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COVID-19 and Pain Management in Oncology Care

 

May 20, 2020

COVID-19 and Pain Management in Oncology Care

By Wendy H. Vogel, MSN, FNP, AOCNP®

Pain management is an essential part of oncology care. Patients with chronic pain are seen regularly by their health-care providers, and appropriate treatments, including opioids, may be prescribed. However, during the COVID-19 pandemic, accessibility to prescribers has become more difficult as practitioners enforce policies to limit the spread of the virus. Patients may not be able to access nonpharmacologic pain treatments, like acupuncture.

Recognizing these barriers, the Drug Enforcement Administration (DEA) launched a COVID-19 Information Page that includes links to DEA policies that modify some restrictions to allow patients access to necessary drug products that contain controlled substances.

 The DEA policy on COVID-19 prescribing guidance became effective March 31, 2020. This policy allows DEA-registered practitioners to prescribe controlled substances without having to interact in-person with the patient. A useful algorithm summarizes this policy. Some of the changes affecting oncology practices include:

  • The DEA-registered practitioner may utilize telemedicine, telephone, or email for initial or follow-up evaluation. This must be an audio-visual, real-time, two-way interactive communication.

  • Schedule II drugs may be called into a pharmacy in an emergent situation that is defined in the policy. This prescription must be confirmed within 15 days by either written prescription, electronic prescribing, or scan/photogram of the prescription.

  • Schedule III-IV may be called into the pharmacy.

  • The DEA-registered practitioner may distribute controlled substances beyond 5% of the total number of dosage units of controlled substances distributed and dispensed during the same calendar year without being registered as a distributor.

  • The DEA-registered practitioner is not required to obtain additional registration with the DEA for prescribing scheduled agents if the practitioner is practicing in a state other than where they are registered.

  • Prescriptions for schedule III-V controlled substances may be dispensed early if state law allows.

  • Urine drug screening may be delayed during this time.

It should be noted that these changes are temporary and only allowed for the duration of the public health emergency as declared by the Secretary of Health and Human Services. These exceptions do not supersede any state rules or regulations. Oncology advanced practitioners should understand their state’s policies and closely monitor for the end of the public health emergency or notification from the DEA that modifies or withdraws the policy.

 

Read more from the APSHO Advance: Special COVID-19 Series