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Chronic Pain and Policy Restrictions: Controversies Holding Back Effective Pain Management

By Karen Selby, RN
PUBLISHED WEDNESDAY, DECEMBER 31, 1969
A recent study in the American Cancer Society Journal confirmed that “cancer survivors appear to have a high prevalence of chronic pain, which is associated with worse mental, functional and employment outcomes.”1

Through years of serving as a surgical nurse and patient advocate who talks to cancer survivors, I have seen this tragic reality up close.

My organization, The Mesothelioma Center, specializes in helping people diagnosed with mesothelioma, a rare form of cancer that often constricts the lungs and invades the chest wall. Because of spinal nerves being closely intertwined where this type of cancer presents, it is known to be very painful for patients.

Add to that a harsh reaction to chemotherapy or a long recovery from surgery, and it is easy to understand that pain management is not an afterthought in cancer care but is one of the most vital types of treatment that cancer patients need.

Unfortunately, policy restrictions have created a climate where many patients trying to manage debilitating pain feel left behind. The examples of opioids and medical marijuana illustrate this problem well.

Opioids and Medical Marijuana Have Uncertain Status in US


Not so long ago, our nation’s authorities assured us that prescription opioids were respectable remedies, whereas medical marijuana was merely a party drug masquerading as medicine.
Now the pendulum is swinging the opposite way.

Consumers and lawmakers have filed legal actions against pharmaceutical giants, alleging their aggressive opioid marketing has contributed to the national drug abuse epidemic. Meanwhile, medical marijuana is now legal in 33 states.2

I’m glad to see new research dispelling old myths about opioids and marijuana. But I worry that without rational policy reform, fresh misconceptions will sink in and continue to make life more painful for cancer patients. Health care providers need improved guidelines for opioid prescribing, as well as the federal government’s go-ahead to conduct research on medical marijuana.

Opioids Are Dangerous But Useful


When it comes to opioids — even with their considerable risks of addiction and overdose — these drugs remain an essential resource for cancer survivors.

Powerful opioid drugs, such as morphine, oxycodone, and fentanyl, can provide life-changing benefits when used appropriately. They should not be the first thing a patient is prescribed, but they should certainly be available as an option of last resort.

I recall one gentleman’s case that shows this nuance perfectly. He was one of the lucky ones whose cancer went into remission after surgery, but it came at the cost of nerve damage that caused him chronic, debilitating pain. He struggled with post-surgery pain management for years, until finally switching to fentanyl. Fentanyl has earned a grim association with thousands of drug overdose deaths. But at low, controlled doses this drug can also allow cancer survivors to lead relatively normal lives when other options for pain relief have failed them.

A tragic consequence of the nationwide crackdown on fentanyl is that many cancer survivors with a legitimate need have lost access to it.3,4 The lesson here is that solving the opioid epidemic is not as simple as forcing our nation to quit drugs cold turkey.

Descheduling Medical Marijuana Will Allow the Research Data Doctors Need


Many experts have pointed to medical marijuana as a potentially safer alternative to opioid pain management. Decades of research have suggested that medical marijuana can help with cancer symptoms, treatment side effects and related conditions such as anxiety and insomnia.

More research needs to be done on the risks and side effects of medical marijuana, but there is a broad consensus that cannabinoids are not as addictive or life-threatening as opioids.

Rather, the rise of medical marijuana presents a different type of hazard: misinformation. People with terminal cancers are particularly vulnerable to buying into claims of miracle cures, and a quick internet search will show you that cannabis plant derivatives have become the folk cure-all of our time.

As with opioids, this issue is not black and white. In fact, my colleagues and I have heard several firsthand accounts from cancer survivors who were certain that medical marijuana products helped them control their pain and increase their quality of life.

The cancer treatment community needs the federal government to deschedule cannabis from the Schedule 1 category, which would remove marijuana from the federal controlled substances list in the Controlled Substances Act. When that happens, doctors will be able to run proper large-scale clinical trials for medical marijuana. If doctors could legally study the medicinal uses of cannabis, then they could determine how to integrate cannabinoids into cancer treatment plans and use medical marijuana to manage pain and reduce the number of opioid prescriptions given out.5

Policymakers Must Act to Improve Pain Management


The American Cancer Society Journal article emphasizes that “screening and management of chronic pain should be addressed by policymakers to improve cancer survivorship care.”1
Oncology nurses can play a vital role in screening for chronic pain, but all too often, medical professionals do not have a full toolkit for pain management. The controversies around opioids and medical marijuana in the U.S. today are holding back effective pain management for cancer patients.

I believe our country is taking steps in the right direction by reigning in our system’s dependence on opioids and increasing access to medical marijuana. But we still do not have enough leadership from policymakers on these issues.

Legislators and health care system administrators must reassess the role of opioids and medical marijuana with a cool head, an open mind, and a critical eye to ensure cancer patients get the care they need.




References
  1.  Sanford NN, Sher DJ, Butler SS, et al. Prevalence of chronic pain among cancer survivors in the United States, 2010‐2017. Cancer. 2019. doi:10.1002/cncr.32450.
  2. Hoffman J, Walsh MW. Purdue Pharma, Maker of OxyContin, Files for Bankruptcy. The Washington Post. https://www.nytimes.com/2019/09/15/health/purdue-pharma-bankruptcy-opioids-settlement.html. Published September 17, 2019. Accessed October 23, 2019.
  3. New Data: Some Measures Meant to Address Opioid Abuse Are Having Adverse Impact on Access to Legitimate Pain Care For Patients. American Cancer Society Cancer Action Network. https://www.fightcancer.org/releases/new-data-some-measures-meant-address-opioid-abuse-are-having-adverse-impact-access. Published October 10, 2019. Accessed October 23, 2019.
  4. Achenbach J, Bernstein L. Opioid crackdown forces pain patients to taper off drugs they say they need. The Washington Post. https://www.washingtonpost.com/health/opioid-crackdown-forces-pain-patients-to-taper-off-drugs-they-say-they-need/2019/09/10/3920f220-c8da-11e9-a4f3-c081a126de70_story.html. Published September 10, 2019. Accessed October 23, 2019.
  5. Grinspoon P. Access to medical marijuana reduces opioid prescriptions. Harvard Health Blog. https://www.health.harvard.edu/blog/access-to-medical-marijuana-reduces-opioid-prescriptions-2018050914509. Published June 25, 2019. Accessed October 23, 2019.
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