Impact of Mandated Online Prescription Drug Monitoring Programs on Opiate Analgesic Use and Patient-Reported Pain during Radiotherapy for Oropharyngeal Cancer

Purpose/Objective(s)

Owing to the dramatic rise in opiate-related deaths, the use of online prescription drug monitoring programs (PDMPs) concurrent with new laws restricting opiate administration has become commonplace across the U.S. Some oncologists, however, have expressed concerns that they may unintentionally limit treatment access to at-risk oncology populations. As opiates are frequently used in the acute management strategies for those undergoing radiotherapy for squamous cell carcinoma of the oropharynx, we sought to evaluate changes in short-term opiate prescription use following the implementation of mandated use of an online PDMP in an outpatient radiation oncology practice.

Materials/Methods

Between July of 2017 and December of 2019, 64 patients with biopsy-confirmed oropharyngeal squamous cell carcinoma undergoing curative-intent radiotherapy were evaluated and divided into two cohorts: (1) 26 patients treated 1 year before and (2) 38 patients treated 1.5 years following mandated PDMP use and implementation of new opiate prescription laws. The primary endpoint was opiate prescriptions during therapy and within 3 months after therapy as well as patient-reported pain per the Defense and Veterans Pain Rating Scale. Opiate doses were treated as the response in a series of chi-square tests using a three-level format: no vs. 40 to 3000 vs. 3000+ MME. Cochran-Mantel-Haenszel chi-square analysis with the row mean score test statistic assessed any proportional shifts in dose rates between strata of selected prognostic factors.

Results

The median total opiate doses were 975 MME and 1025 MME in the pre- and postintervention groups with no significant differences in MMEs prescribed (p=0.8441). There was also no difference in patient-reported uncontrolled pain (p=0.38) between the treatment cohorts. Univariate analysis showed tonsillar/soft-palate subsite (p<0.01) and alcohol use (p=0.04) were associated with higher rates of prescribed opioids. While 75% of patients (n=48) received opiates during their acute care, 78% (n=50) were off all prescription narcotics by 3 months or sooner following treatment.

Conclusion

Although potential concerns that mandated PDMP use would affect opiate utilization, there was no associated change in total opiate use by MME for the management of acute pain during radiotherapy for patients with oropharyngeal squamous cell carcinoma nor differences in patient-reported uncontrolled pain. Furthermore, despite high utilization of opiates during radiotherapy, few patients continued use past 3 months after treatment.