Opioid Screening Practices in the Cancer Pain Patient

J Palliat Med. 2019 Jan;22(1):10-17. doi: 10.1089/jpm.2018.0168. Epub 2018 Aug 28.


Background: Despite the growing use of opioids to treat cancer pain and the probability of opioid aberrancy in the cancer setting, clinical practice guidelines (CPGs) or recommendations for active screening and monitoring of opioid compliance are lacking.

Objectives: To evaluate the current practices and attitudes clinicians have toward monitoring and prescribing opioids in patients with cancer; to describe the current practice of screening and monitoring opioid compliance in the cancer setting; to provide insight into the role that CPGs may have in addressing opioid aberrancy in the oncologic population.

Hypothesis: Clinicians adopt diverse clinical practices and attitudes toward opioid screening and monitoring based on cancer status.

Design: A 24-question survey that evaluated the practices and attitudes that clinicians have when screening, monitoring, and prescribing opioids in patients with active cancer and history of cancer was completed by 105 pain management physicians. A comprehensive literature review was completed, evaluating the current state of available literature regarding opioid aberrancy and opioid risk in the cancer setting and CPGs for opioid monitor compliance in the cancer setting.

Setting: Multicenter, survey-based study to clinicians regarding pain management strategies in patients with active cancer, patients with a history of cancer, and patients with no history of cancer.

Results: Cancer status plays a role in the clinician's decision to screen and monitor opioid compliance in the oncologic population. For patients with active cancer, clinicians are more likely to prescribe opioids despite patient refusal for toxicology screen as well as history of substance abuse. For patients with no history of cancer, clinicians are more likely to refuse a prescription refill and eliminate opioids from treatment regimen.

Conclusions: Based upon the results of our study and evidence from current literature provided, the authors advocate for further investigation and development of CPGs to ensure the safe and prudent screening, monitoring, and prescribing of opioids in the oncologic population.

Keywords: cancer pain; clinical practice guidelines; compliance monitoring; opioid misuse, urine drug screening.

MeSH terms

  • Analgesics, Opioid / therapeutic use*
  • Attitude of Health Personnel
  • Cancer Pain / drug therapy*
  • Drug Prescriptions / statistics & numerical data
  • Female
  • Humans
  • Male
  • Neoplasms / drug therapy
  • Opioid-Related Disorders / epidemiology
  • Patient Compliance*
  • Physicians / psychology
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians'
  • Review Literature as Topic
  • Substance Abuse Detection*
  • Surveys and Questionnaires


  • Analgesics, Opioid