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TREATMENT INSIGHTS
Protecting Access to Treatment:
Opioid Therapy for Cancer-Related Pain
Megan Bodge, working to revise and strengthen their patients.4 Many barriers already exist
PharmD BCOP own laws regarding prescription opioids. for effective pain management in cancer
Clinical Oncology Pharmacist Measures being implemented include patients, and more restrictions may
WVU Medicine limits on quantities of prescribed opioids only compound the issue. Though many
Morgantown, WV and increased requirements regarding regulations already have excluded patients
PDMPs, as well as and provider and patient undergoing active cancer treatment, there
Drug overdose deaths are at an all-time education.3 is ongoing concern that the needs of cancer
high with a large number of those deaths survivors, or those not undergoing active
attributable to opioids, including both pre- Though this is certainly a complex treatment but still with active cancer, may
scription opioid pain relievers and “street” topic and efforts to curb opioid abuse are not be fully met.
drugs such as illicit fentanyl and heroin. largely needed, it is unclear what impact
The Centers for Disease Control and Pre- increased regulations may have on cancer HOPA has identified pain management
vention (CDC) has estimated that 78 peo- patients and survivors suffering from as an issue of importance to monitor as
ple die each day from an opioid overdose in moderate-to-severe pain. It also has been part of its Health Policy Agenda to ensure
America and that between 2000 and 2014, unproven that treatment of cancer-related patients have access to essential pain
nearly half a million Americans perished pain with opioid medications has worsened medications. A policy statement issued
from opioid abuse.1 Heroin initiation and the problem of opioid overdoses. In May in 2014 provides recommendations to
dependence has been rapidly increasing in 2016, the American Society of Clinical help achieve this goal while avoiding
recent years, and many users report initial Oncology (ASCO) issued a policy state- opioid abuse and misuse.6 Pharmacists
use of prescription opioids for nonmedical ment putting forward several principles to are well suited to provide comprehensive
reasons prior to heroin use.2 Analysis of balance access for appropriate patients and education regarding opioid regimens and
prescribing patterns for opioids indicate curbing misuse of prescription opioids.3 assuage patient fears related to addiction
an increase in prescriptions for opioid pain The full statement can be accessed at www. and side effects. We also can serve as a
medications without a reported increase asco.org/advocacy-policy/policies- resource to provide education regarding
in patients reporting pain, which has likely positions-guidance/policy-statements. safe manipulation, storage, and disposal
perpetuated these issues.1 of medications. We can assist providers
Highlighted in the statement is that with selecting appropriate regimens for
To combat the “opioid epidemic,” many cancer patients should be considered a spe- patients based on individual factors and
federal agencies are expanding efforts to cial patient population and should likely suggest tools for assessing adherence, such
reduce opioid misuse and abuse. Efforts be excluded from much of the impending as pain diaries and pill counts.5 All fellow
currently being investigated and imple- legislation and regulations. Pain has pharmacists also are encouraged to stay
mented include expansion of educational been reported as one of the most feared abreast of ongoing regulatory efforts and
efforts, increased availability and improved consequences following a cancer diagnosis legislation, both nationally and at the state
access to naloxone, expansion of resources and may impact quality of life, level. Ultimately, a balance must be found
for addiction treatment of incarcerated physical functioning, psychological well- to address the ongoing problem of opioid
individuals, increased access to drug being, and even survival. Opioid therapy abuse and misuse while still allowing
disposal sites, new evidence-based opioid has been the gold standard for treatment access to essential medications for patients
and heroin treatment programs, and of moderate-to-severe cancer-related pain, with cancer-related pain being treated in
strengthened prescription drug monitor- and guidelines for cancer pain manage- accordance with best clinical practices.
ing programs (PDMPs).3 Many states are ment support opioid use in appropriate
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