• Pain is extremely common in patients with advanced cancer, with prevalence as high as 80% among palliative patients in last stages, the vast majority of patients with cancer pain require opioids for treatment. Pain is widely prevalent in the last weeks of life regardless of the setting in which patients are being managed.
    • In many cases, opioid painkillers or other controlled substances are the best treatment for hospice patients, almost 28% of whom die within a week of enrolling. Hospice patients often face significant pain, shortness of breath, broken bones or aching joints from lying in bed.
    • Albuterol and other nebulizer applied bronchial dilators may no longer be effective for end stage COPD and lung cancers, and opioids are very effective for treating dyspnea.
    • NHPCO has been actively involved in discussions on opioid prescribing policies for some time, as patients with advanced illness and at the end of life are often using opioids in combination with other drugs to manage pain and other distressing symptoms. Current opioid policy provides some exclusions for beneficiaries enrolled in hospice and with cancer. However, there is a large patient population with advanced illness receiving advanced illness management or palliative care and taking opioids and other medications to effectively manage symptoms.
    • NHPCO is very concerned about the patients with a serious advanced illness who are seen by palliative care providers – they are neither hospice patients nor have a diagnosis of cancer. They may be on long-term low or high dose opioids for pain or other symptoms. Requiring them to have scripts filled on a weekly basis would be a significant hardship for both the patient and the provider. Putting a cap on the oral morphine equivalents in some situations would be contrary to the principles of palliative care practice, would limit the ability of providers to effectively manage symptoms in palliative care patients, and would cause significant suffering.

Nezar et al., “Impact of Opioid on Pain Management in Last Days of Life among Hospice Patients: A review.” Journal of Advanced Practices in Nursing 2016; 2:2.

NHPCO Facts&Figures