How Stigma Influences Patients’ Perspectives on Opioids for Cancer-Related Pain

Opioid stigma may create barriers to effective pain management for patients with cancer, according to research published in JCO Oncology Practice.

A group of researchers conducted in-depth interviews with 20 patients who had stage III or IV cancer and 11 support providers (ie, the patients’ family and friends) to explore how opioid stigma manifests in the lives of patients with cancer.

Patient interviews covered the patients’ experiences with pain and pain treatment, their storage and use of opioids, their general thoughts on the opioid epidemic, and their friends’ and family’s opinions on taking opioids for cancer-related pain.

Support provider interviews covered their experiences providing support for the patient, experiences in helping manage cancer-related pain, thoughts on opioid use for cancer-related pain, their own experiences with opioids, and thoughts on the opioid epidemic.

Several themes were identified that illustrated how opioid stigma affects patients with advanced cancer:

  • Participants had direct experience with opioid stigma and opioid-related discrimination in health care settings
  • Participants had concerns about opioid stigma affecting patient care in the future
  • Patients expressed opioid-restricting attitudes and behaviors that may reflect internalized stigma and fear of addiction.

The attitudes didn’t reflect an overt stereotype about opioid misuse; rather, they illustrated a more subtle, internalized kind of stigma. “Left unaddressed, internalized stigma can lead to worsening shame and guilt when cancer progresses, pain worsens, and opioid dosages increase,” the researchers wrote.

“The results also reflected a pervasive unease with perceptions of addiction, which may influence patient coping strategies (eg, distancing and opioid restricting behaviors) and efforts to maintain a positive image with their clinicians,” the researchers added.

They also noted that additional work is necessary to further explore how systemic influences such as racism may interact with opioid stigma to create particular challenges for people of color. Future research could focus on how opioid stigma manifests in diverse populations, the researchers suggested.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Bulls HW, Hamm M, Wasilko R, et al. Manifestations of opioid stigma in patients with advanced cancer: Perspectives from patients and their support providers. JCO Oncol Pract. 2022;18(10):e1594-e1602. doi:10.1200/OP.22.00251

This article originally appeared on Cancer Therapy Advisor