There is a growing concern about protecting patients with cancer’s access to medications for pain management. On May 23, the American Society of Clinical Oncology (ASCO) issued a policy statement about new legislative initiatives that may have the unintended consequence of limiting access to pain treatment for patients with cancer.1
The escalation of abuse, addiction, and diversion of opioids has led to an “opioid epidemic” in the United States. Many states and local agencies are discussing measures to prevent abuse; some have already implemented new laws concerning opioid prescriptions.
“ASCO wanted to draw attention to the unique needs of cancer patients, and to emphasize the need to consider the effects of legislations on patients who are prescribed medical opioids for pain management. The statement attempts to balance public health needs with protecting access for cancer patients,” said ASCO President Julie Vose, MD, MBA, chief of the Oncology/Hematology Division in the Department of Internal Medicine at the University of Nebraska Medical Center (UNMC), in Omaha.
ASCO states that it supports the United States Congress, the Obama Administration, and multiple federal agencies in their efforts to prevent and respond to prescription drug abuse. The policy statement provides principles to balance the public health concerns regarding the abuse and misuse of prescription opioids. It also calls for ensuring access to appropriate pain management for patients with cancer and survivors. ASCO’s policy states that patients with cancer should be largely exempt from regulations restricting access to or limiting doses of prescription opioids, citing the unique nature of the disease, its treatment, and potentially life-long adverse health effects.
“ASCO hopes that policy makers engaged in efforts to curb opioid misuse and abuse will consider the society’s policy statement and introduce proposals that reduce the rates of opioid misuse and abuse while protecting cancer patient access to pain management medications,” said Dr Vose.
ASCO recommends that providers have a choice of source material for opioid-prescription education, which ought to be evidence-based and tailored by specialty. ASCO does not support prescription limits that would impede access to medically necessary treatment. It does support, however, existing exemptions to prescription limits for patients with cancer.
“Cancer patients already face a complex and often fragmented health care system, and they should not face additional hurdles for pain management. For some patients, existing barriers include limits on initial prescriptions, refills, difficulties with insurance authorization, and the higher cost of new opioid formulations. Current proposals being considered by state and federal governments would implement additional restrictions on both patients and physicians,” Dr Vose told Cancer Therapy Advisor.
Providers who treat cancer-related pain may prescribe relatively large numbers of opioids or provide multiple controlled drugs at relatively high doses. The statement cautions that efforts to identify prescription patterns must consider provider specialty, sub-specialization, patient populations, and other factors that influence prescription patterns.