It’s Rare for Cancer Patients to Overdose on Opioids
/By Crystal Lindell
Although most medical guidelines exempt cancer patients from restrictions on the use of opioids, it’s not uncommon for a cancer patient to be denied opioid pain medication by a doctor or pharmacist.
Some providers take the guidelines so seriously they won’t prescribe or fill an opioid prescription – even for someone dying of cancer — fearing it could lead to abuse, addiction, or even an overdose.
A large new study published in JAMA shows how ridiculous that practice is. Out of 554,316 Canadian adults being treated for solid cancer tumors, only 191 of them had a fatal opioid overdose. That’s 0.03%.
Non-fatal opioid overdoses were a bit more common, with 1,591 of cancer patients in the study surviving an overdose. That one comes out to 0.3%.
The overdose rate was higher for patients with advanced cancer or on high opioid doses, but the overall rate is still low – well below 1%.
Unfortunately, researchers concluded that access to opioids should be limited for the other 99% of cancer patients. If opioids are prescribed, they recommend that naloxone should be co-prescribed to reduce the “rare” risk of an overdose even further.
“Opioids are essential for cancer pain management but carry risks, with opioid overdoses being the most severe,” wrote lead author Jenny Lau, MD, a Palliative Care Physician at the Princess Margaret Cancer Centre in Toronto. “(Our) findings suggest that opioids should be prescribed at the lowest effective dose for symptom management, with close monitoring and routine assessment for opioid overdose risk.”
This conclusion was made despite the fact that the overdose rate for cancer patients is actually much lower than the general population.
This was noted by the researchers themselves. In Canada, the fatal overdose rate in the general population is estimated at 19 for every 100,000 people. The U.S. overdose rate is slightly higher.
By comparison, the overdose rate in the cancer study was only 6.5 per 100,000 – about 66% lower than the general population.
“Consistent with past oncology studies, we found that the incidence of opioid overdoses was relatively low among patients with cancer,” wrote Lau.
Perhaps this is a bit of a stretch, but doesn’t that suggest that giving cancer patients opioid medication lowers their risk of overdose? Or that having cancer reduces your risk of an overdose? That’s absurd of course, but that’s what the data implies.
While any overdose is a tragedy, it’s possible that other factors are at play for the cancer patients, such as having other health problems, weakened immune systems, and taking multiple medications.
It’s also unclear how many of the 554,316 patients even had an opioid prescription because the study never lays that out. The researchers did note that those who received an opioid prescription in the prior 30 days were 71% more likely to experience an overdose.
The overdose risk increased by 2-fold if patients received doses higher than 50mg morphine milligram equivalents (MME) per day. The overdose risk was also higher for younger patients, those with gynecologic cancers, and patients with a diagnosis of opioid use disorder.
Patients who overdosed were more likely to have higher pain scores and higher distress scores. Perhaps that was because they took more medication in hopes of alleviating their pain.
The urge to study patient populations like this is understandable, especially in regards to overdoses. That said, it seems a bit of a reach to take mixed results like this and make a sweeping conclusion that doctors should be limiting opioid prescriptions to cancer patients.
In fact, I’d argue the opposite is true. The rates of overdose were so low that they show just how rare an overdose actually is, and how safe prescription opioids can be when used by people who really need them.
