Adherence to Opioid Patient Prescriber Agreements at a Safety Net Hospital

SIMPLE SUMMARY: Opioids are often used to treat cancer-related pain. Non-medical opioid use (NMOU) is a potential concern in all patients. Patient prescriber agreements (PPAs) have been recommended as a risk mitigation strategy. However, few studies have examined their use. The aim of our retrospective study was to assess how often PPAs were completed and how often cancer patients did not adhere to the PPA in a palliative care clinic. We found that 54% of patients had a PPA, and 10% were not adherent. PPAs were associated with younger age and alcohol use. Non-adherence was associated with males, being single, tobacco and alcohol use, contact with persons involved in criminal activity, opioid use for non-cancer pain, and higher pain score. PPA non-adherence occurred in a minority of patients, particularly those with NMOU risk factors. Our findings support the potential role of universal PPAs and systematic screening of NMOU risk factors. ABSTRACT: Patient prescriber agreements, also known as opioid contracts or opioid treatment agreements, have been recommended as a strategy for mitigating non-medical opioid use (NMOU). The purpose of our study was to characterize the proportion of patients with PPAs, the rate of non-adherence, and clinical predictors for PPA completion and non-adherence. This retrospective study covered consecutive cancer patients seen at a palliative care clinic at a safety net hospital between 1 September 2015 and 31 December 2019. We included patients 18 years or older with cancer diagnoses who received opioids. We collected patient characteristics at consultation and information regarding PPA. The primary purpose was to determine the frequency and predictors of patients with a PPA and non-adherence to PPAs. Descriptive statistics and multivariable logistic regression models were used for the analysis. The survey covered 905 patients having a mean age of 55 (range 18–93), of whom 474 (52%) were female, 423 (47%) were Hispanic, 603 (67%) were single, and 814 (90%) had advanced cancer. Of patients surveyed, 484 (54%) had a PPA, and 50 (10%) of these did not adhere to their PPA. In multivariable analysis, PPAs were associated with younger age (odds ratio [OR] 1.44; p = 0.02) and alcohol use (OR 1.72; p = 0.01). Non-adherence was associated with males (OR 3.66; p = 0.007), being single (OR 12.23; p = 0.003), tobacco (OR 3.34; p = 0.03) and alcohol use (OR 0.29; p = 0.02), contact with persons involved in criminal activity (OR 9.87; p < 0.001), use for non-malignant pain (OR 7.45; p = 0.006), and higher pain score (OR 1.2; p = 0.01). In summary, we found that PPA non-adherence occurred in a substantial minority of patients and was more likely in patients with known NMOU risk factors. These findings underscore the potential role of universal PPAs and systematic screening of NMOU risk factors to streamline care.