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Comparison of opioid prescribing among cancer and non-cancer patients aged 18-64: analysis using administrative data

Barbera L, Sutradhar R, Chu A, Seow H, Howell D, Earle CC, O'Brien MA, Dudgeon D, Atzema C, Husain A, Liu Y, DeAngelis C. J Pain Symptom Manage. 2018; 56(1):72-9. Epub 2018 Mar 14.

Background — Opioid prescribing has been increasingly scrutinized among non-cancer patients. As an unintended consequence, opioids may be under-prescribed for cancer patients. The purpose of this study was to compare trends in opioid prescribing in younger adults with and without cancer.

Methods — From 2004 to 2013, Ontario residents 18-64 years eligible for government paid pharmacare were annually stratified into 3 groups: no cancer history, cancer diagnosis >5 years ago and cancer diagnosis ≤5 years ago. We evaluated time trends in 2 annual outcomes: (1) opioid prescription rate and (2) mean daily opioid dose.

Results — In 2013, 800,371 individuals were eligible for this study (3% with recent cancer, 2% with remote cancer). Across all years, compared to non-cancer patients, overall opioid prescription rates were 43% and 26% higher for those with recent and remote cancer, respectively. Overall, a 1% relative annual increase was seen in those without cancer and a 1% decrease was seen in those with a recent cancer. Changes in prescription rates varied with drug class and cancer group. Notably, long acting opioids had a relative annual increase of 7% in non-cancer patients versus 2% in recent cancer patients. Immediate release combination agents had a relative annual decrease of 2% for all cancer groups. Trends in mean daily dose were similar between groups, but by 2013, they were lowest in recent cancer patients, regardless of drug class.

Interpretation — Secular trends in opioid prescribing affect cancer and non-cancer patients similarly. Further research is required to assess the potential impact on symptom management.