Pain in cancer survivors in the US after federal and state opioid prescribing guidelines and laws.

Abstract

11028 Background: Cancer-associated pain is common among survivors and may require opioid medications for effective management. In 2016, the Centers for Disease Control and Prevention (CDC) published guidelines to limit opioid prescribing, leading to a subsequent decline in prescriptions in the US. Many states also enacted opioid prescribing laws after 2016. Cancer-associated pain is explicitly exempted by the CDC and from some state opioid laws. As state laws and exemptions are heterogeneous and sometimes unclear, this study was designed to assess whether cancer survivors were impacted by post-2016 opioid prescribing patterns and legislation. Methods: The 2011-2023 Behavioral Risk Factor Surveillance System (BRFSS), an annual, national survey, was queried for cancer survivors. Quality of life (QoL)-limiting pain (included in 2011-17) was defined as having ≥1 days where pain made it hard to participate in usual activities. A sensitivity analysis utilized a ≥7 day cutoff. Cancer-associated pain (included in 2016-23) was defined as currently having pain caused by cancer or cancer treatment. Linear probability models examined whether there were nationwide changes in QoL-limiting pain after the 2016 CDC guidelines. State-level difference-in-differences (DiD) analyses compared changes in cancer-associated pain over time between states with and without opioid prescribing laws. State opioid laws included (A) any opioid prescribing legislation and (B) explicit cancer-associated pain exemptions. States that enacted opioid policies prior to the 2nd quarter of 2016 were excluded due to lack of cancer-associated pain data before 2016. Analyses accounted for the complex survey design and BRFSS weights and utilized robust SEs, and models were adjusted for sociodemographic, Medicaid expansion, and cancer site factors. DiD analyses also accounted for state and year-quarter fixed effects. Results: 2,725 cancer survivors were included in the 2011-17 QoL-limiting pain analyses and 31,955 in the 2016-23 cancer-associated pain analyses. QoL-limiting pain was present for 40.3% (≥1 days affected) and 27.0% (≥7 days affected) and cancer-associated pain was present in 11.9%. There was no significant change in QoL-limiting pain after 2016 in our primary (-9.6 percentage points [95% CI -30.9, 11.7] ) or sensitivity analysis (≥7 day affected, 4.32 [-14.24, 22.89]). In adjusted DiD analyses, there were no significant associations between cancer-associated pain and state opioid laws (-2.17 [-6.32, 1.98]) or explicit cancer exemptions in state opioid laws (4.16 [-1.75, 10.07]). Conclusions: Among this nationally representative sample of cancer survivors, cancer-associated pain affected >1 in 10 survivors and >1 in 4 had QoL-limiting pain. However, federal and state opioid prescribing guidelines and laws had minimal impact on the prevalence of pain among cancer survivors, perhaps due to effective exemptions for cancer.