05/26/2016

ASCO Policy Statement on Opioid Therapy: Protecting Access to Treatment for Cancer-Related Pain

In a new policy statement, the American Society of Clinical Oncology (ASCO) addresses the complex issues surrounding prescription opioids. ASCO supports the United States Congress, the Obama Administration, and multiple federal agencies in their efforts to prevent and respond to prescription drug abuse. In this context, the society is also working to protect access to appropriate medical opioid therapy for patients with cancer.

The statement, “ASCO Policy Statement on Opioid Therapy: Protecting Access to Treatment for Cancer-Related Pain,” provides principles 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:

• Cancer Patients Are a Special Population - ASCO believes that cancer 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.
• Provider Education - The ASCO statement recommends that providers have a choice of sources of materials for opioid prescribing education. Provider education should be evidence-based and tailored by specialty. .
• Prescription Limits - 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 - Patient education on the medical use of opioids is--in ASCO's view--best provided by a health professional. The society supports efforts by the administration to encourage  greater emphasis on safe storage and disposal of  prescription medication, and believes such efforts should be strengthened.
• Prescription Drug Monitoring Programs - 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 - After the initial screening and assessment of patients with cancer, the type and timing of subsequent assessments should be determined by the treating physician, according to ASCO. Compliance tools following an initial prescription may be valuable, but should not be mandatory for all patients receiving opioids.
• Abuse Deterrent Formulations - ASCO believes that, depending on the clinical situation, the use of either an abuse deterrent formulation or non-abuse deterrent formulation of an opioid medication may be perfectly appropriate. The prescribing physician, in consultation with the patient, should decide which is preferred based on clinical and patient-specific circumstances.
• Treatment for Misuse, Abuse, or Addiction - Individuals with an opioid-related disorder should have rapid access to appropriate assessment, diagnosis, and treatment, regardless of the patient's payer or geographic setting. ASCO fully supports Congress and the Administration's efforts to expand the availability of medication-assisted treatment (MAT) and to expand Medicare and Medicaid coverage of such treatment.
• Wider Availability of Naloxone - ASCO supports increased access to naloxone--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.
• Prescription “Take-Back” Programs - In order to decrease the availability of unused or unwanted opioid drugs, authorized collection sites should be readily available to patients. 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.

The full statement is available now.