Responding to the opioid crisis in a manner that respects oncology patients: A single institution experience writing policy to promote safe opioid use.

Abstract

132 Background: The current opioid crisis has had wide ranging implications across medicine and in particular oncology practice. Opioids have been used for centuries for their analgesic properties. As physicians and historians are aware, the abuse potential of opioids is significant. Despite this, a dramatic shift in medical education in the late 1990s and early 2000s and aggressive marketing and manufacture of opioids has led to widespread opioid misuse and abuse. Therefore, a slew of regulations has been put into effect within a brief period of time. Among practitioners, the oncologist holds a unique and arguably more challenging role, caring not only for those with acute cancer-related pain or those at the end of life, but also for cancer survivors or those who live with their cancer as a chronic condition. ASCO has put forth comprehensive guidelines for the safe use and monitoring of opioids. The ASCO policy statement also highlights the significant barriers that oncology patients face, thereby maintaining a focus on the unique needs of this patient population. Methods: The Lifespan Cancer Institute is an academic practice and writes approximately 880 opioid prescriptions each month with approximately 15% being new prescriptions. Our Multidisciplinary Quality Team implemented a safe opioid prescribing initiative including patient education sheets, an electronic patient-provider treatment agreement, and an electronic template for provider documentation. Our palliative care team monitors pain scores. Results: During month one, 16% of patients newly prescribed an opioid had a completed patient-provider treatment agreement. For the second month, the number of completed agreements increased to 29%. Conclusions: Given the prevalence of opioid misuse, there is a growing overlap between oncology patients and those with opioid misuse disorder. Given high levels of psychological distress, the cancer patient is at risk for opioid misuse. Furthermore, oncology patients can be victims of diversion. Our responsibility is to screen and educate patients on the risk of opioid addiction and diversion while providing compassionate palliative care.