Prescribed opioids adherence among Taiwanese oncology outpatients

[[abstract]]The purpose of this study was to evaluate adherence to prescribed opioids in Taiwanese oncology outpatients and to examine the associations between various demographic and medical characteristics and prescribed opioids adherence. Ninety-two outpatients who had taken prescribed opioid analgesics for cancer-related pain at least once in the past week participated in this study. Patients were asked to recall the dose of each opioid analgesic that they had taken in the past 24 hours. Mean adherence rates were calculated for analgesic adherence. For mean adherence rates, all opioid analgesics were converted to morphine equivalents. The results of this study reveal a priority issue of poor opioid analgesic adherence. The adherence rate of 63.6% for the around-the-clock opioid analgesics in this study is well below acceptable levels. Also, an adherence rate of 30.9% for the as-needed opioid analgesics is very low. This study identified that women tend to be less adherent to their prescribed opioid analgesic regimen than men. Findings of this study suggest that to improve pain control, efforts to promote patients’ opioid regimen adherence should be given high priority. Clinicians should be particularly aware that there may be some gender difference in adherence to prescribed opioid analgesics. There is a need for better programmatic efforts to improve analgesic adherence. Experts estimate that 80%-90% of cancer pain can be relieved with present pharmacologic therapies and advanced techniques (American Pain Society, 2008; Jacox et al., 1994; Kumar, 2007; Reder, 2001 ; World Health Organization, 1996). Pain still remains a major source of suffering experienced by cancer patients (Higginson and Hearn, 1997; Holtan et al., 2007 ; Jun et al., 2000). Although inadequate treatment of cancer pain focus on several aspects, such as health care provider and patient factors (Anderson et al., 2000; Fazeny et al., 2000; Gunnarsdottir et al., 2002 ; Pargeon and Hailey, 1999), patients often remain a key of poor management of cancer pain (Ferrell et al., 1991 ; Liu et al., 2001). Because pharmacologic agents are considered to be a cornerstone of cancer pain management, patient willingness to use a pain management regimen to its optimal effect is one of the critical requirements for effective pain management. However, research has shown that patients tend to use less pain medication than was prescribed (du Pen et al., 1999 ; Miaskowski et al., 2001). Nonadherence might be one of the most common reasons for uncontrolled cancer pain. However, little attention has been paid to this issue. The few studies that measured adherence to analgesic regimens among cancer patients reported adherence rates for prescribed opioids averaging 22%-90% (Ferrell et al., 1999 ; Miaskowski et al., 2001). There is even less information regarding the status of adherence to prescribed opioids among Taiwanese cancer outpatients. The little information presents self-report items to rank analgesics adherence (Lai et al., 2002 ; Tzeng et al., 2008). The present cross-sectional study was designed to evaluate adherence to prescribed opioids in Taiwanese oncology outpatients with calculations of the dosages that patients had used