Conceptual model identifies factors to mitigate risk for opioid misuse during cancer care

Amongst most cancers sufferers, psychological misery and accessibility of opioids typically result in chemical coping, a center floor between dependancy and correct adherence to a medicine routine. Chemical coping can diminish high quality of life and intervene with ache and symptom administration, in addition to predispose people to growing substance use dysfunction. The findings are reported within the Harvard Evaluation of Psychiatry (HRP).

Miryam Yusufov, Ph.D., a psychologist within the Division of Psychosocial Oncology and Palliative Care on the Dana-Farber Most cancers Institute, a Harvard Medical Faculty instructing hospital in Boston, and colleagues have developed the primary conceptual mannequin that integrates the risk factors that provoke and preserve chemical dealing with opioids throughout most cancers care. “This mannequin will assist care groups triage elements that require monitoring and potential danger mitigation . . . in addition to those who require behavioral intervention,” the analysis group notes.

Predisposing danger elements recognized in 4 overlapping domains

Based mostly on a search of medical literature in PubMed and MEDLINE, the group discovered that danger elements and remedy targets for chemical coping in most cancers may be organized based on whether or not they’re historic or present and whether or not they’re malleable (amenable to intervention) or unmalleable. The researchers describe the evidence base for every danger issue, a few of which fall into a number of domains:

• Historic and malleable elements: Melancholy, nervousness, posttraumatic stress disorderand different psychological diagnoses; intolerance of misery
• Present and malleable elements: Power ache, psychological diagnoses, deficit in coping abilities, opioid availability
• Historic and unmalleable elements: Household historical past of substance use disordertogether with alcohol use dysfunction; private historical past of substance use dysfunction; historical past of sexual victimization; childhood abuse
• Present and unmalleable issue: Age 16 to 45

“Subsequently, sufferers with no misuse behaviors are nonetheless in danger for chemical coping primarily based on these preexisting danger elements and long-term opioid remedy,” the authors say.

Implications for scientific follow: Common screening, affected person schooling, and psychological well being care

Dr. Yusufov and her colleagues advocate screening all sufferers for danger of chemical coping earlier than initiating opioid remedy. They level out that “it’s much less stigmatizing to handle chemical coping danger than lively misuse of opioids.” For instance, the Opioid Danger Device (ORT) addresses household and/or private historical past of substance use, historical past of sexual abuse/violence, and psychological issues.

Given the current upward pattern in opioid-related hospitalizations amongst sufferers with most cancers, the authors counsel clinicians might mitigate overdoses and deaths with affected person schooling on naloxone and medicine return insurance policies upon remedy completion or routine modifications.

Lastly, the proposed mannequin can support in choosing parts for behavioral interventions and assist clinicians decide when to refer sufferers to psychosocial assist assets. This method can maximize cost-effectiveness whereas minimizing danger.

“For instance, if a affected person presents with predominantly malleable elements, they might be an applicable candidate for psychosocial assist,” Dr. Yusufov’s group says. “If a affected person presents with predominantly unmalleable elements, nevertheless, they might be a extra applicable candidate for continued monitoring all through opioid remedy.”