‘Multipronged Approach’ Necessary for Mitigating Opioid Disparities in Cancer

An expert from Dana-Farber Cancer Institute says that policymakers and insurers should take a hard look at policies that restrict opioid use in patients with cancer who are at end of life, especially for underserved communities.

Andrea C. Enzinger, MD, indicated that a “multipronged approach” is needed to tackle racial and ethnic disparities in opioid access among patients with cancer near the end of life.

CancerNetwork® spoke with Enzinger, an assistant professor of medicine at Harvard Medical School and a medical oncologist at Dana-Farber Cancer Institute, about possible strategies for mitigating ethnic and racial disparities in opioid access in older patients with cancer.

Offering bias training to providers and lending logistical support to patients of color may help in creating more equitable access to prescription opioids among patients with cancer, she said.


We’re going to need to take a very multipronged approach to tackling these disparities. We also need more information about what the key drivers are. There needs to be some element of bias training for providers. We certainly also need more logistical support around getting patients of color help in filling the prescriptions that they may be given.

It’s not uncommon now for an oncologist or other provider to write an opioid prescription only to be told by the pharmacy that the insurance requires prior authorization, they refuse to cover it, or that the pharmacy doesn’t have that medication in stock and you have to send a new prescription somewhere else.

It can be really complicated for patients to navigate, particularly if you’re looking at a population that’s already disadvantaged; they may face racial prejudices while trying to fill their prescriptions. They may have difficulty getting to the pharmacy or difficulty with co-pays. It’s going to need to be multipronged. There needs to be institutional initiatives to try to look at equity and hold themselves accountable to that.

I really hope that policymakers and insurers take a hard look at all of the added regulations and burdens that they’ve placed on opioid-prescribing with the goal of reducing misuse and addiction. They may also be placing undue burden on patients with cancer who really need these medications, in particular racial and ethnic minority patients.


Enzinger AC, Ghosh K, Keating NL, et al. Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life. J Clin Oncol. Published online January 10, 2023. doi:10.1200/JCO.22.01413

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