Exempt Only Cancer Patients From Opioid Rules?

ASCO: Exempt Cancer Patients From Opioid Rules | Medpage Today |May 25, 2016

Regulations designed to curb opioid abuse and addiction should “largely exempt cancer patients,” according to a policy statement from the American Society of Clinical Oncology (ASCO).

Characterizing cancer patients as a “special population,” ASCO said a broad exemption from regulations that limit access to or doses of prescription opioids is justified because of the “unique nature of their disease, its treatment, and potentially life-long adverse health effects from having had cancer.”

The distinction between cancer-related and all other pain is simply nonsense: cancer pain is no different than other kinds of constant debilitating pain.  (See NO DIFFERENCE between cancer and non-cancer pain)

Under these terms, I also qualify for an exemption because I suffer from the “unique nature of my genetic disease” and “life-long adverse health effects from having EDS“.

Other “unique diseases”, like CRPS or Fibromyalgia also impose “life-long adverse health effects”.

That principle and others in the policy statement provide guidance to “balance the public health concerns regarding abuse and misuse of prescription opioids with the need to ensure access to appropriate pain management for cancer patients and survivors.”

In announcing the policy statement, ASCO officials expressed the organization’s support for federal efforts to prevent prescription drug abuse but also expressed a commitment to protect cancer patients’ access to “appropriate medical opioid therapy.”

Aside from the “special population” perspective, the “ASCO Policy Statement on Opioid Therapy: Protecting Access to Treatment for Cancer-Related Pain” incorporated the following principles:

  • Healthcare provider access to a choice of materials on prescribing education that is “evidence based and tailored by specialty”;
  • No prescription limits that would “artificially impede access to medically necessary treatment for patients with cancer”;
  • Patient education emphasizing safe use, storage, and disposal of prescription pain medication;
  • Allowances in prescription drug monitoring programs for providers who treat cancer-related pain and “may prescribe relatively large numbers of opioids or provide multiple controlled drugs at relatively high doses”;
  • Appropriate patient screening and assessment before and during opioid treatment, although use of compliance tools should not be mandated for all patients who receive opioids;
  • Use of abuse-deterrent — or non-abuse deterrent — formulations of prescription pain medication, as determined by clinical and patient-specific circumstances;
  • Rapid patient access to assessment, diagnosis, and treatment for opioid misuse, abuse, or addiction;
  • Increased access to naloxone, “a life-saving medication in cases of opioid overdose”; and
  • Prescription “take-back” programs to decrease availability of unused or unwanted opioids, including readily available authorized collection sites for patients.

These sound like reasonable provisions for ALL chronic pain patients.

It’s absurd to limit such normal modern medical care to only one kind of pain, but ASCO mirrors our society’s casual and callous disregard for all other pain patients.

The CDC stated that the guideline focus is on “the use of opioids in treating chronic pain … outside of active cancer treatment, palliative care, and end-of-life care.” However, ASCO, and particularly the ACS, remained unconvinced.

During the public comment period late last year, ACS representatives told the CDC that “the proposed guidelines have the potential to significantly limit cancer patient access to needed pain medicines.”

This complete disregard for all other pain from all other causes is outrageous and inhuman.

However, in stating its unequivocal opposition to the CDC guideline, the ACS outlined concerns that those went far beyond those expressed publicly by ASCO.

“We have concerns about the lack of evidence on which the guidelines were based, the methodology used to develop the guidelines, and the transparency of the entire process.

Our concerns are so serious that we cannot endorse the proposed guidelines in any way and suggest suspending the process until the methodological flaws are corrected and more evidence is available to support prescribing recommendations.”

The ACS subsequently joined other groups and individuals in openly questioning the guideline-development process CDC used for the opioid recommendations, alleging that the CDC “failed to disclose the names, affiliations, and conflicts of interest of the individuals who participated in the construction of these guidelines.”  

Despite ASCO’s focus only on cancer pain, this resistance to the CDC guidelines is encouraging. More and more articles with valid criticisms are showing up in medical journals and even mainstream journalism (i.e. The Fix).

1 thought on “Exempt Only Cancer Patients From Opioid Rules?

  1. Laura P. Schulman, MD, MA

    Another absurdity in this thinking: since many cancer patients actually do not experience much pain, some unfortunately are very happy to fill their “unlimited prescriptions” and sell pills, patches, and other dosage forms to whoever has the money to buy them. I’ve seen this among high school students who were using meds obtained from peers with cancer.

    And then, to heap insult upon injury, the “guidelines” deny cancer survivors treatment for their chemo-related neuropathy. Some reward for having survived!

    Liked by 1 person


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