# Long-term Opioid Therapy, Depression and Suicide Mortality Risk in Patients with Head and Neck Cancer

> **NIH NIH R21** · DUKE UNIVERSITY · 2022 · $447,950

## Abstract

PROJECT SUMMARY/ABSTRACT
The proposed project is in response to RFA-DE-22-011: HEAL Initiative: Secondary Analysis and Integration of
Existing Data Related to Acute and Chronic Pain Development or Management in Humans. The HEAL
Initiative is a trans-NIH project, Helping to End Addiction Long-term, was launched in 2018 as a direct
response to the opioid crisis in the US. This crisis is even more complex in oncology as pain is one of the most
feared symptom among cancer survivors, and opioid use is central to pain management in cancer care. While
cancer survivors have a significantly increased risk of long-term use of opioid, in head and neck cancer (HNC),
over 80% of patients have a history of receipt of opioid prescription during care, and up to 15% of patients
continue using opioids long after active treatment, increasing their risk of long-term opioid therapy (LTOT),
which is >90 days of opioid use following treatment. The need to characterize opioid use in HNC is
underscored by the fact that HNC which only accounts for 3% of the total US cancer burden, might be
responsible for 12% of opioid-related deaths among patients with cancer. Risk of both depression and suicide
are higher among patients with HNC compared with the general US population; however, the relative
contribution of long-term opioid treatment to these adverse psychosocial consequences of HNC is unknown.
About 1-in-2 patients with HNC have a lifetime history of depression, which is significantly associated with
chronic pain. In addition, HNC has the second highest rate of suicide of all cancer sites, also associated with
chronic pain. It is unknown if LTOT is associated with risk of depression in these patients, or whether it
increases risk of suicide in HNC. It is therefore critical to understand to establish the relative contribution of
LTOT to adverse psychiatric sequelae in patients with HNC. Long-term, we hope to decrease depression and
suicide risks in cancer, and develop and implement tailored interventions that will inform safe opioid
prescribing, and provide evidence leading to alternative pain management in HNC and oncology care in
general. Our long-term goals align with both the HEAL initiative, and several Healthy People 2030 objectives,
such as reducing the proportion of adults who misuse prescription opioids, as well as decreasing suicide rate
in the US by 25% in the next decade. However, to achieve these long-term goals, it is necessary to first
quantify the role of LTOT in depression and suicide risks among patients with HNC beyond establishing
correlations or associations. Using two distinct, independent large cohorts of patients with HNC, the objective
of this proposed project is to establish the role of LTOT in depression and suicide among patients with HNC,
using advanced analytics that allows for establishing temporality, dose-response and other causal-related
inferences in observational data. Findings from this proposed research will impact clinical care in o...

## Key facts

- **NIH application ID:** 10597344
- **Project number:** 1R21DE032531-01
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Nosayaba Osazuwa-Peters
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $447,950
- **Award type:** 1
- **Project period:** 2022-09-15 → 2026-09-14

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10597344

## Citation

> US National Institutes of Health, RePORTER application 10597344, Long-term Opioid Therapy, Depression and Suicide Mortality Risk in Patients with Head and Neck Cancer (1R21DE032531-01). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10597344. Licensed CC0.

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