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VOLUME 13 | ISSUE 3
Other principles addressed in ASCO’s policy statement3 include
• Education for providers—Risk Evaluation and Mitigation some providers may have legitimate reasons to prescribe
Strategies (REMS) have been in place for certain opioid high quantities of opioids in the course of their practice,
medications for approximately 2 years. In May 2016, the particularly in certain subspecialties.
U.S. Food and Drug Administration (FDA) panel decided
to broaden REMS programs to include immediate-release • Patient screening and assessment before and during
opioids and require mandatory provider education. Devel- opioid treatment—ASCO does not endorse mandating
opment of education related to REMS requirements falls to specific requirements after initial patient screening and
the manufacturer of the medication. ASCO advocates for assessment. Specific practices should be left to the decision
provider choice in materials used for education. It endorses of the treating provider.
the use of materials that are evidence based and geared
toward improving outcomes related to overdoses. • Abuse-deterrent formulations—ASCO cautions that
abuse-deterrent formulations may limit access for certain
• Education for patients—ASCO endorses healthcare patients, given the high cost associated with manufacturing
providers as being best suited to provide education about and obtaining these products. It recommends consideration
opioid therapy for patients. Education should be clear of both abuse-deterrent and nonabuse-deterrent formula-
and comprehensive regarding benefits and risks of opioid tions for appropriate patients.
therapy, with an emphasis placed on safe storage of medi-
cations. Misunderstandings regarding cancer pain can lead • Treatment for misuse, abuse, or addiction—ASCO offers
to suboptimal pain control, so it is essential that education full support of current efforts by Congress and the Adminis-
for both providers and patients does occur to lead to better tration to expand availability and coverage of medication-
patient outcomes. assisted treatment (MAT) for individuals with an opioid-
related disorder.
• Prescription limits—ASCO endorses existing exemptions
for cancer patients in current regulations. It does not • Prescription “Take-Back” programs—ASCO advocates
endorse placing limits on quantities prescribed to patients for increased access to collection sites for unwanted or
for cancer-related pain as they may limit access to needed unused opioid medications. It also endorses changes to the
medication. If limits are put in place, ASCO advocates for Controlled Substances Act that would allow pharmacies to
alternative means by which patients may be able to obtain accept returned opioids and other controlled substances.
additional medication, if needed.
• Wider availability of naloxone—ASCO supports increased
• PDMPs—ASCO recognizes the benefits of PDMPs but also access to naloxone as a lifesaving medication for patients
advocates for increased streamlining of the systems, ease at risk of opioid overdose. It specifically comments on the
of use, and real-time reporting. ASCO also advises caution need for caregiver education so caregivers can properly
with interpretation of data collected from PDMPs, given that administer the medication and distinguish opioid overdose
from symptoms of advancing disease.
REFERENCES 4. Glare PA, Davies PS, Finlay E, et al. Pain in Cancer Survivors. J Clin
Oncol. 2014;32(16):1739-47.
1. Centers for Disease Control and Prevention. Increases in Drug and
Opioid Overdose Deaths—United States, 2000-2014. MMWR. 2015;64:1-5. 5. NCCN. Adult Cancer Pain. Practice Guidelines in Oncology. 2016 Nation-
al Comprehensive Cancer Network. Version 2.2016.
2. Centers for Disease Control and Prevention. Demographic and Sub-
stance Use Trends Among Heroin Users—United States, 2002-2013. 6. HOPA Pain Management Issue Brief. www.hoparx.org/uploads/Health_
MMWR. 2015;64(26):719-25. Policy/2016/HOPA_Pain_Managment_Issue_Brief.pdf. Published August 22,
2014. Accessed June 27, 2016.
3. ASCO Policy Statement on Opioid Therapy: Protecting Access to
Treatment for Cancer-Related Pain. www.asco.org/sites/new-www.asco.
org/files/content-files/advocacy-and-policy/documents/2016_ASCO%20
Policy%20Statement%20on%20Opioid%20Therapy.pdf. Published May
2016. Accessed June 25, 2016.
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