Opioid Crackdowns Are Leaving Dying Hospice Patients in Untreated Pain

In response to the opioid epidemic, federal and state regulators have imposed prescribing restrictions, pharmacy dispensing limits, and monitoring requirements that were designed for outpatient chronic pain management but are being applied indiscriminately to hospice and end-of-life care. Between 2007 and 2017, the proportion of dying cancer patients receiving any opioid prescription near end of life declined 15.5%, from 42.0% to 35.5%. Long-acting opioid prescriptions declined 36.5% in the same period. Why does this matter? Dying patients are experiencing uncontrolled pain because pharmacies are limiting the opioids they stock, prescriptions cannot be transferred between pharmacies, and co-pays for breakthrough medications are unaffordable. In Michigan, a law required providers to review an automated prescription monitoring report before prescribing opioids exceeding a 3-day supply. For a hospice managing 400 patients, that means 400 reports reviewed weekly, an administrative burden that directly delays medication access for people in their final days. Hospice nurses report spending hours driving between pharmacies searching for available morphine while their patients suffer. The structural problem is that opioid policy was designed to address addiction in otherwise healthy populations and was never adapted for the palliative context. The DEA, state pharmacy boards, and prescription drug monitoring programs do not distinguish between a 35-year-old with back pain and an 85-year-old with metastatic cancer. Hospice providers are caught between their obligation to manage pain and their fear of regulatory scrutiny, and the patients who pay the price are the most vulnerable people in the healthcare system: those who are actively dying.