Carve out cancer patients from opioid restriction programs, ASCO says

Cancer patients should be largely exempt from regulations restricting access to or limiting doses of prescription opioids, according to a policy statement from the American Society of Clinical Oncology (ASCO).

“ASCO Policy Statement on Opioid Therapy: Protecting Access to Treatment for Cancer-Related Pain” provides principles that the society intends to balance the public health concerns regarding the abuse and misuse of prescription opioids with the need to ensure access to appropriate pain management for cancer patients and survivors.

The statement was posted on the ASCO Web site on May 23, as was a press release.

The statement's points include the following:

• Clinicians' opioid prescribing education should be evidence-based and tailored by specialty.
• The society does not support prescription limits that would artificially impede access to medically necessary treatment for patients with cancer. ASCO does support existing exemptions to prescribing limits for cancer patients and believes these exemptions should remain in place.
• Patient education on the medical use of opioids is best provided by a health professional. The society supports efforts by the government to encourage greater emphasis on safe storage and disposal of prescription medication and believes such efforts should be strengthened.
• Efforts to identify prescribing patterns must consider clinician specialty, subspecialization, patient populations, and other factors that legitimately influence prescribing patterns, because clinicians who treat cancer-related pain may prescribe relatively large numbers of opioids or provide multiple controlled drugs at relatively high doses.
• After the initial screening and assessment of patients with cancer, the type and timing of subsequent assessments should be determined by the treating physician. Adherence tools following an initial prescription may be valuable but should not be mandatory for all patients receiving opioids.
• Use of either an abuse-deterrent formulation or non-abuse-deterrent formulation of an opioid medication may be appropriate. The prescribing physician, in consultation with the patient, should decide which is preferred based on clinical and patient-specific circumstances.
• Individuals with an opioid-related disorder should have rapid access to appropriate assessment, diagnosis, and treatment, regardless of payer or geographic setting. ASCO fully supports efforts to expand the availability of medication-assisted treatment and to expand Medicare and Medicaid coverage of such treatment.
• ASCO supports increased access to naloxone in cases of opioid overdose. Caregivers should be instructed on the correct use of overdose antidotes, and such education should pay particular attention to timing the administration of the medication, as well as distinguishing the symptoms of an opioid overdose from those of advanced disease.
• Authorized collection sites should be readily available to patients to decrease the availability of unused or unwanted opioid drugs, and ASCO supports federal efforts to provide additional funding for these programs.

“ASCO is supportive of efforts to address issues of opioid abuse and its related consequences; however, some elements of both state and federal tightening of controls could introduce barriers to appropriate treatment of pain related to cancer and its treatment, thereby harming a vulnerable population,” according to the statement. “There is already strong evidence of under treatment of cancer-related pain and new barriers would serve to worsen this situation.”