Risk of opioid misuse in people with cancer and pain and related clinical considerations: a qualitative study of the perspectives of Australian general practitioners

In Australia, between the years of 1998 and 2009, opioid-related hospitalizations increased from 605 to 1564 cases, and in the years 2002-2011, death rates due to accidental poisoning increased from 0.78 to 1.19/100,000 population. In response, studies have been conducted to understand factors underlying the opioid crisis and how to best address them in policy and practice. Having said so, there is limited research on opioid misuse in the cancer pain context. Thus, this study explored the perspectives of general practitioners (GPs) concerning the risk of opioid misuse in people with cancer. Telephone interviews were conducted with 22 Australian GPs and three main themes emerged. (1) Opioid misuse was not the main problem when compared to opioid toxicity, and poor pain management stemming from a lack of communication between prescribers; (2) GPs were more comfortable prescribing opioids for pain in a cancer versus non-cancer, or a disease-free survivor context; (3) GPs acknowledged that opioids are sometimes prescribed for cancer pain as a default. This study was the first of its kind to explore the perspectives of Australian GPs on the risk of opioid misuse in people with cancer vs non-cancer pain. The findings has shed a light on the importance of continuity of care when opioid prescribing is shared. It further highlights the need for greater evidence to distinguish risk of opioid misuse, and to guide opioid prescribing in disease-free survivors and in patients living with chronic cancer. 

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