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


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.



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.

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