Katie Fitzgerald Jones (Lee Pellegrini)
A research team led by recent Connell School of Nursing alumna Katie Fitzgerald Jones Ph.D. ’22 has published a study that offers the first consensus-based guidance to help specialists treat cancer patients who misuse opioids or have a history of opioid use disorder (OUD).
Although more than half of patients with advanced cancer in the United States are prescribed opioids for pain, there is currently little established guidance regarding pain management for patients who are misusing opioids or have in the past, according to Jones’s co-authored paper, which appeared in the August issue of the journal JAMA Oncology. To address this gap, she and her colleagues surveyed 120 palliative care and addiction specialists about how they approach treatment when opioid-related harms or addiction are a risk—or a reality.
“Historically, addiction care has been largely isolated from mainstream health care, both because of stigma and because of policy,” said Jones. “Our practice and research show that there are patients at the intersection who require both pain management and opioid use disorder management.”
One reason these areas of expertise are siloed, Jones said, has to do with policies around the two most commonly prescribed medications for treating OUD: methadone and buprenorphine. Both drugs are heavily regulated in the United States.
“Under current federal law, methadone can only be administered for OUD at methadone treatment programs,” Jones explained. “Buprenorphine can be administered in the regular practice setting, but only five percent of clinicians in the U.S. have the specialty X-waiver needed to prescribe it for OUD.”
Using an online interactive platform informed by the Delphi Method—developed by Jones’s co-author Dmitry Khodyakov, a senior sociologist at the RAND corporation—the team conducted two panels, asking palliative care and addiction specialists which prescription and treatment approaches they viewed as appropriate for a range of patients with cancer-related pain and shorter or longer prognoses.
For patients with untreated OUD, regardless of their prognosis, the specialists agreed that it was appropriate to begin by prescribing Buprenorphine/Naloxone. For those with a shorter prognosis, they also deemed it appropriate to prescribe split-dose methadone, though they were uncertain about the appropriateness of prescribing methadone to patients who were expected to live longer. The specialists concurred that, for patients who were misusing opioids but had no past history of OUD, the first step should be to increase monitoring rather than immediately tapering the opioid dose.
“Our study showed us that specialists actually want to use methadone for opioid use disorder and pain,” Jones noted, “but the current system doesn’t make that feasible, because it’s a tall order to ask someone going through cancer treatment to drive to a separate clinic every day.”
Historically, addiction care has been largely isolated from mainstream health care, both because of stigma and because of policy. Our practice and research show that there are patients at the intersection who require both pain management and opioid management.
Jones and her colleagues have garnered attention in the medical community and beyond for this research. Their study has been featured in articles by HealthDay and the U.S. Department of Veterans Affairs’ Research Currents blog, and Jones’s April appearance on the geriatrics and palliative care podcast “GeriPal” led to an email from a documentarian from Stat News who is now making a film about her work. For Jones herself, who works as a palliative care nurse practitioner in the VA Boston Healthcare System and Massachusetts General Hospital, this study and recognition represents a much-needed step toward consensus-based guidance and better care, but there is still much work to be done.
“To the best of my knowledge, there are only a handful of clinicians in this country who are trained in both addiction care and palliative care. Those of use doing this work know each other well, and we are working to raise awareness and bring addiction competencies into palliative care,” she said.
Alongside peers and mentors like the University of Pittsburgh’s Jessica Merlin, whom Jones credits with designing and securing funding from the Cambia Foundation for the JAMA Oncology study, she continues to advocate for policy changes and educate clinicians about obtaining the waiver to prescribe buprenorphine—efforts she will continue next year as a postdoctoral fellow in the Center for Aging and Serious illness at the Mongan Institute at Massachusetts General Hospital.
“We're trying to fill the knowledge gap by writing about policy issues, putting resources out there, and giving talks,” Jones said. “I’m lucky to have a group of collaborators who care about this work.”
John Shakespear | University Communications | October 2022