Cancer Patients' Perceived Difficulties Filling Opioid Prescriptions After Receiving Outpatient Supportive Care

Abstract

Context. Limited access to opioids for patients with cancer has been reported as a potential unintended consequence of recent regulations restricting opioid use and prescribing practices. To our knowledge, there are a limited number of peerreviewed studies that evaluate the perceived difficulties of the patients with cancer when filling their opioid prescription. To understand these difficulties, we surveyed patients receiving opioids in our outpatient supportive care center (SCC).Objectives. The primary objective of this study was to evaluate cancer patients' perceptions of overall difficulties when filling their opioid prescription. Secondary objectives included determining associations between patient characteristics and difficulty and comparing difficulty between filling opioid and nonopioid prescriptions.Methods. Patients with cancer receiving opioids that had been seen two times or more at our SCC were asked to complete a survey. The information collected included patient demographics, clinical characteristics, and patients' experiences filling their opioid prescription.Results. The patients' median age was 60 years; 54% were female and 69% were white. Forty-four patients (32%) reported that they have experienced difficulty filling their opioid prescription. More than 25% of those 44 patients perceived difficulty from interactions with the pharmacy and/or pharmacist. Forty-six patients (33%) reported more difficulty filling their opioid prescriptions than filling their nonopioid prescriptions.Conclusion. This study provides evidence that patients with cancer visiting our SCC perceived difficulties obtaining their opioid prescriptions. The results suggest that negative interactions with the pharmacy and/or pharmacist contribute to their perceived difficulty. Additional research is needed to further characterize the contributors of the difficulties patients with cancer face in filling their opioid prescriptions. J Pain Symptom Manage 2020;60:915e922.

Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline

“…99,100 When provided a prescription for an opioid, patients with cancer consistently recount problems obtaining the medication, with one quarter describing perceived difficulties during interactions with pharmacy staff. 101 Some of these problems arise because of the complexities of medication dispensing in our current health care system. Is the drug available at the pharmacy, and if so, will insurance pay?…”

Manifestations of Opioid Stigma in Patients With Advanced Cancer: Perspectives From Patients and Their Support Providers

“…6 Since then, studies conducted in Massachusetts, Georgia, Texas, and the Midwest described patient-reported fears of addiction, difficulty filling opioid prescriptions, negative media coverage, and guilt. [7][8][9][10] A recent study of oncologists in western Pennsylvania, an area severely affected by the opioid crisis, described stigmatizing interactions between patients and clinicians, pharmacists, and society in general. 11 Exploring these concerns with patients directly will fill an important gap in this literature.…”

When Management of Cancer-Related Pain Is Complicated by Coexisting Opioid Use Disorder

“…These recommendations include limits on daily dosing, the use of signed agreements, urine drug screening, medication-assisted therapy (MAT), prescription drug monitoring programs (PDMPs) monitoring, and prescribing rescue doses of naloxone 3 . The CDC guidelines specifically state that they are “not intended for patients undergoing active cancer treatment, palliative care, or end-of-life care.” This was reiterated in an additional statement published in 2019 after case reports of patients receiving cancer treatment being denied opioid prescriptions because of insurance company and pharmacy chain policies and restrictions based on the CDC guidelines 7-10 …”

“…This was reiterated in an additional statement published in 2019 after case reports of patients receiving cancer treatment being denied opioid prescriptions because of insurance company and pharmacy chain policies and restrictions based on the CDC guidelines. [7][8][9][10] Cancer pain guidelines often fail to fully address how to approach care for patients who are deemed high risk for development of or have already been diagnosed with SUDs. 4,11 Many national and international organizations, including the American Society of Clinical Oncology, World Health Organization, The European Society for Medical Oncology, and the National Comprehensive Cancer Network (NCCN), have developed clinical practice guidelines specifically addressing the treatment of cancer-and treatmentrelated pain.…”