Increased Pain in Veterans with Cancer - Time to Re-evaluate Opioid Prescribing Practices?

Abstract: The United States continues to grapple with an opioid epidemic, with opioid-related overdose deaths reaching unprecedented levels in 2021, surpassing 80,000 fatalities. Synthetic opioids, particularly fentanyl, account for the majority of these deaths, underscoring the urgency of the crisis. In response, regulatory measures and prescribing guidelines have been tightened, leading to a notable decline in prescription opioid deaths since their peak in 2017. Veterans, owing to the physical and psychological toll of military service, face a disproportionate burden of chronic pain and opioid misuse. The Veterans Health Administration (VHA) initiated the Opioid Safety Initiative in 2013 to promote safer opioid use among veterans, yet the impact on long-term pain management remains unclear, particularly among cancer patients and survivors. This study examines opioid prescribing trends and pain outcomes among veterans within a tertiary VHA system from 2015 to 2021. Analysis of electronic health records revealed higher opioid prescription rates and morphine milligram equivalents (MME) among patients with cancer compared to those without. Over the study period, both cohorts experienced a significant reduction in opioid prescribing, with a more pronounced decline observed among cancer patients. Concurrently, severe pain incidence increased among cancer patients while remaining stable in non-cancer patients. These findings highlight potential unintended consequences of reduced opioid prescribing, suggesting a correlation between decreased opioid use and worsened pain control, particularly in cancer patients. The study advocates for a nuanced approach to opioid prescribing that considers individualized patient needs and challenges the assumption that reduced opioid use universally improves outcomes. Future research is needed to explore these trends across diverse patient populations and to elucidate optimal pain management strategies in the context of evolving opioid prescribing practices.