The complex issues surrounding prescription opioids are addressed in a new policy statement from the American Society of Clinical Oncology (ASCO). As multiple federal offices and agencies make efforts to prevent and respond to prescription drug abuse, ASCO supports their effort and is also working to protect access to appropriate medical opioid therapy for patients with cancer.1
Several concepts are included in the new policy statement.
First, ASCO asserts that persons with cancer are a special population. These patients should be largely exempt from regulations restricting access to or limiting doses of prescription opioids in recognition of the unique nature of their disease, its treatment, and potentially life-long adverse health effects from having had cancer.
The ASCO statement recommends that providers have a choice of sources for educational materials on prescribing opioids, and that these materials should be evidence-based and tailored by specialty.
ASCO 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.
The view of ASCO on patient education on the medical use of opioids is that it is best provided by a health professional. ASCO supports efforts to encourage more emphasis on safe storage and disposal of prescription medication.
Regarding prescription drug monitoring programs, ASCO states that 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 prescribing patterns must consider the provider’s specialty, sub-specialization, patient populations, and other factors that legitimately influence prescribing patterns.
Patient screening and assessment before and during opioid treatment should be determined by the treating physician. Although adherence tools after an initial prescription may be valuable, they should not be mandatory for all patients receiving opioids.
Whether abuse deterrent or nonabuse deterrent formulations of opioids are used depends on the clinical situation and the use of either may be appropriate. The decision should be made by the prescribing physician, in consultation with the patient, based on clinical and patient-specific circumstances.
For patients with an opioid-related disorder, ASCO supports rapid access to appropriate assessment, diagnosis, and treatment regardless of the patient’s payer or geographic setting. In addition, ASCO supports increased access to naloxone, which is a life-saving medication 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 reduce the availability of unused or unwanted opioid drugs. ASCO strongly supports efforts to rid our communities of unused and unneeded prescription drugs, and supports Congressional and Administration efforts to provide additional funding for these programs.
1. American Society of Clinical Oncology. ASCO releases principles for balancing appropriate patient access to prescription opioids with curbing misuse, abuse of these drugs. http://www.asco.org/advocacy-policy/asco-in-action/asco-releases-principles-balancing-appropriate-patient-access?et_cid=37861275&et_rid=1530150673&linkid=ASCO+Releases+Policy+Statement+on+Opioid+Therapy%3a+Protecting+Access+to+Treatment+for+Cancer-Related+Pain_btn#sthash.kGuVBPVj.dpuf. Published May 23, 2016. Accessed May 29, 2016.