New data on opioid use disorder and risk of overdose in adolescent and young adult disease-free survivors prescribed opioids after cancer treatment.

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Published in final edited form as: Cancer. 2025 Jun 1;131(11):e35916. doi: 10.1002/cncr.35916 New data on OUD and risk of OD in AYA disease-free survivors prescribed opioids after cancer treatment Natalie Moryl 1, * , Jasmine Tomita-Barber 2 Author information Copyright and License information 1 Memorial Sloan Kettering Cancer Center, New York City, New York 2 Memorial Sloan Kettering Cancer Center, New York City, New York * Corresponding Author: moryln@mskcc.org PMC Copyright notice PMCID: PMC13043203  NIHMSID: NIHMS2090380  PMID: 40407147 The publisher's version of this article is available at Cancer Abstract The study by Chao et al. examines the prevalence of long term and high dose opioid therapy, opioid use disorder (OUD), and overdose among adolescent and young adult (AYA) cancer survivors at two years into survivorship. These data provide extremely important insight for clinicians making complex pain management decisions in the treatment of disease-free young adults with cancer pain. Chao et al. demonstrated that cancer survivors were at a lower OUD risk than age matched controls. Although the data are very reassuring, the authors make an extremely important conclusion that risk-stratified monitoring of cancer-free survivors on opioids and better understanding of the risks of OUD in AYA cancer survivors is paramount. Condensed Abstract: Chao et al. demonstrated that although 5.2% of cancer survivors being prescribed opioids, they were at a lower OUD risk than age matched controls. OUD, if diagnosed, should be treated as a medical comorbidity resulting from cancer treatment; harm reduction principles can be employed, emphasizing humanism, autonomy, and accountability without termination. The study by Chao et al. examines the prevalence of long term and high dose opioid therapy, opioid use disorder (OUD), and overdose among adolescent and young adult (AYA) cancer survivors at two years into survivorship. These data provide extremely important insight for clinicians making complex pain management decisions in the treatment of disease-free young adults with cancer pain. In the present study of AYA survivors, the prevalence of opioid prescribing was 5.2% at two years into survivorship. The prevalence ratio was 1.8 as compared with the controls. Our group recently examined chronic opioid prescribing in older adult cancer survivors aged 66 and above. We found that the prevalence of chronic opioid prescribing in older cancer survivors at year 2 was similar to the AYA. It varied by cancer diagnosis between 3.2% and 6.9%. 1 Differences in chronic opioid prescribing between survivors and controls declined each year after the index date and disappeared by year 6. 1 Chao et al. demonstrated that cancer survivors were at a lower OUD risk than age matched controls. Although the data are very reassuring, the authors make an extremely important conclusion that risk-stratified monitoring of cancer-free survivors on opioids and better understanding of the risks of OUD in AYA cancer survivors is paramount. While opioids are the standard of care for moderate to severe cancer pain, the role of long-term opioid therapy in disease-free cancer survivors is complex. The National Comprehensive Cancer Network (NCCN) defines pain from cancer treatment as cancer pain, however the decision to continue long term opioid therapy through stable survivorship should not be made lightly. Chao et al. demonstrated that opioid use during cancer treatment most strongly predicted long-term high dose use, OUD, and overdose during AYA survivorship. Chronic opioid therapy is associated with chronic constipation, hypogonadism, sleep disorders, hyperalgesia, tolerance, and effects on sexual drive and fertility. 2 It has also been associated with OUD and overdose. Beyond physical side effects, chronic use of opioids by long-term survivors may interfere with independence, driving, employment, family dynamics and personal identity. 2 It also continues to expose the family and caregivers of the survivor to opioids at home. There are additional challenges for those with a history of OUD. Continuous exposure to opioids increases the risk of OUD relapse and can cause alienation from the peer support group (such as Narcotics Anonymous (NA). There may be other social costs of accepting pain medications during treatment for those engaged in a recovery community, especially for survivors who require opioid replacement therapy with buprenorphine or methadone for OUD. 2 Among adolescents and young adults with cancer, greater than 80% will survive for 5 years after diagnosis, becoming long-term survivors. 3 This population of survivors is faced with an additional unique set of obstacles distinct from pediatric and older adult patients. These challenges can manifest in several domains of an AYA survivor’s life, including physical such as deconditioning or disfigurement from treatment, psychological such as posttraumatic stress disorder or fear of cancer recurrence, and social including challenges with social engagement or returning to education or employment. 4 The long-term use of opioids for treatment of cancer pain in AYAs may present another added layer of complexity. Younger age has been shown to be a risk factor for opioid misuse and OUD among the general population and cancer survivors. 5 This developmental period is traditionally characterized by experimentation with risky health behaviors which can raise the concern for susceptibility to substance use disorders (SUD) and complications from long-term opioid use. 6 AYA cancer survivors are also of reproductive age. Therefore, those who are pregnant or want to become pregnant may need their pain management coordinated with an obstetrician, especially if a comorbid OUD is present. Based on these side effects and concerns, when cancer pain decreases during survivorship and off treatment, opioids that were initiated during cancer treatment should be re-evaluated and tapered down if possible. This should be done gradually to avoid pain exacerbation, opioid withdrawal, and other adverse events including depression, suicide, illicit drug use, and accidental overdose. Concomitant non-cancer pain such as fibromyalgia, arthritis, and migraines, should be treated according to the standard of care for the specific cause of pain. If a decision to continue opioids is made and during the opioid taper, AYA patients need to be carefully monitored for compliance, safety, symptoms of opioid withdrawal, and signs of OUD given that young age and prolonged opioid exposure are risk factors for opioid withdrawal, OUD and overdose. Concomitant alcohol and benzodiazepine use, both prevalent in younger adults, increase the risk of OD and need to be evaluated and addressed. 5 Realistic goals for ongoing opioid therapy through disease free survivorship need to be established and care plans re-evaluated if treatment or safety goals are not met. The present study highlights the need to identify the underlying risks for long term and high dose opioid prescribing, as well as risks of OUD and overdose within the AYA patient population. It is important to separate tools to screen for risk of OUD from the diagnosis of OUD. Current screening tools recommended for patients on opioids have not been validated in cancer pain or cancer survivors. Our recent study of the NCCN recommended screening tool, Current Opioid Misuse Measure (COMM), showed that using COMM in a cancer population may significantly overestimate risk of opioid misuse. Contrary to the intended use of COMM to identify aberrant opioid use, COMM greater than or equal to 13 predicted mortality and a 1.9 times increased risk of death in 12 months. We concluded that using COMM without modifications may not be accurate in his setting and can create an additional barrier to cancer pain management, such as limiting appropriate opioid use, and further research is needed to identify better screening tools. 7 Increasing interest in the prevalence of OUD within the AYA cancer population should lead to increased access to evaluation and treatment of OUD and should not condone widespread deprescribing of opioids. 8 One study by Xu Ji et al. utilized data from the National Survey of Drug Use and Health to assess substance use, misuse, and substance use disorders among AYA cancer survivors. 9 They found AYA survivors were more likely than noncancer AYA patients to have a SUD but only 1 in 5 received treatment. 9 If an OUD is suspected or diagnosed, it is essential to name the problem, and identify institutional resources available to support the patient through recovery. OUD resulting from or exacerbated by prescribed opioids for cancer pain should be treated as a medical comorbidity. Self-disclosure of craving, withdrawal, or history of OUD should be safe for the patient. While there may be concerns about the risk of OUD among other physiological effects of opioids, it is important that this information be used to provide additional evaluation and support to this population rather than the reason for limiting or withdrawing appropriate treatment. In a recent retrospective study of 80 patients with median overall survival of 2.3 months admitted for severe cancer pain, patients who volunteered information about having OUD (of whom 50% were in stable remission for OUD), received no increase in their opioid doses by the time of discharge. By comparison, the control group without OUD had their opioid dose increased by 62%. 10 Cancer pain is a multidimensional entity with complex interplay between physical, cognitive, psychological, and social factors. 11 , 12 As such, it necessitates a multidisciplinary approach and team. 4 In cases where OUD develops or recurs during cancer treatment, it should signal the need to address OUD as a comorbidity through additional resources and support rather than abandonment. 13 Harm reduction principles can be employed, emphasizing humanism, autonomy, and accountability without termination. 13 Our goal should remain to meet patients wherever they are in their healthcare journey and to devise a plan of care centered on patient values and goals. 14 Funding: P30 CA008748/CA/NCI NIH HHS/United States Footnotes Conflicts of Interest : None. Contributor Information Natalie Moryl, Memorial Sloan Kettering Cancer Center, New York City, New York. Jasmine Tomita-Barber, Memorial Sloan Kettering Cancer Center, New York City, New York. References 1. Salz T, Lavery JA, Lipitz-Snyderman AN, et al. Trends in Opioid Use Among Older Survivors of Colorectal, Lung, and Breast Cancers [published correction appears in J Clin Oncol. 2019 Sep 1;37(25):2299. doi: 10.1200/JCO.19.01267 .]. J Clin Oncol. 2019;37(12):1001–1011. doi: 10.1200/JCO.18.00938 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 2. Glare P, Aubrey K, Gulati A, Lee YC, Moryl N, Overton S. Pharmacologic Management of Persistent Pain in Cancer Survivors. Drugs. 2022;82(3):275–291. doi: 10.1007/s40265-022-01675-6 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 3. Close AG, Dreyzin A, Miller KD, Seynnaeve BKN, Rapkin LB. Adolescent and young adult oncology-past, present, and future. CA Cancer J Clin. 2019;69(6):485–496. doi: 10.3322/caac.21585 [ DOI ] [ PubMed ] [ Google Scholar ] 4. Janssen SHM, van der Graaf WTA, van der Meer DJ, Manten-Horst E, Husson O. Adolescent and Young Adult (AYA) Cancer Survivorship Practices: An Overview. Cancers (Basel). 2021;13(19):4847. Published 2021 Sep 28. doi: 10.3390/cancers13194847 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 5. Jairam V, Yang DX, Verma V, Yu JB, Park HS. National Patterns in Prescription Opioid Use and Misuse Among Cancer Survivors in the United States. JAMA Netw Open. 2020;3(8):e2013605. Published 2020 Aug 3. doi: 10.1001/jamanetworkopen.2020.13605 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 6. Marjerrison S, Hendershot E, Empringham B, Nathan PC. Smoking, Binge Drinking, and Drug Use Among Childhood Cancer Survivors: A Meta-Analysis. Pediatr Blood Cancer. 2016;63(7):1254–1263. doi: 10.1002/pbc.25943 [ DOI ] [ PubMed ] [ Google Scholar ] 7. Moryl N, Mendoza TR, Horn SD, Eustaquio JC, Cleeland CS, Inturrisi C. Should We Use COMM (Current Opioid Misuse Measure) to Screen for Opioid Abuse in Patients With Cancer Pain?. J Natl Compr Canc Netw. 2023;21(11):1132–1140.e3. doi: 10.6004/jnccn.2023.7054 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 8. Bennett M, Paice JA, Wallace M. Pain and Opioids in Cancer Care: Benefits, Risks, and Alternatives. Am Soc Clin Oncol Educ Book. 2017;37:705–713. doi: 10.1200/EDBK_180469 [ DOI ] [ PubMed ] [ Google Scholar ] 9. Ji X, Cummings JR, Mertens AC, Wen H, Effinger KE. Substance use, substance use disorders, and treatment in adolescent and young adult cancer survivors-Results from a national survey. Cancer. 2021;127(17):3223–3231. doi: 10.1002/cncr.33634 [ DOI ] [ PubMed ] [ Google Scholar ] 10. Singh SA, Moreland RA, Fang W, et al. Compassion Inequities and Opioid Use Disorder: A Matched Case-Control Analysis Examining Inpatient Management of Cancer-Related Pain for Patients With Opioid Use Disorder. J Pain Symptom Manage. 2021;62(3):e156–e163. doi: 10.1016/j.jpainsymman.2021.05.002 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 11. Zaza C, Baine N. Cancer pain and psychosocial factors: a critical review of the literature. J Pain Symptom Manage. 2002;24(5):526–542. doi: 10.1016/s0885-3924(02)00497-9 [ DOI ] [ PubMed ] [ Google Scholar ] 12. Burton AW, Chai T, Smith LS. Cancer pain assessment. Curr Opin Support Palliat Care. 2014;8(2):112–116. doi: 10.1097/SPC.0000000000000047 [ DOI ] [ PubMed ] [ Google Scholar ] 13. Jones KF, Broglio K, Ho JJ, Rosa WE. Compassionate Care for People with Cancer and Opioid Use Disorder. Am J Nurs. 2023;123(8):56–61. doi: 10.1097/01.NAJ.0000947480.74410.06 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 14. Trimbur MC, Sumser B, Brown C, Steinhoff T, Almhanna K, Guyer D. Special considerations in managing pain and psychosocial distress in patients with opioid use disorder and cancer: the role of the supportive care and psycho-oncology interdisciplinary team. Ann Palliat Med. 2024;13(4):1076–1089. doi: 10.21037/apm-22-1409 [ DOI ] [ PubMed ] [ Google Scholar ] ACTIONS View on publisher site PDF (42.0 KB) Cite Collections Permalink RESOURCES Similar articles Cited by other articles Links to NCBI Databases Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top

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