Seventy per cent still on opioids three months after head and neck radiotherapy

Design

Retrospective single-institution cohort

Population

789 patients with non-metastatic head and neck cancer after definitive (chemo)radiotherapy

Primary outcome

Opioid use 3 months after radiotherapy

Effect

70.0% at 3 months, 47.3% at 6 months; prior use aOR 2.57 (1.82-3.63)

A single-institution cohort (JAMA Otolaryngology-Head & Neck Surgery, 1 October 2026) followed 789 patients with non-metastatic head and neck cancer treated with definitive radiotherapy or chemoradiotherapy between 2011 and 2023.

Almost all (95%) received prescription opioids between diagnosis and six months after treatment. At three months after radiotherapy 70% were still taking them, and at six months 47%. Ongoing use at three months was associated with prior opioid use (adjusted OR 2.57), former smoking (1.55) and palliative care referral (3.90). Among the 296 who were opioid-naive before treatment, 58% were still taking opioids at three months and 38% at six.

Mucositis pain is real and opioids are often needed, but these figures suggest that many patients never come off them. The findings point to building an exit plan into the start of treatment: agreed tapering after mucositis heals, review at each follow-up, and adjuvant approaches for neuropathic pain. Single-centre data cannot show which strategies work.

• Agree an opioid tapering plan at the start of radiotherapy, not after it
• Review opioid need at every post-treatment visit
• Consider extra support for patients already on opioids before treatment, former smokers and those under palliative care
• Use adjuvants and mucositis care to reduce opioid need where appropriate
• Name who owns the prescription after treatment ends - oncology, ENT or primary care

Why it matters

Opioids started for mucositis are often never stopped, and no one owns the prescription after treatment.

Don't overread it

Prescription data show opioids were taken, not whether use was inappropriate or harmful.

The statistics, in plain English

Adjusted odds ratios above 1 mean higher odds of still taking opioids: those on opioids before treatment had about 2.6 times the odds. This is one US centre, and prescribing practice varies widely between countries.

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