Opioid Treatment of Pain in People with Cancer: Intended and unintended consequences of state policies addressing opioid prescribing

ABSTRACT
Chronic cancer-related pain is highly prevalent and international guidelines have long supported the use of
opioid therapy for moderate to severe pain related to active disease. The strength of such consensus is
strongest for patients experiencing advanced disease and limited life expectancy. For patients experiencing
long-term remission, or, stable or indolent disease without the need for ongoing anti-cancer treatment (“long-
term survivorship”), there is emerging consensus that opioid therapies should be addressed in a similar
manner as for patients with chronic non-cancer pain. There is mounting ambiguity regarding best practices for
patients receiving active anti-cancer treatment intended for cure. In the wake of the opioid epidemic, state
policies have proliferated in an effort to reduce unsafe opioid prescribing. Prominent recent policies include
state mandates for prescriber participation in the Prescription Drug Monitoring Programs (PDMPs) and state
legislative limits on duration and/or dosage of opioid prescriptions for acute pain. These policies vary in their
intended applicability to subpopulations of cancer patients, and, coupled with the ambiguity regarding clinical
best practices, may have inadvertently impacted opioid use and related outcomes among the different
subpopulations of people with cancer. We propose a study to evaluate intended and unintended consequences
of the two types of state policies for opioid prescriptions and pain- and opioid-related adverse health events
among cancer patients with advanced disease, long-term survivors, and patients receiving active cancer
treatment. To help elucidate mechanisms underlying changes in response to policies, we will also explore the
trajectories of opioids dispensed and clinical encounters within each subpopulation, using an innovative pattern
mining approach. We will use the SEER-Medicare linked database and a large national commercial insurance
database to achieve study aims. Findings will inform consensus-building, guideline and intervention
development, and policy and practice changes by providers, health care organizations, and policymakers in
optimizing opioid prescribing and pain management for cancer patients.

Grant Number: 5R01CA267996-04
NIH Institute/Center: NIH
Principal Investigator: Yuhua Bao