# Prescription Monitoring Program Review Among Patients with Cancer Receiving Opioids at a Safety-Net Palliative Medicine Clinic

## TL;DR

This study shows that prescription monitoring programs may not effectively detect non-medical opioid use in cancer patients, highlighting the need for more comprehensive clinical evaluations.

## Contribution

The study demonstrates that clinical reviews and urine tests are more effective than prescription monitoring programs in identifying opioid misuse in cancer patients.

## Key findings

- Prescription monitoring program reviews identified only 4% of patients with non-medical opioid use behaviors.
- Clinical review identified 20% of patients with non-medical opioid use behaviors.
- History of illicit drug use and non-malignant pain were strong predictors of PMP concerns.

## Abstract

Patients with cancer frequently require opioid therapy for pain management and are at risk for non-medical opioid use. Prescription monitoring programs are often used to track patients’ prescribed opioids and to promote safe opioid use; however, their utility in patients with cancer is uncertain. In this study, we aimed to determine the prevalence of NMOU behaviors and examine the effectiveness of prescription monitoring program reviews compared to chart review and/or urine drug testing concerning opioid-related behaviors in cancer patients at a safety-net palliative medicine clinic. We found that abnormal findings on prescription monitoring program review were uncommon and identified far fewer patients with concerning behaviors than clinical review and urine drug screen. These results suggest that prescription monitoring programs alone may miss important signs of non-medical opioid use in patients with cancer. Our findings highlight the importance of comprehensive clinical evaluation when monitoring opioid safety in cancer care.

Introduction: Prescription monitoring programs (PMPs) are commonly used to monitor non-medical opioid use (NMOU); however, the effectiveness of PMPs for identifying cancer patients with risk factors is not well known. Methods: This study assessed the frequency and predictors of concerning PMP findings among cancer patients in a palliative care clinic and examined the ability of PMPs, clinical review, and urine drug testing to identify NMOU behaviors. This was a retrospective analysis of consecutive cancer patients seen by palliative care at a safety-net hospital over four years. Demographic, clinical, and psychosocial risk factors for NMOU were extracted from the medical record. Concerning PMP findings were based on prescriber documentation. Logistic regression models identified predictors of documented PMP concerns. Results: Among 906 patients, 844 (93%) had PMP reviews at either consultation or a follow-up visit. Of these, 31/844 (4%) demonstrated documented PMP concern. Predictors of documented PMP irregularities included a history of illicit drug use (OR 6.30, 95% CI: 2.35–17.06), opioid use for non-malignant pain (OR 19.49, 95% CI: 6.24–60.90), and a family history of illicit drug use (OR 5.42, 95% CI: 0.96–25.04). Discussion: A total of 166 patients (20%) were identified as having NMOU behaviors based on clinical review; in contrast, PMP review identified only 31 (4%) patients with NMOU behaviors, and two (6%) were missed by clinical review. Documented PMP concern was low in cancer patients. Clinical review identified most patients with NMOU behaviors, with limited contribution from PMP review. Our findings suggest that PMP should not be used in isolation when assessing opioid-related risk in this population.