How Patients With Advanced Cancer Experience Opioid Stigma

New research sheds light on how stigma surrounding prescription opioids manifests in patients with advanced cancer and highlights the coping strategies patients use to alleviate their unease.

In interviews with patients with advanced cancer and members of their support system, three major themes emerged: direct experiences with opioid stigma and discrimination in healthcare settings; anticipated stigma; and guilt surrounding opioid use as well as opioid-restricting behaviors.

Overall, “opioid stigma and its sequelae, including undermanaged pain, has the potential undermine the health and well-being of patients with cancer,” lead author Hailey W. Bulls, PhD, with University of Pittsburgh, Pennsylvania, and colleagues write.

The report was published online July 25 in JCO Oncology Practice.

Opioids are often prescribed to treat cancer pain but efforts to curb the opioid epidemic can lead to negative attitudes surrounding these drugs and complicate efforts to provide effective cancer pain management.

Taking a deeper dive into opioid stigma, the researchers interviewed 20 patients with advanced cancer as well as 11 family members and close friends.

One theme the authors uncovered involved patients’ direct experiences with stigma and discrimination. Overall, patients felt comfortable talking with their oncologist about using opioids for pain management but some reported stigmatizing experiences in other healthcare settings, such as in the pain clinic or pharmacy. In these situations, patients often felt they were being treated like a drug user, and some decided to change care providers, switch pharmacies, or send a family member to pick up their prescription.

Another theme to emerge involved anticipated stigma, with participants expressing concern about stigma occurring in the future, even if they had not directly experienced it. These patients often were concerned about their clinician’s views of them and didn’t want to be seen as seeking more drugs, the authors report.

Outside of healthcare settings, participants generally felt they had strong support from family and loved ones to take prescription opioids to combat advanced cancer pain. However, the authors found that some worried this support would shift in the future, especially if they continued to need opioids for an extended period.

And finally, some patients displayed opioid-restricting attitudes and behaviors that might reflect internalized stigma and a fear of addiction. Despite the common perception that using prescription opioids is appropriate for cancer pain, several patients wanted to take less or attempted to minimize their medication use. Others felt they should be able to just quit.

Participants also indicated that the stigma around opioids made them feel guilty about taking opioids, especially when filling prescriptions at the pharmacy.

The authors noted several limitations to the study, including the fact that there was little racial and ethnic diversity among participants who were largely non-Hispanic white individuals residing in urban areas.

Still, the interviews can improve awareness of opioid stigma and help ensure patients with advanced cancer receive appropriate care for their pain, the researchers note.

The potential consequences of poor pain management include suboptimal prescription opioid behaviors and pain management, social isolation, emotional distress, and reduced quality of life.

“Given these wide-ranging consequences, it is important to develop strategies to mitigate opioid stigma in patients with cancer pain,” they add.

This research was supported by a grant from the Hillman Development Fund and the Palliative Research Center (PaRC) at the University of Pittsburgh. A complete list of author disclosures is available with the original article.

JCO Oncol Prac. Published online July 25, 2022. Abstract

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