Ending the Opioid Crisis: How Targeted Drug Delivery May Improve Pain Management for Cancer Patients

In a recent edition of The Onco’Zine Brief, an interview and discussion program made for public radio covering a broad range of topics and information about cancer, cancer prevention and treatment, I recently spoke with Charlie Covert, Vice President & General Manager Targeted Drug Delivery, Restorative Therapies Group - Pain Division at Medtronic, about opioids and pain management in patients with cancer.

While considered safe, reliable, and effective for all types of pain, opioids are also a potentially abuseable drugs. And the public health consequences of opioid abuse are really bad.

The numbers are clear, more than 11.5 million people abused prescription opioids. As every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids.

Prescription Opioids

Prescription opioids are used to treat moderate-to-severe pain and are often prescribed following surgery or injury, or for serious health conditions including cancer.

In recent years, there has been a dramatic increase in the acceptance and use of prescription opioids for the treatment of acute and chronic pain, despite serious risks and the lack of evidence about their long-term effectiveness.

The Centers for Disease Control and Prevention estimates the total economic burden of prescription opioid misuse in the United States alone, to be $78.5 billion dollar each year.

This includes the costs of health care, lost productivity, addiction treatment, and the involvement of the criminal justice system.

A review of latest information also confirms that many steps to mitigate and reduce the risks associated with long-term systemic opioid use, including misuse, addiction and overdose -- have failed – leading to the Opioid Crisis we see today.

Cost of cancer

The burden of cancer continues to increase on a personal and societal level – and the National Cancer Institute projects that the yearly cost of cancer treatment in the United States will increase to $157 billion in 2020.

And pain is prevalent in all cancer patients. A recent study published in the journal of the American Medical Association confirms that 55 percent of cancer patients, undergoing active treatment, report pain.

Living with acute and chronic pain can be devastating. And effective pain management is important to secure the health related Quality of Life of a patient with (cancer-) pain.

It is essential that patients and and doctor discuss treatment options, carefully considering all the options, the risks and benefits associated with pain management.

And while some medications, including prescription opioids, can help relieve pain in the short term. But these drugs may also come with serious risks and potential complications— While they have a role in proper pain management, doctors are encouraged to prescribe them cautiously. And patients, while cautioned to use them as prescribed - are are also encourage to use these drugs carefully.

Proper use

One major concern is that pain has been identified as a preventable reason for hospital admission and is associated with more than 40% of cancer Emergency Room visits. And despite increased health care utilization cost, in most cases, liberal oral opioid use for cancer pain, remains the standard of care.

So, what can be done to provide better care for patients? Are their alternatives? What can be done limit addiction, but still provide adequate pain management? One of their options to help patients with acute and chronic pain involves Targeted Drug Delivery.

And the results of this approach are noteworthy.

In one study published in Neuromodulation, a peer-reviewed journal, patients report a reduction in pain scores after receiving targeted drug delivery. The journal also reports that more than 51% of patients completely eliminated the use of other prescribed opioids within 12 months.

Another study, this one published in the Journal of the American Medical Association, shows that using targeted drug delivery may also reduce health care utilization and cost for cancer-pain patients. This study found significant cost savings to payors, with fewer inpatient visits, shorter inpatient length of stay, and fewer emergency department visits.

Furthermore, while evidence suggests that targeted drug delivery for intractable cancer pain is generally characterized by high initial costs followed by low maintenance costs, conventional medical management is generally associated with steadily increasing, cumulative costs that, over time, can equal the costs of targeted drug delivery.[1]

In one study, the majority of high expenditures for conventional pain management were attributed transdermal and transmucosal fentanyl products along with ambulatory, patient-controlled IV analgesia. However, in contrast, 69% of patients discontinued their systemic opioid pain medications after implantation of a targeted drug delivery drug infusion system.

Likewise, 72% of patients receiving targeted drug delivery completely stopped taking fast-onset opioids to control breakthrough pain.[2]

These novel opportunities in pain management for patients with (cancer) pain are good news for doctors helping their patients

They are good news for friends & family members of cancer patients

But above all, it’s good news for cancer patients suffering from acute and chronic pain.

• To listen to this episode of The Onco'Zine Brief, click here. The Onco'Zine Brief is produced by the editors of Onco'Zine for Sunvalley Communication, LLC

References

[1] Brogan SE, Winter NB, Ablodun A, Safapour R. Therapy for refractory cancer pain: identifying factors associated with cost benefit. Pain Med. 2013;14:478-486.

[2] Hassenbusch SJ. Cost modeling for alternate routes of administration of opioids for cancer pain. Oncol. 1999;13(5 suppl 2):63-67.