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Best practices for opioid abuse screening in cancer patients
  1. Jai Narendra Patel1,
  2. Mariam Salib1 and
  3. Armida Parala-Metz2
  1. 1Department of Cancer Pharmacology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
  2. 2Center for Supportive Care and Survivorship, Section of Palliative Medicine, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
  1. Correspondence to Dr Jai Narendra Patel, Department of Cancer Pharmacology, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA; jai.patel{at}atriumhealth.org

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Scope of the problem

More than 115 opioid-related deaths from intentional or accidental overdoses occur every day in the USA.1 Opioids are the leading cause of injury-related fatalities, surpassing automobile-related and gun-related deaths. The Centers for Disease Control and Prevention (CDC) estimates the total economic burden of US prescription opioid misuse is US$78.5 billion per year, including addiction treatment, criminal justice costs, healthcare and lost productivity.2 Opioid overprescribing, lack of universal screening guidelines, regulatory lapses and lack of reimbursement for non-pharmacologic pain control methods contribute to this crisis. In response, the US Department of Health and Human Services is focused on five priorities: (1) improved treatment and recovery access, (2) promoting overdose-reversing treatment awareness, (3) better public health surveillance, (4) support for cutting-edge pain and addiction research and (5) advancing pain management practices.

In 2016, the CDC published guidelines to limit opioid use in non-cancer patients with chronic pain. Nevertheless, cancer patients were impacted since opioids remain the mainstay for cancer-related pain. The American Cancer Society Cancer Action Network identified cancer patients in 2018 reported more difficulty accessing opioids than 2016.3 The proportion with opioid prescriptions (43%) did not change from 2016 to 2018; however, there was a substantial increase (16%–41%) in those unable to obtain opioids at the pharmacy. In nearly half, physicians’ pain treatment options were limited by guidelines, insurance coverage or laws. In response, a letter from the American Society of Clinical Oncology, American Society of Hematology and National Comprehensive Cancer Network (NCCN) requested guideline amendments to increase opioid access for cancer patients.4 The CDC issued a clarification stating that the guidelines were recommendations for primary care clinicians who prescribe opioids for chronic pain outside of active cancer treatment, palliative care and end-of-life care.5 The update also stated that clinical practice guidelines should be used to manage …

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