Despite Regulations, Patients With Cancer Pain Still Need Safe Access to Opioids
Each day, more than 175 Americans die (https://www.ons.org/sites/default/files/ONS_Issue_Brief_on_Opioid_Crisis.pdf) from an opioid-related overdose. Misuse of, addiction to, and overdose from opioids cost the United States $78.5 billion a year (https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis), “including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.”. Other alarming numbers abound (https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis): 21%–29% of patients who are prescribed opioids misuse them, 4%–6% of those transition to heroin, and 80% of people who use heroin first misused prescription opioids.
To address these disturbing statistics, in October 2017, President Trump declared the opioid crisis a national public health emergency, and state governments began implementing regulations to limit and control the drugs’ dispensing. However, many groups, including ONS, want to ensure that such regulations and policies do not restrict access for patients with cancer who need opioids for the pain that can occur during cancer.
ONS Perspective
ONS has maintained a longstanding position statement (https://www.ons.org/advocacy-policy/positions/practice/pain-management) regarding cancer pain management, where one of the tenets posits that “regulatory, legislative, economic, and other barriers to effective cancer pain management must be eliminated.” When it comes to public health regulations and policies, officials should understand the impact that new restrictions on pharmacies and prescribers may have on patients with cancer. Patients experiencing cancer pain don’t have the luxury of waiting for prior authorizations, mandatory wait times, and dose or packaging restrictions. Congress and regulatory officials should make policy exceptions for patients with cancer (https://www.ons.org/sites/default/files/ONS_Statement_on_Opioid_Crisis_Dec_2017.pdf) to prevent unnecessary suffering and improve quality of life.
What Oncology Nurses Need to Know
According to ONS’s position statement, oncology nurses have an ethical responsibility to assess cancer-related pain and use evidence-based management guidelines for opioids. They are responsible for educating patients and family caregivers (https://www.ons.org/advocacy-policy/positions/practice/pain-management) on proper dosing as well as the safe usage, storage, and disposal of opioids.
Despite these measures, opioid misuse can still occur. At this point, ONS’s recommendation is that oncology nurses question patients and families where misuse is suspected; however, the Society will be exploring different ways that oncology nurses can better monitor and assess for opioid misuse. Additionally, because opioid misuse becomes more likely the longer a patient is taking the medication, ONS will also be investigating opioid addiction (https://www.ons.org/sites/default/files/ONS_Issue_Brief_on_Opioid_Crisis.pdf) in cancer survivors who may be taking opioids for long-term effects.
The President’s Commission on Combatting Drug Addition proposed a model training program to better equip healthcare providers, including oncology nurses, to monitor and treat patients who are likely to misuse opioids prescribed for cancer pain. ONS supports the training program as well as the commission’s proposed requirement of continuing nursing education courses on opioid prescribing.
For ongoing coverage about the opioid crisis and other opioid-related news, check out similar articles on the ONS Voice (http://voice.ons.org/topic/pain-management).