PDMP mandates linked to reductions in opioid analgesics for people dying of cancer
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CHICAGO — Comprehensive prescription drug monitoring program mandates appeared associated with a moderate reduction in the number of opioid analgesics dispensed to people dying of cancer, according to study results.
Reductions were two to three times higher among non-Hispanic Black and Asian/Pacific Islander decedents than non-Hispanic white decedents, findings presented at ASCO Annual Meeting showed.
“Prescription drug monitoring program (PDMP) mandates should explicitly exempt cancer-related pain,” Yuhua Bao, PhD, professor of population health sciences at Weill Cornell Medicine, said during a presentation. “Health care organizations when implementing such mandates should effectively exempt oncology, hematology and palliative medicine providers and [patients with cancer] from mandated use of PDMP.”
Prior research showed rapid decline in the volume of analgesics dispensed to individuals with advanced cancer since 2011, with one study showing a 40% decrease among those with poor-prognosis cancers near the end of life.
“Such rapid declines suggest unintended consequences of policies that were intended to address unsafe opioid prescribing in the general population,” Bao said.
Comprehensive PDMP mandates apply to all settings and specialties, leaving no provider discretion, with prescribers required to check PDMP at the time of first prescription to a patient and annually thereafter.
Twenty-seven states had comprehensive mandates by the end of 2019, with six explicitly exempting cancer-related pain. Another 20 states had non-comprehensive PDMP mandates.
A prior study by Bao and colleagues showed comprehensive PDMP mandates were associated with substantial reductions in opioids dispensed to patients with cancer who had bone metastasis following an ED counter. Another study showed racial or ethnic minority patients had substantially and persistently lower access to opioids than non-Hispanic white patients, Bao said.
In their current study, Bao and colleagues evaluated associations of comprehensive PDMP mandates with opioid- and pain-related outcomes among individuals dying of cancer. They also evaluated potential differences in these associations based on patients’ race or ethnicity.
Researchers used SEER-Medicare data to identify patients aged 66 or older with primary breast, colorectal, prostate or lung tumors who died of cancer in 2011 to 2019 in one of 10 SEER states with operating PDMP on or before Jan. 1, 2011.
Investigators measured opioid prescriptions dispensed to patients near the end of life, defined as 30 days prior to death or hospice admission.
The analysis included 184,123 decedents (52.2% men; 76.3% non-Hispanic white; 9.2% non-Hispanic Black; 7.8% white; 5.1% Asian/Pacific Islander), with more than 45% of the study sample living in California.
Results showed comprehensive PDMP mandates were associated with a 4% to 9% relative reduction in opioid analgesics dispensed to individuals dying of cancer.
Non-Hispanic black decedents having a twofold reduction in the rate of opioid analgesics receipt compared with non-Hispanic white decedents, and Asian/Pacific Islander decedents had a two- to threefold reduction in total dose and daily dose of opioids received compared with non-Hispanic white decedents.
Comprehensive PDMP mandates did not appear associated with changes in the rate of one or more ED visits or hospitalizations.
“More research is needed to shed light on the reasons why we saw disproportionate unintended consequences for minoritized patients and ways to mitigate them,” Bao said.
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Bao Y, et al. Abstract 11003. Presented at: ASCO Annual Meeting; May 31-June 4, 2024.
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