Perceptions of prescription opioids among marginalized patients with hematologic malignancies in the context of the opioid epidemic: a qualitative study

Nadia A Nabulsi; Jonathan L Nazari; Todd A Lee; Pritesh R Patel; Karen I Sweiss; Thy Le; Lisa K Sharp

doi:10.1007/s11764-023-01370-9

Perceptions of prescription opioids among marginalized patients with hematologic malignancies in the context of the opioid epidemic: a qualitative study

J Cancer Surviv. 2023 Apr 6. doi: 10.1007/s11764-023-01370-9. Online ahead of print.

Authors

Nadia A Nabulsi¹, Jonathan L Nazari², Todd A Lee², Pritesh R Patel³, Karen I Sweiss⁴, Thy Le⁵, Lisa K Sharp²

Affiliations

¹ Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA. nnabul2@uic.edu.
² Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA.
³ Division of Hematology and Oncology, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA.
⁴ Department of Pharmacy Practice, University of Illinois Chicago, Chicago, IL, USA.
⁵ College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA.

PMID: 37022642
DOI: 10.1007/s11764-023-01370-9

Abstract

Purpose: Opioids are essential for treating pain in hematologic malignancies (HM), yet are heavily stigmatized in the era of the opioid epidemic. Stigma and negative attitudes towards opioids may contribute to poorly managed cancer pain. We aimed to understand patient attitudes towards opioids for HM pain management, particularly among historically marginalized populations.

Methods: We interviewed a convenience sample of 20 adult patients with HM during outpatient visits at an urban academic medical center. Semi-structured interviews were audio-recorded, transcribed, and qualitatively analyzed using the framework method.

Results: Among 20 participants, 12 were female and half were Black. Median age was 62 (interquartile range = 54-68). HM diagnoses included multiple myeloma (n = 10), leukemia (n = 5), lymphoma (n = 4), and myelofibrosis (n = 1). Eight themes emerged from interviews that seemed to influence HM-related pain self-management, including (1) fear of opioid-related harms, (2) opioid side effects and harms to health, (3) fatalism and stoicism, (4) perceived value of opioids for HM-related pain, (5) low perceived susceptibility to opioid-related harms and externalizing blame, (6) preferences for non-opioid pain management approaches, (7) trust in providers and opioid accessibility, and (8) external sources of pain management support and information.

Conclusions: This qualitative study demonstrates that fears and stigmatized views of opioids can conflict with marginalized patients' needs to manage debilitating HM-related pain. Negative attitudes towards opioids were shaped by the opioid epidemic and reduced willingness to seek out or use analgesics.

Implications for cancer survivors: These findings help expose patient-level barriers to optimal HM pain management, revealing attitudes, and knowledge to be targeted by future pain management interventions in HM.

Keywords: Cancer pain management; Hematologic malignancies; Marginalized patients; Opioid epidemic; Opioids; Qualitative.