Experts agreed that it was appropriate for patients who use methamphetamine or cocaine to continue opioid use if clinician monitoring was increased and tapering was avoided.
Clinicians who treat cancer-related pain with opioids regularly encounter nonmedical stimulant use such as methamphetamine and cocaine; however, there are no guidelines in place or evidence-based research to help health care professionals navigate these situations. A recent study published in Cancer identified expert consensus on different methods of opioid management involving nonmedical stimulants for patients with advanced cancer and pain related to cancer.1,2
The study authors conducted 2 modified Delphi panels with a total of 120 palliative care and addiction experts: Panel A consisted of patients with shorter prognoses (weeks to months), and Panel B consisted of patients with longer prognoses (months to years). The experts reviewed, rated, and commented on each case using a 9-point Likert scale from 1 (very inappropriate) to 9 (very appropriate), explaining their responses. To determine the consensus and level of clinical appropriateness, the study authors had applied a 3-step analytical approach outlined in the RAND/UCLA.2
The experts agreed that regardless of prognosis, it was safe and appropriate for patients with advanced cancer who use methamphetamines or cocaine to continue opioid use while increasing clinician monitoring, without tapering off opioids. These management strategies prioritize pain control, allowing health care professionals more time to develop individualized harm-reduction approaches for patients. Buprenorphine/naloxone transition was inappropriate for a patient with a short prognosis and the appropriateness for patients with longer prognoses was undetermined.1,2
“The study findings provide consensus-based guidance for clinicians who treat cancer-related pain and encounter stimulant use, and include management strategies they can bring immediately to their practice,” said lead author Katie Fitzgerald Jones, PhD, of the VA Boston Healthcare System, in a press release. “The results highlight a need for integrated care models to address substance use during cancer and create a research agenda that prioritizes substance use disorder as an important comorbidity in people with cancer.”1
1. How should clinicians prescribe opioids for cancer-related pain in patients who use cocaine or methamphetamines? News release. September 11, 2023. Accessed September 12, 2023. https://www.eurekalert.org/news-releases/1000380
2. Jones KF, Khodyakov D, Han BH, et al. Expert consensus-based guidance on approaches to opioid management in individuals with advanced cancer-related pain and nonmedical stimulant use. Cancer. 2023. doi:10.1002/cncr.34921