Key points are not available for this paper at this time.
Women with breast cancer are often prescribed opioids for pain-relief post-operatively and/or during treatment. Opioids have a high risk of leading to a substance use disorder, and prolonged use can result in overdose, drug dependence, hospitalization, and mortality. We aimed to determine risk factors for prolonged opioid use or continued opioid use for more than one year after breast cancer diagnosis. We identified women diagnosed with stage I-III breast cancer from the Danish Cancer Registry (1997–2020). We excluded women who were prescribed an opioid in the year before breast cancer diagnosis. Prolonged opioid users were defined as women who received one or more opioid prescriptions 0-12 months after diagnosis and two or more prescriptions 12-24 months after diagnosis. We linked patients to several population-based registries to obtain information on risk factors as of the diagnosis date. Multivariable logistic models adjusted for covariates identified from directed acyclic graphs were used to evaluate odds ratios (ORs) and 95% confidence intervals (95% CIs). Among 75, 618 non-prevalent opioid users diagnosed with breast cancer during the study period, 2, 534 (3.4%) became prolonged users. Prolonged use was more likely in earlier years of the study period (1997-2008 vs. 2009-2020, OR: 1.41, 95% CI: 1.30, 1.53). Women with stage III disease (vs. stage I or II) had higher risk of prolonged use (OR: 2.00, 95% CI: 1.81, 2.22). Unmarried women (vs. married) also had a higher risk of prolonged use (OR: 1.29, 95% CI: 1.19, 1.41). Compared with college-educated women, women with a high-school education were more likely (OR: 1.37, 95% CI, 1.25, 1.51) and women with a tertiary-level education were less likely (OR: 0.79, 95% CI, 0.70, 0.90) to have prolonged opioid use. Women with higher-stage disease were more likely to be prolonged users of opioids, raising the possibility of long-term adverse treatment effects. Socioeconomically vulnerable patients and women who may lack at-home support also appeared to be at increased risk. It is important for healthcare providers to consider how to best manage long-term pain and potential addictions in these at-risk patient groups.
Woolpert et al. (Wed,) studied this question.