Jul 19, 2019
By Hilary Adams, ASCO Communications
In policy, as in medicine, the devil is in the details. The placement of a comma, the use of “should” vs. “shall,” the omission of the word “survivor”—such details can alter a policy in a way that has tremendous effects on patients with cancer. Understanding the need to pay attention to policy details, advocates joined forces to ensure Washington state’s restrictions on opioid prescribing didn’t inadvertently limit access to pain management for patients with cancer.
As the opioid crisis continues to persist in communities across the United States, state legislatures and regulators are working to curtail opioid misuse and abuse by restricting access only to those who meet certain medical criteria. In 2017, the Washington state legislature passed a law to improve the system of opioid prescribing and monitor prescriptions for signs of potential abuse. An opioid prescribing task force with representatives from five of the state’s medical professional boards held meetings around the state to gather input for the rules that would guide implementation of the new law. The task force met with private citizens, pain patients, professional associations, community leaders, health care providers, and public health partners.1
The original statute exempted “cancer pain” from the rules, but the initial draft rules failed to define cancer pain. The Washington State Medical Oncology Society (WSMOS), an ASCO State Affiliate, offered a definition of cancer pain they believed was consistent with legislative intent. However, the task force rejected the recommendation and elected to leave cancer pain undefined, but defined chronic pain as including “pain resulting from the treatment of cancer or the residual effects of a previous cancer tumor of a patient who has completed treatment, is cured or in full clinical remission with no current evidence of disease, or is under cancer surveillance only.”
This definition failed to exclude patients with cancer from severe opioid prescribing restrictions from the moment they were without evidence of disease and not on active therapy.
In March 2018, WSMOS, ASCO, and the American Cancer Society Cancer Action Network jointly submitted a comment letter to the task force proposing a revised definition for survivors of cancer. Representatives from WSMOS spearheading this initiative include the society’s immediate past president Sibel Blau, MD, and president-elect Blair Irwin, MD. Dr. Irwin also provided public comment to the task force. However, these efforts were rebuffed, and the final draft rules sent to the Washington State Department of Health retained the objectionable definition.
“We were concerned that the oblique reference would create confusion and be used to deny opioids access to patients with ongoing pain from their cancer or its treatment, specifically patients with chemotherapy-induced neuropathic pain,” said Dr. Blau.
In an effort to convey the need to revise the rule to improve access for patients and survivors of cancer, in July 2018, Dr. Blau and Jeffrey Ward, MD, chair of ASCO’s Government Relations Committee, met with the policy director for Washington Governor Jay Inslee. They discussed a variety of issues, including the development of opioid prescribing regulations and the definition of cancer pain versus chronic pain in Washington. As is often the case, the director had a personal cancer connection: a family member who was struggling with advanced cancer and associated pain. He understood acutely the concerns of the oncology community.
By the time the rules were finalized late last fall, they included clarification that pain resulting from cancer or its treatment was exempted from the regulations, an acceptance of the definition that had been offered by WSMOS and ASCO.
“I personally learned three lessons from what happened. First, don’t think you have won a victory when favorable legislation is passed. You have to follow it through the regulatory rule making. Second, don’t ever give up if you believe that you have the moral high road. Finally, personal connections can make all the difference when you are trying to impact the legislative process,” Dr. Ward said.
ASCO encourages State Affiliates to engage with their respective legislatures and regulatory agencies to ensure that health policy-related proposals do not impede the ability of oncology professionals to deliver quality cancer care. For more information on how you can advocate for policies related to cancer care, visit ASCO’s State Advocacy page or sign up through ASCO’s ACT Network.
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- Washington State Department of Health. Opioid Prescribing, Background. 2018. Accessed Mar 4, 2019.