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Aberrant opioid use behaviour in advanced cancer
  1. Sebastiano Mercadante1,
  2. Claudio Adile1,
  3. Walter Tirelli2,
  4. Patrizia Ferrera1,
  5. Italo Penco2 and
  6. Alessandra Casuccio3
  1. 1 Main regional center for Pain Relief and Palliative/supportive Care La Maddalena cancer Center Palermo, Palermo, Sicilia, Italy
  2. 2 Hospice Sacro Cuore, Rome, Italy
  3. 3 Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Sicilia, Italy
  1. Correspondence to Dr Sebastiano Mercadante, pain relief and supportive care, Private Hospital La Maddalena, 90146 Palermo, Sicilia, Italy; terapiadeldolore{at}


Objectives To evaluate the presence of aberrant behaviour in a consecutive sample of patients with advanced cancer treated with opioids in a country like Italy, with its peculiar attitudes towards the use opioids. The second objective was to detect the real misuse of opioids in clinical practice.

Methods Prospective observational study in two palliative care units in Italy in a period of 6 months. At admission the Edmonton Symptom Assessment Scale, the Memorial Delirium Assessment Scale, Brief Pain Inventory (BPI) and the Hospital Anxiety Depression Scale were measured. For detecting the risk of aberrant opioid use, the Screener and Opioid Assessment for Patients With Pain (SOAAP), the Opioid Risk Tool (ORT), the Cut Down-Annoyed-Guilty-Eye Opener (CAGE) questionnaire adapted to include drug use (CAGE-AID) were used. Aberrant behaviours displayed at follow-up within 1 month were recorded.

Results One-hundred and thirteen patients with advanced cancer were examined. About 35% of patients were SOAPP positive. There was correlation between SOAPP, CAGE-AID and ORT. SOAPP was independently associated with a lower Karnofsky level, pain intensity, poor well-being, BPI pain at the moment. No patient displayed aberrant behaviours, despite having a moderate-high risk.

Conclusions Despite a high percentage of patients showed a high risk of aberrant behaviours, no patient displayed clinical aberrant behaviours after 1 month-follow-up. This does not exempt from continuous monitoring for patients who are at risk.

  • cancer
  • chronic conditions
  • hospital care
  • pain

Data availability statement

Data are available on reasonable request. na.

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Data availability statement

Data are available on reasonable request. na.

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  • Contributors SM: planning, analysis, writing. CA: recruitment. WT: recruitment. PF: recruitment. IM: recruitment. AC: statistical analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.