The United States is at war on a number of fronts. But here at home, a war is waging that might best be called the “Opioid War.” And like most wars, it is having a number of serious and unintended consequences.
As deaths from both prescription and non-prescription opioids skyrocketed in recent years, American policymakers have responded in a number of ways. The most pervasive of these has been to pass laws and regulations that limit which opioids doctors can prescribe, and in what doses and under what circumstances they can prescribe them. The Centers for Disease Control and Prevention has also issued guidelines that discourage the use of opiates for patients with chronic pain. The goal: to limit the amount of prescription painkillers in circulation and decrease opioid-related deaths.
The result of these efforts has been a decrease in the number of opioid prescriptions patients receive. However, there has not been a concomitant decrease in overall drug deaths. In fact, over 50,000 Americans died from drug overdoses in 2016, the highest number ever reported. And while the death rate from prescription opioid overdoses stayed relatively flat, deaths from heroin were up 23 percent. Even more disturbingly, deaths from illicit synthetic opioids such as fentanyl were up a whopping 73 percent.
Thus, it appears that the nation’s Opioid War is failing miserably — at least in curbing drug-related deaths. However, it has succeeded in limiting legal access to prescription painkillers for many patients who need them, including those with cancer.
Cancer Pain Undertreated
Historically, cancer pain has been seriously undertreated. This is especially true for people who are no longer undergoing intensive therapies and are doing “well.” Yet, according to Dr. Natalie Moryl, a pain specialist at Memorial Sloan Kettering Cancer Center in New York City, up to 40 percent of patients who are “off-therapy” report persistent pain. And it’s these patients who are at the greatest risk of needless suffering.
“It is important that there are proper measures in place to prevent overdoses,” Dr. Moryl said in a statement on the MSKCC website. “But we in the cancer community place the highest priority on controlling the pain of our patients.”
Dr. Moryl goes on to describe the obstacles that even cancer patients who are undergoing treatment now face. She relates the case of a young single mother with breast cancer who was suffering persistent pain. Her primary doctor prescribed a fentanyl patch, a safe means of delivering a strong painkiller continuously through the skin. Unfortunately, the patch is only effective for 72 hours. And because of stricter prescribing guidelines, her pharmacy could only dispense one patch at a time.
“Every three days the patient had to contact her doctor’s office to get a three-day supply of the opioid e-prescribed, then go to the pharmacy and wait for the prescription to be filled — all while being very ill from the cancer and busy receiving radiation and chemotherapy as well as being a single parent for her teenage daughter,” Dr. Moryl says.
Looking for Solutions
Dr. Moryl is a member of the Adult Cancer Pain Panel for the National Comprehensive Cancer Network. The group is an alliance of leading cancer centers that develops treatment guidelines for cancer and cancer-related symptoms such as pain. She and other members of the initiative work with pharmacies and insurers to teach them about the importance of pain management in cancer care.
Teaching safety and safe storage practices to patients is also important, Moryl explains. As a rule, opioids are very safe for cancer patients. The risk of addiction is minimal, and most overdose deaths occur in people for whom the medication was not prescribed. “My colleagues and I make a point of explaining why it’s essential not to share medications with family members or friends — or other cancer patients — and to store the drugs safely,” she says. “Even disposing of the drugs properly is important…You should not have leftovers from six months ago sitting around.”
As drug-related deaths continue to soar, it’s inevitable that lawmakers will seek even more restrictions on prescription opioids, regardless of how effective those restrictions are at preventing deaths. In the meantime, Dr. Moryl and others like her will continue to help patients living with cancer achieve a reasonable quality of life.