The Exchange

Commentary and Observations from
the Medical Front Lines

The Dilemma of the Opioid Crisis and Cancer Pain

The Dilemma of the Opioid Crisis and Cancer Pain

The misuse of opioids and inappropriate prescribing patterns have led to addiction and overdose deaths in the United States that have risen sharply in the past 10 years. According to the Centers for Disease Control and Prevention website, from 2016 to 2017 alone drug overdose deaths rose by 9.6%, with over 70,200 opioid-related deaths. Fentanyl or fentanyl analogs are the number one drug causing opioid overdose deaths.

In 2016, the American Society of Clinical Oncology offered recommendations for prescribers for managing chronic cancer pain in the age of the opioid crisis. Some of these recommendations include:

  1. Screen for pain at each patient encounter
  2. For new-onset pain: evaluate, treat, and monitor
  3. For complex pain cases: seek the help of pain management clinicians
  4. Consider non-opioid medications to manage pain and improve function
  5. Employ conservative management first, then a trial of opioid therapy in carefully selected patients who continue to experience distress or functional impairment
  6. Assess for the risks of adverse events from opioid therapy
  7. Understand the terminology surrounding tolerance, dependence, abuse, and addiction as they relate to opioids, and use strategies to minimize abuse, addiction and adverse consequences

Cancer pain must be managed appropriately, but proper assessment and detailed evaluation of the pain, as well as the patient, must be implemented. In Pennsylvania, where I practice, nurse practitioners must undergo 2 hours every 2 years of specific opioid prescribing education to maintain their licenses. Plus, many insurances now require routine urine drug screening in patients actively taking opioids, to look for the presence of the drug in the urine. We must remain vigilant to properly evaluate and manage cancer pain while taking into consideration the overwhelming opioid crisis resulting in more deaths annually than some cancers themselves.

Reference
  • Paice JA, Portenoy R, Lacchetti C, et al. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016;34:3325-3345.

Filed under: Oncology/Hematology, Substance Abuse

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