Opioid use in gynecologic oncology in the age of the opioid epidemic: Part II – Balancing safety & accessibility

• Published in: Gynecologic oncology 2018-05, Vol.149 (2), p.401-409
• Main Authors: Ramzan, Amin A., Fischer, Stacy, Buss, Mary K., Urban, Renata R., Patsner, Bruce, Duska, Linda R., Fisher, Christine M., Lefkowits, Carolyn
• Format: Article
• Language: English
• Subjects: Opioid epidemic; Opioid misuse; Opioids; Pain management; Palliative care
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2018.02.008

As the only oncologists that provide both medical and surgical care, gynecologic oncologists encounter an exceptionally broad range of indications for prescribing opioids in clinical situations ranging from management of acute post-operative pain to chronic cancer-related pain to end-of-life care. While opioids are essential to the practice of gynecologic oncology, they can also have significant side effects and can be misused. Due to the explosive growth of opioid prescriptions and opioid-related overdoses and deaths during the first decade of the 21st century, there has been a recent concerted public health effort to prevent and treat opioid misuse through both legislation and education [1]. The first article in this two part series focused on appropriate use of opioids across clinical settings. This article addresses both the clinical and regulatory aspects of balancing opioid safety and accessibility for patients with gynecologic cancer. •Nationally, opioid misuse is causing significant morbidity and mortality.•Historically the problem in cancer pain has been undertreatment, not overtreatment.•Validated screening tools exist for opioid misuse risk.•Patients should be counseled about safe opioid storage and disposal.•We must advocate to have opioid regulations recognize the uniqueness of cancer pain.