A Practical Approach to Assessment and Management of Patients at Risk for Non-medical Opioid Use: a Focus on the Patient with Cancer-Related Pain

Purpose of Review: Over the past decade, the perception of prescription opioids changed dramatically. Once considered a savior from all types of pain, with few side effects and no celling dose, opioids are now restricted by many states, health insurance companies, and pharmacies. This narrative review aims to synthesize the latest evidence for managing oncology patients at risk for non-medical opioid use (NMOU). Recent Findings: Opioids are effective medications for reducing severe cancer pain, despite their side effects. Screening tools identify high-risk patients, and a nomogram is available, using routine clinical data. Prescription monitoring plans have some evidence for improving selected outcomes; however, the role of UDT remains unclear. Harm reduction measures include de-prescribing of benzodiazepines, opioid rotation, and scheduled rather than PRN dosing. Summary: About one in five cancer patients are at risk for NMOU. There are effective strategies for identifying high-risk patients, reducing harm, and providing interdisciplinary psychosocial support.