Opioids are often prescribed to cancer patients to help them manage pain, but there is now concern that this practice could raise the risk of abuse. Pain is a common and often difficult symptoms of cancer, and prescription opioids are prescribed to help the patient handle the pain.
Cancer Patients and Risk of Opioid Dependence
Studies show that more than half of cancer patients report moderate to severe pain while undergoing treatment. Opioids are effective in acute pain relief, but there are risks when prescribing it for chronic pain. Chronic pain is defined as pain that lasts for three to six months or longer, which is often the case in patients who are on long-term treatment plans.
Chronic use of opioid prescription medications can cause it to lose its effectiveness. The patient may become dependent on the drug, leading to misuse and abuse. They could even end up overdosing accidentally.
Many experts are concerned that any recommendations to reduce risk of dependence on opioid drugs don’t consider cancer patients. The study looked at patients who survived cancer and were diagnosed between 2000 and 2015. They considered their use of opioids, diagnoses of any abuse and any admissions to medical care for toxicity of opioids. Patients were diagnosed with one of the 12 most common forms of cancer. The patients in the study had all survived for at least two years post-treatment.
Post-treatment opioid use was 8.3 percent with ranges averaging from 5.3 percent to 19.8 percent, depending on the type of cancer involved. Prostate cancer was the lowest while liver cancer had the highest rate. Another factor was whether the patients had used opioids in the past. Those who had never used any opioids had a lower rate of use after treatment than those with intermittent or chronic use.
Several factors seemed to increase the risk of opioid use post-treatment. These factors include:
- Younger age
- Lower median income
- Current or prior use of tobacco
- Increased comorbidity
- Prior drug or alcohol abuse
- Prior diagnosis of depression
Anyone with a history of chronic opioid use had a much higher risk for persistent opioid use.
Reducing Opioid Dependency
The goal with the study was to identify risk factors for opioid abuse in cancer patients, which could provide important information to health care providers. It could allow doctors to identify those with a higher risk for developing opioid dependence and lead them to recommend alternative strategies for pain management. They may even refer these high-risk patients to pain specialists.
Opioids have an important role in pain management for those with cancer. However, the benefits must be weighed against the risks, especially since statistics show that two-thirds of patients diagnosed with cancer live for five years or longer post-treatment. This means they are at an increased risk for developing an addiction if they continue to take opioid medications for the long-term.
Most experts agree that it cannot be a blanket strategy for determining how opioids are used or who uses them. Rather, the medical condition and history of the patient must be considered.
FDA Failed in Monitoring of Program to Curb Opioid Prescriptions
The US Food and Drug Administration (FDA) requested that drug manufacturers of long-acting opioid prescriptions pay for safety training in 2011. However, records show that the agency failed to follow up on whether the program was successful.
The goal of the program was to determine if the training for physicians who prescribed opioids was effective and to monitor other measures being taken to reduce addiction of opioid prescriptions as well as overdoses and fatalities.
A Flawed Program
According to critics, the program had a flawed design from the beginning, but it was never evaluated accurately either. Congress granted authority to the FDA back in 2007 to require training of physicians on drugs that were likely to cause addiction. The bill went into effect as a response to the oversight of the agency to monitor dangerous drugs.
Documents showed that the FDA couldn’t determine if the program was effective because the design of the studies was poor. Around 60 drugs can be included in the risk-management program. This not only includes opioids but other medications, such as isotretinoin, which is a drug to treat acne and often branded as Accutane.
Critics of the program say that the FDA allowed the pharmaceutical companies to monitor their own training. It also fails to monitor the quality of the training being given. According to a report from the Department of Health and Human Services, only about 14 percent of the programs for safety that had been reviewed by the FDA were able to meet the requirements.
The Dangers of Prescription Drugs
When it came to opioids, the requirement was that 60 percent of prescribers must take the classes, but only less than 30 percent followed through during 2012 to 2016. Even though the number of prescriptions given out was dropping, it couldn’t be determined if it was because of the training. Another issue with the program is that it didn’t provide accurate data on the correlation between the training and the reduction in overdoses and deaths. National data on overdoses had no distinction to show which doctors had taken the training and which ones hadn’t. Because of this, it was impossible to determine if the program was effective in this area.
This same problem has occurred in other programs. For instance, one program was designed to monitor the prescribing of fentanyl drugs that are to be given only to patients with cancer. While these drugs were meant only for those specific patients, many doctors prescribed the medication for other conditions.
The FDA made it a requirement for safety programs to be in place when prescribing all opioid prescriptions and not just the long-acting kinds. This change happened in 2017, but it implies that the long-acting opioids are safe for chronic pain, which goes against most research.
Prescription painkillers have been responsible for many deaths related to overdose. Doctors were prescribing these drugs at a high rate that reached its peak in 2012 at 81.3 prescriptions per 100 patients. While the rate has declined, overdosing is still a major problem in the US, especially in certain regions.
House Approves Bill Which Could Reduce Prescription Drug Prices
The House recently approved a bill that is aimed at lowering the cost of prescription medications by allowing the government to negotiate with manufacturers of the drugs.
Bill H.R. 3
The bill is titled H.R. 3 and would have a direct impact on Medicare programs. The provisions include benefits for vision, dental and hearing, and it also caps the costs Medicare beneficiaries pay out of pocket to $2000.
This bill was proposed and supported by Democrats, but the Republicans have also been working on legislation to cut prescription costs. Pharmaceutical companies oppose both this bill and the Senate bill.
One of the features of the bill includes allowing the Department of Health and Human Services to negotiate pricing for as many as 250 of the most common drugs. Manufacturers would have to provide the same prices to insurers as what was agreed upon during negotiations.
Drug manufacturers would be required to pay rebates to Medicare if prices went up faster than inflation. The Senate bill, which is sponsored and supported by Republicans, doesn’t contain the same provisions, but it does require the companies to pay rebates for raising prices above the rate of inflation.
Other Options for Legislation
Even though the Republicans didn’t agree with the Democrats’ bill, they did come up with a similar measure, which had the support of eight Democrats at the vote. It would not only cap the expenses paid out of pocket, but it would require insurance providers to provide information about medication prices to patients before they were prescribed the drugs.
The argument against the legislation to allow government to negotiate prices is that it would reduce the amount of money for research and development with pharmaceutical companies, which could limit the number of new medicines available for life-threatening illnesses. It has been estimated that the enactment of the bill would reduce the number of new drugs available by 40 for the next 20 years.
H.R. 3 allocates over $10 billion for the National Institutes of Health, which would be used for research to provide breakthrough cures. Taxpayers could save as much as $5 billion during the next ten years if it is enacted.
The rising costs of prescription medications has placed a hardship on many Americans. Some even have difficulty affording food and other necessities because of the expensive drugs they need. The situation has put pressure on lawmakers to find a solution.
Prescription manufacturers do not support the measures that limit their ability to raise prices. However, politicians recognize the need to make drugs more affordable for the average American. With another election year coming up, they are working on their campaign promises to ensure support from their constituents for the next election.
While it’s not expected for the bill to become law in its present state, there is hope that the overall goal will be met even with the changes that would be made. Some day in the future, Americans may be able to afford the drugs they need to manage their medical conditions or cure them.
FDA Tests Diabetes Drug for Carcinogen Levels
The US Food and Drug Administration is testing for the presence of certain cancer-causing chemicals in the diabetes medication metformin. This medication is a prescription drug that is given to patients with type 2 diabetes to control high blood sugar.
Continued Risks with NDMA in Drugs
Several drugs have been discovered to contain known carcinogens at levels not acceptable to the FDA in the past year. Now, metformin is under scrutiny due to the possibility that it may also contain a carcinogenic substance. The concern with these chemicals is that continued exposure could raise the risk for developing cancer in the future.
Other countries have found some metformin drugs to have low levels of N-nitrosodimethylamine or NDMA. After testing those medications, it has been determined that the level of NDMA is in the acceptable range, which is what is naturally found in food and water. However, some countries are recalling metformin medications. The US is not on that list at this time.
The FDA has a current investigation into the medication to determine if NDMA is found and whether it is above the acceptable limit of 96 nanograms per day. The agency is working with manufacturers to test the samples of the drug. If levels above 96 nanograms are found, the FDA will recommend recalls.
Experts recommend that patients continue taking the medication. If a recall is issued, the FDA will provide information to health care personnel and patients. It can be dangerous to stop taking this medication without the advice of their physician. There are no alternative medications to treat the high blood sugar in the same way.
What Does Metformin Do?
This medication works in several ways to control blood sugar in diabetics. It reduces the amount of sugar the liver makes as well as how much is absorbed throughout the body from the person’s diet. It also causes the insulin receptors in the body to be more accurate in how much insulin the system manufactures.
One of the benefits of this medication is that it doesn’t increase the amount of insulin being made in the body, which means the patient has a lower risk of hypoglycemia or low blood sugar. Other medications carry a higher risk for this condition.
The doctor may prescribe metformin in tablet form, a liquid or one of two long-acting medications. Brand names for metformin include Glucophage XR, Glumetza, Fortamet and Riomet. The medication was originally manufactured by Bristol-Myers Squibb, but several manufacturers make the generic version.
Taking a medication like metformin can control sugar levels and prevent many health issues that are related to high blood sugar. This includes diabetic neuropathy, heart disease and diabetic retinopathy. Regular use of the medication may prevent complications which arise from diabetes.
Manufacturers of metformin are working with the FDA to determine if metformin is safe for use. Anyone who is concerned about the risk of carcinogenic chemicals in this medication or other medicines should discuss the issue with their health care provider. The doctor can recommend other options or put their minds at ease.
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