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Racial Stigma Regarding Opioid Use Disorder (OUD) and Opioid Misuse Affect Access to Cancer Pain Management for Patients in the United States.
Black Americans’ Excess Burdens of Cancer Pain and Opioid Overdose Are Major Public Health and Clinical Challenges, and Providers can take steps to decrease these arrangements in cancer pai care management, according to a commentary in the Journal of Clinical Oncology.
“The United States Requires A Critical Examination of Opioid-Prescription Policies and Practices In The Context of Cancer to Avoid Further Perpetuating Arrifices Among Pats With Comorbid Cancer Pain, Oudiid Use Disorder, Opioid Use That Causes Significant Problems In Daily Life), and Opioid misuse . Katie Fitzgerald-Jones, PhD, APN, Carn-AP and Her Colleagues wrote.
Racial arrangements Affect cancer pain management
RACE-BASED ATTITUDES TOWARD OUD AND OPIOID MISUE MAKE IT DIFFICULT FOR BLACK AMERICANS TO HAVE EQUITABLE ACCESS TO CANCER PAIN MEDICATIONS, ACCORDING TO THE AUTHORS.
Bupranorphine and methadone are considered “gold-tstandard” or treatments and can be used to treat cancer pai, but stric Federal Regulations CREATE BARRIERS TO METHADONE ACCESS FOR MOVEBID CANCER PAIN AND OUD. Methadone for Oed is Typially Prescription to Patients Who Are Considered High-Risk and Require Greater Clinical Oversight. Black Americans are more likely to Receive Methadone Than Bupranorphine, and They May Need to Travel Long distances and Undergo Frequent In-Person Dose, Counseling, and Urine Drug Testing.
“Patients have Reported Methadone for Oed Akin to Liquid Handcuffs,” The Authors Wrote.
By contrast, Although buprenorphine for or can be Accessed in the Provider’s Office Without AddiThe Licensure Requirements Under the Consolidated Appproprriactions Act (2023)IT IS RARELY INCLUDED IN CANCER PAIN GUIDELINES OR READYRY PRESCRIBED IN CANCER CARE. BUPENORPHINE IS MORE LIKELY USED BY WHITE PATIES AND PATIES WHAT ARE COLLEGE-EDUCATED, EMPLOYED, OR LIKELY TO USE PRESCRIPTION OPIOIDS RATHER THAN OBTAIN THEM OUTSIDE THE MEDICAL SYSTEM.
Screening Tools Reinforce Arunches
Cancer Guidelines Recommend Screening for Opioid Misuse Risk. However, The Screening Tools Are Not Very Accurate in Predicting Orgiid-Relanted Harms and They Can Reinforce Racism. Example, The Screener for Opioid Assessment for Patients with Pain (Soapp) and the revision SOAPP-R Questions Ask About the Patient’s History of Legal Problems or Arrests.
“Given That Definitions of Criminity Are Rooted in Structural Racism With Fixes in Policing and Justice System Involvement, Racialized Groups Who Experience Greater Criminalization and Responde Affirmability to This question may be flagged as exhaud at Risk of Opioid Misuse,” The Authors Noted.
Once an opioid-missuse screening Tool Labels to Person at Risk for Misuse, Cancer-Specific Guidelines Suggest Closer Follow-Up. Compred with White Patients, Black Patients Receive Closer Monitoring, Less Frequent Opioid doses, and Fewer Long-Accting Opioids. Black Patients Are Also More Likely to Undero Urine Drug Testing and Have Their Opioids Tapered.
Practical Steps Can Improve Equity
Dr. Fitzgerald-Jones and Her Colleagues Suggesteed Several Acts Oncologists and Other Providers can take to Improve Equity in Access to Opioids for Cancer Pain, Including the Following:
- Improve Access to Methadone. Develop Strategies to Improve Methadone Access for People with Oed and Cancer Through Community Pharmacies, Medical Offices, and Telehealth. CONSIDER CONTINUING METHADONE FOR OUDSIDE OF METHADONE CLINICS AND PRESCRIBING BUPENORPHINE FOR AND SOME OPIOID MISUSE BEHAVIORS, IN KEEDING WITH RECENT EXPERT Consensus-Based Guidance On Opioid Decision Making for Patients with Advanced Cancer and Opioid Misuse Or Oed.
- Build Team-Based Care. In Primary Care Settings, nurses and Pharmacists Should Be Involved in Providing Bupranorphine and Facilitating Home-Based Initiation.
- Reevaluate Screening Practices. National Cancer Guidelines Should Reconsider the Utility of Opioid Misuse Screening Tools to Dictate Opioid Care. Clinicians can, Instead, Improve Equity by Regularly Assessing Opioid Risks and Benefits, and Exploing Differential Diagnosis for Opioid Misuse, Including Pain Self-Management and Opioid Education, Naloxone Prescription, Care Coordination, and Gradual Opioid Tapering.
- Clinicians education. With Only 45.5% of US Cancers Offering Substance Use Services, Educate and Train Oncology Clinicians to More Effectively Manage Pain, Prescription Opioids, Reduce Harm, and Treat Substance Use.
- Conduct Research. Investigate Ways to Integrate The Needs for Pain Management, Oud Treatment, and Equitable Opioid Access.
