Akhila Reddy, MD
Maxine de la Cruz, MD
Improper storage, use, and disposal of prescribed opioids can lead to diversion or accidental overdose. Given that opioids are the mainstay of cancer pain treatment, this issue is particularly germane in the oncology community. The ASCO Post recently spoke with Akhila Reddy, MD, and Maxine de la Cruz, MD, palliative care specialists at MD Anderson Cancer Center, who were lead authors on two studies examining patterns of opioid handling and disposal.
National Opioid Epidemic
What initiated your interest in opioid handling among cancer patients?
Dr. Reddy: A few years ago, Dr. de la Cruz and I were discussing the prescription opioid epidemic in the nation and a report that 70% of prescription opioid drug abusers obtain the medications from family or acquaintances. That report led us to keep a close eye on our patient population, and we found a number of our patients admitted they lost their pain medication or did indeed share it with a family member or friend. Or, they kept their opioid prescriptions out in open in their home.
Surveying Patients About Opioids
How did you pursue this issue?
Dr. Reddy: In 2014, Dr. de la Cruz and I did our first survey on cancer patient patterns of storage, utilization, and disposal of opioids. We surveyed 300 cancer outpatients receiving opioids in our supportive care center and collected information on opioid use, storage, and disposal. The questionnaire comprised 23 questions related to patients’ living circumstances and their handling of their prescriptions. The mean age was 56 years, 72% were white, and 63% were married. Lung cancer was the most common disease, and 89% had advanced cancer.
We found 19% of the patients surveyed kept their opioid medications out in the open, and 46% of patients kept unused opioids at home for extended periods.— Akhila Reddy, MD
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We found 19% of the patients surveyed kept their opioid medications out in the open, and 46% of patients kept unused opioids at home for extended periods. We also found 9% of patients shared their pain medications with family or friends, and 39% were unaware their opioid could result in a fatal overdose if used by others.
We repeated this study in emergency room patients in our hospital and found about 77% of the patients surveyed reported they either kept their pain medications out in the open, lost them, or kept unused medications for extended periods—often in easily available storage areas.
After these findings, we sat down and began to develop a comprehensive educational plan, which now is provided to every patient in our clinic who undergoes opioid pain management. Then Dr. de la Cruz repeated the survey in 2016.
Patient Education Improves Behavior
Please shed light on your follow-up survey.
Dr. de la Cruz: The second survey was in response to our first study in 2014. Standard practice in prescribing opioids has always included a brief discussion about usage and side effects but rarely about issues surrounding their storage and disposal. Also, pain management specialists often need to change medications or rotate dosages, and handling the buildup of unused medications is another issue that has historically been left out of the conversation.
The results of our work are encouraging. Patient education can improve patterns of behavior among opioid users if delivered in a clear and patient-friendly manner.— Maxine de la Cruz, MD
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When we did the second survey, the educational program we established after the first survey had already been running about 8 months. We compared those patients with our original cohorts that did not receive the education and pamphlet and saw an improvement in both the storage and disposal habits of opioids among the second group who had received the educational material.
It’s important to note it has been previously shown that educational material in the form of pamphlets or brochures is only useful if the patient is motivated to learn and know more. Personal contact with the clinical staff when the material is given can encourage patients to read the material they might otherwise have disregarded.
The results of our work are encouraging. Patient education can improve patterns of behavior among opioid users if delivered in a clear and patient-friendly manner. However, there is still a lot of work that needs to be done on the clinical and research fronts in addressing the problem of opioid abuse. ■
Dr. Reddy is Associate Professor, Department of Palliative Care and Rehabilitation Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston. Dr. de la Cruz is Associate Professor, Department of Palliative Care and Rehabilitation Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston.
DISCLOSURE: Drs. Reddy and de la Cruz reported no conflicts of interest.
