• Jung Hye Kwon, David Hui, and Eduardo Bruera.
• 1 Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center , Houston, Texas.
• J Palliat Med. 2015 Aug 1; 18 (8): 703-6.

Background"Chemical coping" is a commonly used term in the pain and palliative care literature, but is heterogeneously defined. We conducted a Delphi survey among palliative care and pain specialists internationally to identify a consensus definition for "chemical coping with opioids" and warning signs for chemical coping.MethodsThis Delphi survey consisted of two rounds on the following: (1) concepts and definition related to chemical coping, (2) warning signs for chemical coping, and (3) demographics. Consensus in this study was defined as agreement by a minimum of 70% of the experts.ResultsParticipating in the first round were 14/19 (74%) physicians; 12/14 (86%) participated in the second round. The international experts reached the following consensus definition for chemical coping with opioids (92% agreement): "The use of opioids to cope with emotional distress, characterized by inappropriate and/or excessive opioid use." They also identified depression (consensus 93%); psychiatric disease (86%); a history of substance abuse (86%); a positive score for the Cut-down, Annoyed, Guilty, and Eye-opener (CAGE) alcoholism screening test (79%); a history of alcoholism (79%); and a history of smoking (71%) as important warning signs for chemical coping.ConclusionOur expert panel reached a consensus definition for chemical coping and related warning signs, which may help clinicians and researchers to identify patients at risk of opioid misuse.

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