About 70 percent of patients with advanced cancer and near the end-of-life experience moderate-to-severe pain. While there is international support for using opioid analgesics as first-line pain management in this population, opioids dispensed to patients with advanced cancer or in palliative care have seen a 40 percent decline since 2011.
In the years since, a multitude of policy and practice changes were implemented in the US to mitigate unsafe opioid prescriptions among the general population. One prominent strategy is state legislative mandates that require prescribers to check state Prescription Drug Monitoring Programs (PDMPs) when prescribing opioids. These statewide databases provide information on controlled substances filled at retail pharmacies. Mandated PDMP use may negatively, albeit inadvertently, restrict access to opioid analgesics for cancer-related pain. These negative effects may disproportionately impact racial and ethnic minorities, as recent national studies have documented persistently lower opioid analgesics received by non-Hispanic Black, Hispanic, and Asian patients dying of cancer compared with non-Hispanic white patients.
A study in JCO Oncology Practice from Dr. Yuhua Bao, professor of population health sciences, and colleagues evaluated the association between comprehensive PDMP mandates and opioid analgesics dispensed to older Medicare patients dying of cancer. The study further determined how these associations differed by patient race and ethnicity.
Results indicate that state implementation of comprehensive PDMP mandates was associated with a two-to-five-percent relative reduction in the rate or dose of opioid analgesics dispensed to patients dying of cancer. The overall modest effect, however, masked substantial differences by patient race and ethnicity. Compared with non-Hispanic whites, non-Hispanic Black decedents experienced a four-fold reduction, and Asian/Pacific Islander decedents experienced a two-fold reduction in the rate of receiving opioid analgesics at the end of life. These findings can help guide public and private policies regarding PDMP mandate implementation, especially concerning effective exempting and overriding mechanisms to mitigate unintended consequences for patients dying of cancer.
- Highlights