A Matched Case-Control Analysis Examining Inpatient Management of Cancer-Related Pain for Patients With Opioid Use Disorder
Creators: Sarah A. Singh - West Virginia University
Rachel A. Moreland - West Virginia University
Wei Fang - West Virginia University
Parvez Shaikh - West Virginia University
John Michael Perez - West Virginia University
Ann M. Morris - West Virginia University
Basem Dahshan - West Virginia University
Rebecca F. Krc - West Virginia University
Dilip Chandran - West Virginia University
Monika Holbein - West Virginia University
Resource Type: Journal article
Publication Details: Journal of pain and symptom management, Vol.62(3), pp.e156-e163
DOI: 10.1016/j.jpainsymman.2021.05.002
PMID: 33984461
PMCID: PMC8416788
NLM abbreviation: J Pain Symptom Manage
ISSN: 0885-3924
eISSN: 1873-6513
Publisher: Elsevier Inc
Language: English
Date published: 09/01/2021
Academic Unit: Psychiatry
Record Identifier: 9984949237602771

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