MDLinxYale Study Finds Reduced Opioid Prescribing for Some Patients with Cancer

New opioid prescribing in cancer patients dropped from 71.1% to 64.6% between 2016 and 2020, driven largely by declines in patients reporting no pain. Prescribing for patients with metastatic cancer and no pain fell most sharply, from 61.6% to 36.1%, raising questions about under-treatment in high-risk populations.

Clinical Considerations

• Opioid prescribing for patients reporting pain stayed stable, suggesting policy pressure is correctly targeting preventive prescriptions rather than active pain management.
• Patients with metastatic cancer reporting no pain saw the steepest declines, a population where preemptive prescribing may still be clinically justified.
• Surgical oncology patients experienced an 8% drop in new opioid prescribing, with no corresponding increase in reported pain documentation.
• Under-prescribing risk now rivals over-prescribing concern as the pendulum swings in cancer pain management.

Practice Applications

• Reassess preemptive opioid protocols for metastatic patients who present without active pain.
• Document pain assessments at every visit to ensure prescribing decisions are defensible and patient-driven.
• Counsel patients proactively to report pain early, reducing the gap between symptom onset and prescription access.
• Audit your practice’s opioid prescribing trends against this 2016-2020 baseline to identify potential under-treatment patterns.

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