Guidance offered for managing pain in patients with cancer and OUD

Jessica S. Merlin, M.D., Ph.D., from the University of Pittsburgh, and colleagues developed a consensus statement on the appropriateness of strategies for managing cancer pain in individuals with co-occurring advanced cancer and OUD. A total of 120 experts in palliative care, addiction, or both participated in a three-round modified Delphi process.

The researchers deemed it appropriate to continue buprenorphine-naloxone with three times-daily dosing for patients with OUD taking buprenorphine-naloxone. For patients with a prognosis of weeks to months, continuing buprenorphine-naloxone and adding a full-agonist opioid was deemed to be appropriate; appropriateness was uncertain for those with a prognosis of months to years. It was deemed appropriate to take over prescribing for a patient with OUD taking methadone dispensed at a methadone clinic and to dose two or three times daily. For patients with a diagnosis of weeks to months, continuing methadone daily while adding another full-agonist opioid was deemed appropriate, while the appropriateness was uncertain for those with a prognosis of months to years.

“Merlin et al demonstrated the urgent need for more data to inform the experts. In addition to palliative care and addiction experts, oncologists, interventional pain, mental health, and nursing professionals need to join at the table to discuss best practices in supporting and treating vulnerable patients with cancer pain and OUD,” write the authors of an accompanying editorial.