Dangerous Variation or Patient-Centered Care? Palliative Care and Pain Providers' Comfort, Experiences, and Approaches when Treating Cancer Pain With Coexisting Aberrant Behaviors

The opioid epidemic in the United States has influenced numerous regulations and guidelines intended to mitigate opioid misuse. This misuse, also known as aberrant drug use behaviors (ADB), can include self-escalation of opioids, concurrent use of illicit substances, and drug diversion, among other high-risk behaviors. ADB has been observed in patients with cancer-related pain, for whom opioids remain a standard form of treatment. However, little research has been done to guide opioid prescribing for patients with cancer-related pain. 

In a study in the American Journal of Hospice and Palliative Medicine, Dr. Yuhua Bao, professor of population health sciences, and colleagues characterize how specialists evaluate and manage high-risk behaviors in patients with cancer-related pain. This study is the first to explore how cancer pain management specialists navigate ADB. 

Findings indicate that both pain and palliative care specialists experience significant difficulty when balancing symptom management with harm reduction for patients. Many clinicians have both resource and educational gaps that prevent more effective care. Further research is needed to inform guidance regarding opioid prescribing, monitoring, and discontinuation in high-risk patients. 

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