{"doi":"10.1002/cncr.34921","title":"Expert consensus‐based guidance on approaches to opioid management in individuals with advanced cancer‐related pain and nonmedical stimulant use","abstract":"BACKGROUND: Clinicians treating cancer-related pain with opioids regularly encounter nonmedical stimulant use (i.e., methamphetamine, cocaine), yet there is little evidence-based management guidance. The aim of the study is to identify expert consensus on opioid management strategies for an individual with advanced cancer and cancer-related pain with nonmedical stimulant use according to prognosis. METHODS: The authors conducted two modified Delphi panels with palliative care and addiction experts. In Panel A, the patient's prognosis was weeks to months and in Panel B the prognosis was months to years. Experts reviewed, rated, and commented on the case using a 9-point Likert scale from 1 (very inappropriate) to 9 (very appropriate) and explained their responses. The authors applied the three-step analytical approach outlined in the RAND/UCLA to determine consensus and level of clinical appropriateness of management strategies. To better conceptualize the quantitative results, they thematically analyzed and coded participant comments. RESULTS: Consensus was achieved for all management strategies. The 120 Experts were mostly women (47 [62%]), White (94 [78%]), and physicians (115 [96%]). For a patient with cancer-related and nonmedical stimulant use, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering. Buprenorphine/naloxone transition was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis. CONCLUSION: Study findings provide urgently needed consensus-based guidance for clinicians managing cancer-related pain in the context of stimulant use and highlight a critical need to develop management strategies to address stimulant use disorder in people with cancer. PLAIN LANGUAGE SUMMARY: Among palliative care and addiction experts, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering in the context of cancer-related pain and nonmedical stimulant use. Buprenorphine/naloxone transition as a harm reduction measure was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis.","journal":"Cancer","year":2023,"id":346668,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":12,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9597,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":820591,"name":"Dmitry Khodyakov","orcid":"0000-0002-2818-6906","position":1,"is_corresponding":false},{"id":240122,"name":"Benjamin H. Han","orcid":"0000-0001-6882-0142","position":2,"is_corresponding":false},{"id":369070,"name":"Robert M. Arnold","orcid":"0000-0003-1610-8932","position":3,"is_corresponding":false},{"id":1087512,"name":"Emily Dao","orcid":"0000-0002-8318-3935","position":4,"is_corresponding":false},{"id":1088054,"name":"Jeni Morrison","orcid":null,"position":5,"is_corresponding":false},{"id":1088055,"name":"Jennifer Kapo","orcid":null,"position":6,"is_corresponding":false},{"id":608749,"name":"Diane E. Meier","orcid":"0000-0002-8823-2898","position":7,"is_corresponding":false},{"id":107120,"name":"Judith A. Paice","orcid":"0000-0001-7534-1756","position":8,"is_corresponding":false},{"id":503280,"name":"Jane M. Liebschutz","orcid":"0000-0003-3492-1521","position":9,"is_corresponding":false},{"id":396960,"name":"Christine S. Ritchie","orcid":"0000-0002-4881-9416","position":10,"is_corresponding":false},{"id":430080,"name":"Jessica S. Merlin","orcid":"0000-0003-3207-4875","position":11,"is_corresponding":false},{"id":691075,"name":"Hailey W. Bulls","orcid":"0000-0003-1005-0303","position":12,"is_corresponding":false},{"id":805665,"name":"Katie Fitzgerald Jones","orcid":"0000-0002-0825-8394","position":0,"is_corresponding":true}],"reference_count":52,"raw_metadata":null,"created_at":"2026-07-19T01:11:53.085356Z","pmid":"37691479","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}