Chronic opioid use and incident opioid use disorders in survivors of adolescent and young adult cancer after cancer treatment.

Abstract

The use of opioids and its benefits and harms among cancer survivors are poorly understood. The authors examined opioid use and related outcomes among adolescent and young adult (AYA) cancer survivors after cancer treatment. The authors identified 2-year cancer survivors diagnosed between 15 to 39 years of age at Kaiser Permanente Southern California (2000-2012, followed through 2019). Individuals without cancer were matched to survivors on age, sex, and calendar year for comparison. The authors used robust Poisson regression to compare long-term (≥90 days) opioid use during follow-up and Fine-Gray hazard models to compare incident long-term high-dose use (≥50 morphine milligram equivalents daily dose ≥90 days), benzodiazepine co-use, opioid use disorder (OUD), opioid overdose, and opioid-related hospitalization. We also restricted analyses to individuals on long-term opioid therapy, and evaluated risk factors for opioid-related outcomes within cancer survivors. Of 5908 AYA cancer survivors and 81,833 noncancer individuals, 5.2% and 1.8% had long-term opioid use during follow-up, respectively (prevalence ratio = 1.8, 95% confidence interval, 1.6-2.0). Cancer survivors had higher incidence of long-term high dose opioid use (hazard ratio [HR] = 2.2 [1.8-2.8]), benzodiazepine co-use (HR = 1.4 [1.3-1.5]), and opioid-related hospitalization (HR = 1.5 [1.1-2.2]) compared with noncancer individuals. Among those on long-term opioid therapy, cancer survivors had elevated risk for long-term high dose use (HR = 1.4 [1.1-1.8]) and benzodiazepine co-use (HR = 1.6 [1.2-2.1]), but lower OUD risk (HR = 0.6 [0.4-0.9]). Opioid use during cancer treatment phase most strongly predicted long-term high dose use and OUD/overdose during survivorship. Findings call for risk-stratified patient monitoring and better understanding of the differential OUD risk in AYA cancer survivors.