Opioid restrictions may contribute to unrelieved pain in mNSCLC
Although it is common to prescribe opioids for pain management for patients with metastatic non-small cell lung cancer, there has been a decline in opioid prescription rates since 2015, which may be attributed to the increased restrictions on opioid access, according to data presented at the virtual ASCO Annual Meeting.
“The unintended consequences of efforts to address the opioid epidemic are changing prescribing patterns for cancer patients,” Judith A Paice, PhD, RN, research professor of medicine at Northwestern’s Feinberg School of Medicine, told Healio. “There is great concern that this is resulting in unrelieved cancer pain.”
The researchers conducted a retrospective, observational analysis to evaluate the impact of opioid reduction policies put in place by the government, payers and institutions on the oncological prescription rate of opioids for the management of cancer pain among patients with metastatic non-small cell lung cancer (mNSCLC). Using deidentified electronic health record data from ASCO’s CLQ Discovery database, Paice and colleagues analyzed 18,106 patients with mNSCLC who had a clinical encounter between 2010 and 2017.
Between 2010 and 2015, the annual rate of opioid prescriptions increased. However, the rate then decreased in 2016 and 2017. Hydrocodone was prescribed to 4,211 patients, making it the second most frequently prescribed opioid overall. Despite this, the rate of prescriptions began to decline in 2012, according to the abstract.
“The American Society of Clinical Oncology published guidelines in 2016 about safe pain management for people who are survivors of cancer pain,” Paice said. “The guidelines are available, but we need greater dissemination and education.”
The prescription rates for tramadol and acetaminophen with codeine gradually increased over the 7-year analyses period. According to Paice, both drugs were designated as schedule 3 narcotics so “there is the perception that they are safer because they aren’t as regulated.”
“We have to take a multipronged, or multifaceted, approach,” Paice said. “We need more specific information about what people were actually taking, ... all the different demographic variables that we are concerned about that demonstrate either geographic changes in reimbursement or possibly even implicit bias.”
Paice continued to emphasize the need for robust data and more research, particularly regarding the impact of reimbursement policies.
“Much of the concern related to the change in the prescribing is a sense that some of these changes are related to reimbursement,” she said. “This is another area where we need information: were patients denied access or was access limited because of fears in terms of prescribing or lack of reimbursement for particular medications?”
Collapse
Paice JA, et al. Abstract 2076. Presented at: ASCO20 Virtual Scientific Program; May 29-31, 2020.
Read more about