(081) The use of opioid and non-opioid analgesics and illicit drugs among patients with cancer in the U.S.: prevalence and association with mortality

Background: There are rising concerns over the adverse outcomes of prescription analgesic medications and illicit drug use among patients with cancer, including drug dependence, abuse or drug-related accidental deaths.

Objectives: To investigate the utilization patterns of prescription opioid and non-opioid analgesic drugs, and non-prescription illicit drugs among a cohort of patients with cancer in the U.S., and its association with all-cause and cause-specific mortality.

Methods: Patients who reported a history of cancer were identified from the National Health and Nutritional Examination Surveys (NHANES) from 2009 to 2018. Sociodemographic and health-related variables were collected by interviews. The use of prescription opioid and non-opioid analgesics, and the intake of illicit drugs were self-reported by participants. Long-term use was defined as a reported intake of > 90 days. Linear-by-linear association was used to analyze the utilization trends. Logistic regression was used to identify predictors of drug use. Cox proportional hazards models were used to examine the association of drug use with all-cause, cardiovascular disease (CVD), cancer-specific mortality, and death from accidents.

Results: This analysis included 2,792 patients with cancer (mean age at survey 65.7 [SD=14.0] years; 53.0% female). The average age at cancer diagnosis was 55.1 (SD=16.8) years. Overall, the prevalence of any long-term prescription opioid and non-opioid analgesics use were 9.5% and 4.4%, respectively. 498 (17.8%) patients reported any illicit drugs usage (including cannabis, cocaine, heroin, methamphetamine, or steroids by injection). The prevalence of long-term opioids medication reached a peak (12.3%) in 2013-2014, while the use of long-term non-opioid analgesics demonstrated a significant decline over 10 years from 7.4% to 3.7% (Est=-0.02, P< 0.001). Patients diagnosed at a younger age ( < 40 years) were more likely to take opioid medications (OR=1.38, P=0.025). After adjusting for age, gender, race and income level, the long-term use of opioids was associated with all-cause mortality (HR=1.58, P< 0.001), CVD-specific mortality (HR=1.77, P=0.025), and accidental deaths (HR=3.43, P=0.03). Injection or oral intake of illicit drugs was associated with all-cause (HR=2.34, P=0.022) and cancer-specific mortality (HR=2.99, P=0.044).

Conclusions: The long-term use of opioid analgesics and illicit drugs was commonly reported by cancer patients, especially younger patients, and was found to be associated with higher risk of all-cause mortality. It is important to develop recommendations and policies to strike a balance between effective pain management and minimizing the risks associated with the misuse of opioids and illicit drugs among patients with cancer.