• Sarah A Singh, Rachel A Moreland, Wei Fang, Parvez Shaikh, John Michael Perez, Ann M Morris, Basem Dahshan, Rebecca F Krc, Dilip Chandran, and Monika Holbein.
• Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia, USA. Electronic address: sarah.amrita.singh@gmail.com.
• J Pain Symptom Manage. 2021 Sep 1; 62 (3): e156-e163.

ContextThe opioid epidemic spurred guidelines intended to reduce inappropriate prescribing. Although acute cancer-related pain was excluded from these recommendations, studies demonstrate reduced opioid prescribing for patients hospitalized with advanced cancer.ObjectivesWe performed a matched case-control analysis to determine how a history of opioid use disorder (OUD) affects inpatient management of cancer pain.MethodsCharts of patients with OUD admitted for cancer pain from 2015-2020 were retrospectively reviewed. Hospitalizations were matched 1:1 by patient age and sex. Home milligram-morphine equivalent per day (MME/day) was calculated from the home medication list. Admission MME/day was the average MME/day administered during hospitalization.ResultsA total of 80 hospitalizations (40:40) were matched for 25 patients with a history of OUD and 31 patients with no history of OUD. Cancer was metastatic/relapsed for 70% of admissions. The median overall survival was 2.3 months (95% CI 0-5.21, P = 0.13). Patients with OUD had a significantly lower change from Home to Admission MME/day (-3 vs. 37, P < 0.01) and were less likely to have any increase in Admission MME/day (OR 0.1, 95% CI 0.02-0.43, P < 0.01). When considering opioids administered after pain specialty consultation, there was no difference between groups.ConclusionOur results suggest that patients with OUD receive lower quality inpatient management of cancer-related pain. Provider education and early involvement of pain specialists are crucial in delivering equitable and compassionate end-of-life care for patients with OUD.Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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