Opioid Campaigns' Impact on Advanced Cancer and Hospice and Palliative Care: An Invited Commentary

Abstract

Background: Opioids effectively manage pain, but increasing misuse has resulted in significant abuse, addiction, and even death. This misuse has accelerated to the point that an “opioid epidemic” has been declared. Several government agencies and professional associations (including the APTA) are developing well-meaning programs to address opioid abuse. Purpose: Recent national opioid campaigns may have significant, unintentional, and adverse consequences on the medical management of patients with advanced cancers or those receiving hospice and palliative care (HPC). This commentary describes the role of the physical therapist (PT) in the palliative symptom management of terminally ill individuals during this paradigm shift in opioid-prescribing practices. Discussion: Opioids have long been a staple in the management of symptoms present in patients with advanced cancer or in HPC (ie, pain, dyspnea). New opioid management guidelines are likely to impose even tighter controls on opioids, further reducing accessibility to these drugs for these individuals. There is concern that these well-meaning public initiatives may have unintended consequences for end-of-life care if the HPC community is not vigilant in its advocacy. The expected reduction in opioid prescriptions prompts an increasingly critical role for PTs in palliative symptom management to optimize remaining quality of life. Conclusion: During refinement of policies, procedures, and legislation related to medical use of opioids, health care providers (including PTs) caring for individuals with a life-threatening illness must provide input to regulatory bodies in order to avoid overly restrictive regulations that may increase pain and suffering near the end of life.