What’s so special about cancer? The need for responsible opioid prescribing for cancer pain.

Abstract: Over the last decade, the United States has fairly aggressively swung away from the rather free attitude towards opioid prescribing of the late 1990s and early 2000s towards a more restrictionist model. In response to the “opioid epidemic,” academics and medical and governing bodies made many recommendations for limiting opioid prescribing. These recommendations tended to focus on one of two groups. In the first group, many provided guidelines for prescribing opioids for acute pain; examples of this sort of recommendation can be found at Michigan OPEN (https://michigan-open.org). While other guidelines—most prominently, the CDC’s 2016 guidelines—provided recommendations for chronic, non-cancer pain.

Cancer pain, however, was often overlooked, which has left a growing population of cancer survivors without guidelines. In this panel discussion, we will explore why that is the case, and what should be done about it. Panelist #1, a pediatric hematologist/oncologist and bioethicist, will frame the discussion by providing examples of cancer and non-cancer patients, and suggest that a form of “cancer exceptionalism” concerning opioid prescribing leads to very different care in the two cases. Panelist #2, an oncology fellow and bioethicist who has written on ethical issues concerning pain management, will explore the risks to cancer patients by this exceptionalism, as it tends to limit exploration of responsible prescribing. And Panelist #3—a philosopher and bioethicist who has published widely on ethical and policy issues concerning pain and opioids—will draw on the first two panelists in order to formulate lessons for ethics and pain medicine.

Keywords: cancer exceptionalism, opioid epidemic, responsible prescribing