{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:41:34Z","timestamp":1791362494891,"version":"4.3.1"},"reference-count":19,"publisher":"Wiley","issue":"17","license":[{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["KL2 TR001856"],"award-info":[{"award-number":["KL2 TR001856"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Cancer\u2010related pain is highly prevalent and is commonly treated with prescription opioids. The Centers for Disease Control and Prevention (CDC) now encourages conservative opioid prescribing in recognition of potential opioid\u2010related risks. However, CDC guidelines have been misapplied to patients with cancer. Recent laws at the state level reflect the CDC's guidance by limiting opioid prescribing. It is unclear whether states exempt cancer\u2010related pain, which may affect cancer pain management. Thus, the objective of this study was to summarize current state\u2010level opioid prescribing laws and exemptions for patients with cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Two study authors reviewed publicly available state records to identify the most recent opioid prescribing laws and cancer\u2010related exemptions. Documents were required to have the force of law and be enacted at the time of the search (November 2020).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Results indicated that 36 states had enacted formal legislation limiting the duration and\/or dosage of opioid prescriptions, and this was largely focused on acute pain and\/or initial prescriptions. Of these states, 32 (89%) explicitly exempted patients with cancer\u2010related pain from opioid prescribing laws. Exemptions were broadly applied, with few states providing specific guidance for cancer\u2010related pain prescribing.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The results of this study indicate that most states recognize the importance of prescription opioids in cancer\u2010related pain management. However, drafting nuanced and clinically relevant opioid legislation is challenging for a heterogenous population. Additionally, current attempts to regulate opioid prescribing by state law may unintentionally undermine patient\u2010centered approaches to pain management. Additional resources are needed to facilitate clarity at the intersection of opioid\u2010related legislation and clinical management for cancer\u2010related pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>LAY SUMMARY<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>In this review of state\u2010level legislation, current limitations on opioid prescribing are summarized and detailed information is provided on exemptions for patients with cancer.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>The majority of states have enacted specific dosage and\/or duration limitations on opioid prescribing while including broad exemptions for cancer\u2010related pain.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Cancer\u2010related pain exemptions are important to include, as is consistent with national and professional guidelines (eg, the Centers for Disease Control and Prevention). However, these exemptions may also unintentionally undermine patient\u2010centered approaches to pain management.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Additional resources, including specific guidance for patients with cancer, are needed to facilitate clarity at the intersection of opioid\u2010related legislation and clinical pain management.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><jats:p>\u200b<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.33639","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T16:32:13Z","timestamp":1622133133000},"page":"3137-3144","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Exemptions to state laws regulating opioid prescribing for patients with cancer\u2010related pain: A summary"],"prefix":"10.1002","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1005-0303","authenticated-orcid":false,"given":"Hailey W.","family":"Bulls","sequence":"first","affiliation":[{"name":"Section of Palliative Care and Medical Ethics and Palliative Research Center Division of General Internal Medicine Department of Medicine University of Pittsburgh Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay F.","family":"Bell","sequence":"additional","affiliation":[{"name":"Section of Palliative Care and Medical Ethics and Palliative Research Center Division of General Internal Medicine Department of Medicine University of Pittsburgh Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven R.","family":"Orris","sequence":"additional","affiliation":[{"name":"Center for Research on Health Care Division of General Internal Medicine Department of Medicine University of Pittsburgh Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burel R.","family":"Goodin","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Alabama at Birmingham Birmingham Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane M.","family":"Liebschutz","sequence":"additional","affiliation":[{"name":"Center for Research on Health Care Division of General Internal Medicine Department of Medicine University of Pittsburgh Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoinette","family":"Wozniak","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology Department of Medicine University of Pittsburgh Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica S.","family":"Merlin","sequence":"additional","affiliation":[{"name":"Section of Palliative Care and Medical Ethics and Palliative Research Center Division of General Internal Medicine Department of Medicine University of Pittsburgh Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yael","family":"Schenker","sequence":"additional","affiliation":[{"name":"Section of Palliative Care and Medical Ethics and Palliative Research Center Division of General Internal Medicine Department of Medicine University of Pittsburgh Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,5,27]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31303"},{"key":"e_1_2_8_3_1","first-page":"CD012592","article-title":"Opioids for cancer pain\u2014an overview of Cochrane reviews","volume":"7","author":"Wiffen PJ","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_4_1","volume-title":"Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations","author":"Pain Management Best Practices Inter\u2010Agency Task Force","year":"2018"},{"key":"e_1_2_8_5_1","volume-title":"Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use","author":"Phillips JK","year":"2017"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001773"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.1464"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.1574"},{"key":"e_1_2_8_9_1","unstructured":"CDC advises against misapplication of theGuideline for Prescribing Opioids for Chronic Pain. US Centers for Disease Control and Prevention. Accessed December 20 2020.https:\/\/www.cdc.gov\/media\/releases\/2019\/s0424\u2010advises\u2010misapplication\u2010guideline\u2010prescribing\u2010opioids.html"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.19.00149"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2015.12.340"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/EDBK_100020"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.36.30_suppl.230"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.soncn.2019.04.015"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djaa110"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2020.2211"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/0098858816644712"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pny307"},{"key":"e_1_2_8_19_1","unstructured":"Cancer Action Network American Cancer Society.Achieving Balance in State Pain Policy: A Report Card. Accessed December 20 2020.https:\/\/www.fightcancer.org\/sites\/default\/files\/NationalDocuments\/Pain\u2010Report\u2010Card\u20102018\u2010accessible.pdf"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2019.01.013"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.33639","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cncr.33639","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.33639","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T09:43:53Z","timestamp":1760262233000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.33639"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,27]]},"references-count":19,"journal-issue":{"issue":"17","published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1002\/cncr.33639"],"URL":"https:\/\/doi.org\/10.1002\/cncr.33639","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,27]]},"assertion":[{"value":"2021-02-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-05-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}