Challenges to Opioid Prescription Access among Patients with Advanced Cancer

Vidal, Marieberta; Reddy, Akhila; Rodriguez, Eden Mae; Park, Minjeong; Liu, Diane; Bruera, Éduardo

doi:10.1089/jpm.2018.0577

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…63 Furthermore, although a prior authorization may eventually be approved, patients are frequently charged higher, onerous copays. 102…”

Section: Barriers To Opioid Accessmentioning

confidence: 99%

“…63 Furthermore, although a prior authorization may eventually be approved, patients are frequently charged higher, onerous copays. 102 The consequences of these burdensome regulatory and payment requirements include stigma and fear. People with cancer report stigma related to opioid use generated by their interactions with clinicians, pharmacists, and society.…”

Section: Barriers To Opioid Accessmentioning

confidence: 99%

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

Paice

Bohlke

Barton

et al. 2023

JCO

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PURPOSE To provide guidance on the use of opioids to manage pain from cancer or cancer treatment in adults. METHODS A systematic review of the literature identified systematic reviews and randomized controlled trials of the efficacy and safety of opioid analgesics in people with cancer, approaches to opioid initiation and titration, and the prevention and management of opioid adverse events. PubMed and the Cochrane Library were searched from January 1, 2010, to February 17, 2022. American Society of Clinical Oncology convened an Expert Panel to review the evidence and formulate recommendations. RESULTS The evidence base consisted of 31 systematic reviews and 16 randomized controlled trials. Opioids have primarily been evaluated in patients with moderate-to-severe cancer pain, and they effectively reduce pain in this population, with well-characterized adverse effects. Evidence was limited for several of the questions of interest, and the Expert Panel relied on consensus for these recommendations or noted that no recommendation could be made at this time. RECOMMENDATIONS Opioids should be offered to patients with moderate-to-severe pain related to cancer or active cancer treatment unless contraindicated. Opioids should be initiated PRN (as needed) at the lowest possible dose to achieve acceptable analgesia and patient goals, with early assessment and frequent titration. For patients with a substance use disorder, clinicians should collaborate with a palliative care, pain, and/or substance use disorder specialist to determine the optimal approach to pain management. Opioid adverse effects should be monitored, and strategies are provided for prevention and management. Additional information is available at www.asco.org/supportive-care-guidelines .

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“…63 Furthermore, although a prior authorization may eventually be approved, patients are frequently charged higher, onerous copays. 102…”

Section: Barriers To Opioid Accessmentioning

confidence: 99%

Section: Barriers To Opioid Accessmentioning

confidence: 99%

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

Paice

Bohlke

Barton

et al. 2023

JCO

Self Cite

View full text Add to dashboard Cite

show abstract

“…Many pharmacies carry limited supplies and some decline stocking any controlled substance [ 14 ]. Insurers require time-consuming, labor intensive prior authorizations which cause delays, narrow formulary options and increase high co-pays for patients [ 15 ]. These obstacles and increased concern about regulation and fear of legal action on prescribing opioids has affected prescribing practices.…”

Section: Opioid Use: Benefits and Challengesmentioning

confidence: 99%

Cancer pain during an epidemic and a pandemic

Paice

2022

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review As our global population ages, cancer has become more prevalent. Thankfully, oncologic treatments are highly effective, leading to significantly improved rates of long-term survival. However, many of these therapies are associated with persistent pain syndromes. Clinicians caring for people with cancer must understand how the influence of the current epidemic of opioid misuse and the coronavirus disease 2019 (COVID-19) pandemic have complicated cancer pain management. Creative solutions can emerge from this knowledge. Recent findings Persistent pain due to cancer and its treatment can be managed through multimodal care, although efforts to mitigate the opioid misuse epidemic have created challenges in access to appropriate treatment. Isolation measures associated with the COVID-19 pandemic have limited access to nonpharmacologic therapies, such as physical therapy, and have exacerbated mental health disorders, including anxiety and depression. Summary Cancer pain treatment requires more nuanced assessment and treatment decisions as patients live longer. Societal factors multiply existing challenges to cancer pain relief. Research is needed to support safe and effective therapies.

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