Guidelines for Opioid Use in Cancer Management are Needed, Expert Says

Although opioid use guidelines from the Centers for Disease Control exclude patients with cancer, drug screenings are required that could further contribute to racial disparities.

A 10-fold rise in urine drug screenings for opioid prescriptions from 2007 to 2019 following guidelines from the Centers for Disease control with particular scrutiny towards Black men has troubling implications when considering racial disparities in opioid access for cancer, according to Andrea C. Enzinger, MD.1

Enzinger, assistant professor of medicine at Harvard Medical School and medical oncologist at Dana-Farber Cancer Institute, spoke with CancerNetwork® in an interview about how these data may indicate that racial discrimination plays a part in these disparities despite the prescription opioid epidemic having a more notable impact on white populations.2


There has been a real push to encourage providers to screen patients for substance misuse. In 2016, the Centers for Disease Control issued their guidelines statement on opioid prescribing for chronic non-cancer pain. Those guidelines specifically excluded cancer patients but have been applied anyways.

Those guidelines suggested that every patient who’s being started on opioid therapy undergo baseline and annual urine drug screening. We, in the oncology field, have some guidance and encouragement to use these tests. However, it’s really unclear where their optimal place lies in treatment of patients with cancer.

There are certain populations that should be having this more proactively and there are certain populations like dying patients that should be excluded. We looked at rates and trends of urine drug screens between 2007 and 2019 and found a more than 10-fold rise in urine drug screens, which was really surprising.

Disturbingly, we also saw that Black patients were more likely than White patients to undergo urine drug screening. Black men in particular were the most likely to undergo urine drug screening. For us, we really worry that this may implicate some racial discrimination and that clinicians looking at a Black patient in front of them, particularly a Black man, may perceive their risks to be higher than it really is.

This is notable because the opioid misuse epidemic has impacted White populations more than Black populations, if we’re being honest about it. Those trends and disparities almost run in the opposite of what they should be.


  1. Enzinger AC, Ghosh K, Keating NL, et al. Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life. J Clin Oncol. Published online January 10, 2023. doi:10.1200/JCO.22.01413
  2. Alexander MJ, Kiang MV, Barbieri M. Trends in Black and White opioid mortality in the United States, 1979–2015. Epidemiology. 2018;29(5):707-715. doi:10.1097/EDE.0000000000000858
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