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Oncologists, Hematologists Welcome CDC Clarification on Opioid Therapy for Chronic Pain

Allison Inserro
Oncologists and hematologists are welcoming a clarification from the CDC about the use of opioid pain relief for patients with cancer, past cancer, or sickle cell disease, and they are hopeful that payers see the update so that patients in pain are not denied or delayed relief.
Oncologists and hematologists are welcoming a clarification from the CDC about the use of opioid pain relief for patients with cancer, past cancer, or sickle cell disease, and they are hopeful that payers see the update so that patients in pain are not denied or delayed relief.

In 2018, 2 years after the CDC issued voluntary guidelines meant for primary care physicians prescribing opioids for acute pain, physicians across the country started reporting that payers had adopted the guidelines as gospel and were denying opioid prescriptions, or increasing the use of prior authorizations, for patients suffering from pain stemming from cancer treatment, end-of-life care, and other conditions.

The issue picked up steam as organizations like the American Medical Association stepped in; in addition, a viewpoint published in JAMA Oncology said that inconsistency in and lack of evidence were putting patients at risk of inadequate pain relief.

In November, representatives of the National Comprehensive Cancer Network, the American Society of Clinical Oncology (ASCO), and the American Society of Hematology met with the CDC to discuss the complex issue, as clinicians have to decide how to prescribe opioids safely while also being mindful of the potential for dependence and abuse, either by the patient or possibly by those taking care of the patient who might have access to the medication.

Scott Gottlieb, MD, who departed the FDA as commissioner last week, gave a presentation in the beginning, said Judith A. Paice, PhD, RN, who directs the cancer pain program in hematology-oncology at Northwestern University’s Feinberg School of Medicine, in an interview with The American Journal of Managed Care® (AJMC®). Stakeholders at the meeting discussed how multiple guidelines for opioid prescribing had the unintended consequence of changing both practice and reimbursement by payers.

In mid-February, the organizations followed up with a letter to Deborah Dowell, MD, MPH, the chief medical officer for the opioid response coordinating unit at the CDC, asking the CDC to release an immediate clarification that the 2016 guidelines were not intended to apply to patients in active cancer treatment.

“Although the CDC guideline clearly states that the guideline is not intended to apply to this population, many payers are still inaccurately applying the CDC guidelines to patients in active treatment for coverage determinations relating to opioids,” the February letter said.

In addition, while the CDC guidelines on pain management are intended to apply to cancer survivors, the organizations said that at their meeting they discussed that for some groups of cancer survivors “the relationship of benefits to risk in the use of opioids is unique and distinct from the needs of other patients with chronic pain. These survivors may have persistent pain due to either past cancer or past cancer treatment.”

On Tuesday, the organizations released a February 28 letter from the CDC that they hope will gain the attention of payers. “The Guideline is not intended to deny any patients who suffer with chronic pain from opioid therapy as an option for pain management,” the letter states.

The guidelines were written in response to rising drug overdose deaths, starting first with increased prescribing of opioids, followed by increases in overdose deaths from heroin and now from illicitly manufactured fentanyl (as opposed to prescription fentanyl, which comes as a patch or lozenge, usually for advanced cancer pain).

The CDC has said that on average 130 Americans die every day from an overdose of opioids, although in 2017 synthetic opioids, or illicit opioids, drove most of the 47,600 opioid-related deaths.


 
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