Changes in Opioid Prescription for Cancer Patients Referred to Outpatient Palliative Care

Key Points

  • Among cancer patients seen at MD Anderson Cancer Center’s outpatient palliative care clinic, the median morphine equivalent daily dose of opioids decreased significantly between 2010 and 2015.
  • Use of hydrocodone decreased after its reclassification as a schedule II opioid, whereas the use of the schedule IV agent tramadol increased.

In a study reported in the Journal of Oncology Practice, Haider et al found that the median morphine equivalent daily dose decreased significantly among cancer patients seen at MD Anderson Cancer Center’s outpatient palliative care clinic between 2010 and 2015. Use of hydrocodone decreased after its reclassification as a schedule II opioid and use of tramadol increased.

Study Details

The study involved data from electronic health records of 750 patients who were new consultations at MD Anderson Cancer Center’s outpatient palliative care clinic between January 1 and April 30 each year from 2010 through 2015. Patients had a median age of 59 years, 51% were female, 70% were white, and 87% had advanced cancer.

Change in Opioid Prescription

In 2010, the median morphine equivalent daily dose before referral was 78 mg/d; it decreased to 66, 60, 50, 50, and 40 mg/d in 2011, 2012, 2013, 2014, and 2015 (P = .001), respectively.

Hydrocodone was the most common opioid prescribed between 2010 and 2015; it was followed by oxycodone and transdermal fentanyl, use of both of which declined in more recent years. When hydrocodone was a nonschedule II opioid, it was used in 31% to 35% of patients in 2010 through 2013, with its use increasing to 43% in 2014, when it was reclassified as a schedule II opioid; in 2015, its use declined to 33%. Use of tramadol when it was a nonscheduled opioid in 2010 through 2014 ranged from 0% to 11% of patients; its use in 2015, when it was a schedule IV opioid, increased to 19% (P < .001).

The investigators concluded: “During the past several years, the [morphine equivalent daily dose] prescribed by referring oncologists has decreased. After hydrocodone reclassification, the use of tramadol with less stringent prescription limits has increased.”

Eduardo Bruera, MD, of the Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, is the corresponding author of the Journal of Oncology Practice article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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