Opioid painkillers largely fuel our nation’s opioid epidemic. They’re also one of the most frequently used medications to manage cancer-related pain. This reality forces treatment providers, patients and their families to be mindful of how and when these medications are used. This knowledge and communication between these parties can help to minimize the risk of drug misuse and abuse.

Preventing Substance Abuse In Cancer Patients

Every individual receiving opioid painkillers should be monitored on a regular basis, however, those individuals who are active drug abusers or currently in recovery require more intensive monitoring and supportive services.

There is a strong link between addiction and family history, or genetics. For this reason, at the onset of care, it’s important to notify a doctor if a patient has a family history of addiction. This question should be one of several delivered in an evaluation prior to the prescribing of opioid pain medications.

A mental health screening is also beneficial, both prior to and during treatment, as untreated mental health problems frequently lead to substance abuse. Administering a routine substance abuse screening can also identify drug misuse and abuse before it gets out of control.

Cancer treatment and unresolved pain can cause triggers for relapse and initiation into substance-abusing behaviors for some individuals. The stress of treatment and inadequate pain management can cause sleep troubles, extreme fatigue and feelings of loneliness and social isolation. All of these can be risk factors for substance abuse.

Proper pain management can curtail drug misuse, as individuals experiencing unresolved pain may be tempted to self-medicate on their own. Peer support groups can help individuals cope with feelings of inadequacy and isolation which could otherwise trigger thoughts of drug using.

While it can be difficult to engage life at the same level one did prior to a cancer diagnosis, it’s still important to interact with loved ones and bring meaning to a person’s life in other ways. Maintaining relationships with loved ones can boost positive thoughts, a sense of purpose and self-worth, and increase accountability, all things which can help to reduce triggers for drug abuse.

Does Prescribed Opioid Painkiller Use Lead To Addiction?

As our nation confronts the opioid epidemic, many individuals question the abuse potential of opioid painkillers. These medications have a high potential for abuse and addiction, however, they also have a valuable role within the treatment of pain, especially for cancer patients.

The following opioid medications are used to treat cancer-related pain, as detailed by the American Cancer Society:

  • codeine
  • hydromorphone (Dilaudid)
  • levorphanol
  • methadone (Dolophine, Methadose)
  • morphine (Avinza, MS-Contin)
  • oxycodone (OxyContin)
  • hydrocodone (Vicodin)
  • oxymorphone (Opana)
  • fentanyl (Actiq, Duragesic, Subsys)

With proper medical oversight and guidance, an individual using these medications faces a reduced risk of abuse compared to someone self-medicating, however, there is still cause for concern.

According to the National Institute on Drug Abuse, “Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.” Of this number, “between 8 and 12 percent develop an opioid use disorder.”

Despite this, many experts claim that drug misuse and substance abuse are relatively low in oncology patients. But even then, individuals taking these medications to manage cancer-related pain must be mindful of their side effects and potential for abuse.

Preventing Painkiller Abuse In Cancer Patients

Treatment providers must maintain an active dialogue with patients for the duration of opioid painkiller treatment to help ensure a patient’s use is only as prescribed. It’s also important that close loved ones become familiar with treatments that way they can identify any behaviors which point to drug misuse or abuse.

Knowing the dose and frequency of medications can help loved ones to spot the first signs of drug misuse. It’s important to realize that patients who exhibit a tolerance and dependence to medications aren’t necessarily abusing their drugs. Prescribed use can cause these conditions. It’s when these states are accompanied by compulsive behaviors of drug seeking and using that there’s cause for concern.

Loved ones should be aware of the following signs of drug misuse and abuse:

  • taking a medication more frequently than prescribed
  • taking a dose higher than prescribed
  • taking the medication when a person isn’t experiencing pain
  • hoarding pills
  • chewing the medication
  • changing the medication’s form (crushing the drug to snort, smoke or inject it)
  • taking someone else’s medication
  • purchasing pills of the street
  • claiming a medication is “lost” so that more can be obtained

Any suspected abuse should be communicated to the prescribed doctor and the appropriate drug rehabilitation services sought.

Opioid painkillers aren’t the only way to manage pain. Employing alternative methods of pain management can help to reduce the potential of painkiller abuse.

The American Cancer Society notes that non-narcotics like acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) “are stronger pain relievers than most people realize,” and for this reason, useful in controlling mild to moderate pain. Gabapentin (Neurontin) has been used with success to treat certain forms of cancer-related pain, however, it can also be abused to the point of addiction.

Other options exist to manage pain beyond medications. According to the Cleveland Clinic, physical therapy may help to alleviate certain types of cancer-related pain. In addition to this, they also note that acupuncture, guided imagery, neurostimulation, or Reiki may provide a measure of relief too.

Preventing Other Forms Of Substance Abuse In Cancer Patients

Opioid pain relievers aren’t the only substances’ cancer patients abuse. Any drug of abuse may be abused, however, certain substances may be more attractive to cancer patients.

Some individuals may self-medicate physical symptoms with marijuana or misuse their medical marijuana. Alcohol may be tempting to those who wish to dull feelings of isolation, fear or despondency associated with a cancer diagnosis. Individuals experiencing high levels of stress, anxiety or depression may turn to benzodiazepine drugs like Valium or Xanax to self-treat their symptoms.

Identifying and managing mental health concerns, in addition to a substance abuse screening, can help to reduce this risk.

Preventing Substance Abuse In Active Drug Abusers And Individuals In Recovery

Active substance abusers of alcohol, illicit drugs or prescription medications (including opioid painkillers) have needs distinct from those individuals in an abstinent state of recovery. An individual’s medical team needs to be adept at delivering treatments to individual’s with these concerns.

These individuals and those in recovery undergoing cancer treatment face unique challenges. These patients are at risk of experiencing inadequate pain management and insensitivity about their needs. This is because treatment providers may not have the necessary knowledge about treating patients with addiction, while also being fearful of aggravating the substance use disorder by introducing the opioid medications.

In these circumstances, doctors should consider the behavioral, biological, chemical, social and psychological elements of drug abuse, so that a person is best supported in prevention and sobriety goals.

In either of these instances, an individual needs to be more vigilant of their relationship with their medication and the way they’re handling the stressors of life and their illnesses. Creating an open dialogue with medical providers and loved ones can help these individuals to stay strong and focused on their recovery, both in terms of cancer and substance abuse.

Here’s some tips which can help these patients maintain their recovery goals and proper use of their medications:

  • keep a pain journal which details the frequency and intensity of pain
  • build and maintain a strong support system
  • maintain communication with doctors and keep regular appointments
  • let a trusted loved one manage and oversee the patient’s medications
  • speak up about any thoughts of relapse or medication misuse
  • don’t use anyone else’s medications
  • don’t self-medicate
  • enroll in peer support groups and/or counseling sessions (both for substance abuse and the cancer diagnosis)
  • get treatment for co-occurring disorders

These tips can be useful for any person currently in cancer treatment, especially those undergoing pain management with opioid painkillers.

Dual Diagnosis Concerns In Cancer Patients

A cancer diagnosis affects an individual’s mental health standing too. Facing a new diagnosis, treatments, and recovery from cancer can place an immense strain on a person’s mental and emotional health.

Oncology patients frequently experience mental health problems, including, but not limited to, depression and anxiety. Depression and anxiety are the two forms of mental illness most frequently linked to substance abuse. Coupled with the pain and stress of treatment, these disorders may tempt certain individuals to self-medicate with drugs or alcohol.

Individuals experiencing mental or emotional issues should seek counseling or therapy to ensure that their psychological health is adequately treated as well. An untreated mental illness can serve as a trigger for relapse for a patient in recovery or precipitate first-time substance abuse in individuals who have never abused drugs before.

Individuals who are suffering from both a substance use and mental health disorder during cancer treatment will have better outcomes with targeted, dual diagnosis care. Treatment should address the challenges associated with all three illnesses to ensure a person has the highest opportunity to recover, body and mind.

The Dangers Of Using Drugs Or Alcohol As A Cancer Patient

In addition to the general risks associated with drug and alcohol abuse, cancer patients face complications which are specific to the disease and treatment.

Certain drugs of abuse may reduce the efficacy of cancer treatments or therapies. Others may cause side effects similar to those caused by drug abuse, such as nausea and vomiting.

One of the greatest concerns is harmful, and even deadly, interactions between opioid painkillers and certain drugs of abuse. Opioids are strong central nervous system (CNS) depressants. This means they slow down critical life support systems, including blood pressure, breathing, heart and temperature rates.

Alcohol and benzodiazepines are both CNS depressants. When used in conjunction with opioid painkillers (even prescribed amounts), the combined depressant effects can become extreme. In these instances the risk of respiratory depression, overdose and death run high.

As a person undergoes cancer treatments, it’s important for them to keep their body and immune system as healthy as possible. This helps the patient’s body to recover more fully and quickly after treatment. Substance abuse depletes a person’s immune system, making it difficult for the body to fight infection and the invading cancer cells.

Further, certain forms of substance abuse are associated with an increased risk of cancer. Using marijuana is believed to increase cancer risk. Alcohol abuse is linked to various cancers, including those of the head and neck.

Getting Treatment For Substance Abuse

The level of treatment an individual with a cancer diagnosis can receive varies. Acute cases may not permit an individual to enroll in an inpatient, residential program. In these instances, the hospital will likely refer a person to an in-house treatment program.

Individuals who have stabilized may be able to engage in outpatient treatment. Once a person has remained cancer free and stable for a significant amount of time, they may be able to seek inpatient services.

Contact Vertava Health to learn more about preventing drug abuse in cancer patients.