Opioid use disorder in cancer patients—a scoping review by experts with recommendations to improve the current situation

Opioid use disorder (OUD) is an emerging clinical and public health concern in cancer care. Although opioids remain essential for cancer pain management, a substantial subset of patients develops OUD, including many iatrogenic cases. This scoping review (ScR) synthesized evidence on the epidemiology, risk factors, screening approaches, and multidisciplinary management of OUD in adults with cancer. The review followed Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-ScR guidelines. Four databases (PubMed, Medline, Scopus, ScienceDirect) were searched for English language randomized trials, quasi-experimental studies, and observational studies published from 2019–2025. Eligible studies included adults aged ≥ 18 years with cancer. Two independent reviewers conducted the study selection (OA and YI). The search identified 1,044 records; 403 abstracts were screened; 164 full-texts were assessed; and 46 studies met the inclusion criteria. OUD prevalence averaged 8% (range 6–50%), with 23.5% of patients classified as at risk. New persistent opioid use occurred in 19% within 8 weeks. Postoperative persistent opioid use was 33.3% overall, higher among patients with prior opioid exposure (48.3%) than opioid-naive individuals (18.5%). Reported risk factors included prior opioid use, younger age, male sex, substance use history, anxiety, and financial distress. Screening tools identified approximately 20% of patients as high risk. Multidisciplinary interventions—including buprenorphine/naloxone treatment and structured monitoring—were effective in managing concurrent cancer pain and OUD. OUD in cancer populations is preventable and manageable through systematic risk assessment and integrated multidisciplinary care. Early screening with validated tools, structured monitoring, and compassionate communication support safe opioid use while maintaining adequate analgesia. Evidence supports expanding access to medication-assisted therapies, psychosocial support, and harm-reduction strategies. These findings provide a foundation for improving clinical outcomes and guiding future research.