It’s difficult to avoid the news of how opioids have ravaged many cities in the United States. And rightly so. According to the National Institute on Drug Abuse, more than 130 people die every day from an opioid overdose. While the midwest has been known to be a hotspot for opioid abuse, the crisis has spread to nearly every corner of the country.

What are opioids?

Opioids are a specific class of drugs. It includes prescription medicines like oxycodone (OxyContin(R)), hydrocodone (Vicondin(R)), morphine, codeine, and others. In addition to these, the class of drugs also includes heroin and synthetic (chemically-developed) opioids like fentanyl. Fentanyl is about 80-100 times stronger than morphine.

When prescribed by a healthcare provider, such as an oncologist, pain medication can be extremely helpful for those in need of pain management when other options, like ibuprofen, nerve blocks, or nonpharmacological therapies like massage and acupuncture, do not provide sufficient relief. Often times, opioids could be prescribed for short term use versus use for the management of chronic pain.

What about cancer patients?

With opioids and opioid addiction constantly in the news (and rightly so!), some complications have arisen for cancer patients. Many cancer patients experience pain, and pain medications are a standard part of cancer treatment. However, recently there have been accounts of provider anxiety associated with prescribing opioids for pain. And while many oncologists continue to prescribe them, many primary care doctors no longer do.

On the flip side, there have been accounts of patients refusing to seek prescriptions for pain medication, or underutilizing their medication. All this in part due to the stigmatization of opioid use. Results from a recent study published in April 2019 in The Journal of Pain and Symptom Management entitled “Cancer and Opioids: Patient Experiences With Stigma (COPES)—A Pilot Study,” suggest that there are real concerns about the use of opioids among cancer patients. In the study, which included 125 adult cancer patients, 61 percent experienced opioid stigma (including 36 percent who reported a fear of addiction, and 22 percent who reported difficulty filling prescriptions), and 29 percent reported stigma-related behaviors, such as taking less of the medication than needed. Other stigma-related behaviors included hoarding opioids, avoidance of opioids, not getting prescriptions filled, and not discussing pain with doctors, friends, or loved ones.

According to Ashley Glode, PharmD, Assistant Professor, Department of Clinical Pharmacy at the University of ColoradoSkaggs School of Pharmacy and Pharmaceutical Sciences:

It is important for patients in pain to be able to receive proper management.  We need to do a better job educating patients and society about opioid use in order to minimize barriers to this important treatment option.

Yes, opioids are highly addictive, especially when abused. However, they are treatments that have shown great efficacy for those who truly need them, like cancer patients.

How to avoid addiction

Anyone can become addicted to opioids. Opioid addiction crosses all racial, economic, and gender lines. However, there are steps to take to avoid addiction. Most importantly, take the medication as prescribed, under the supervision of your doctor.

Talk to your health care team if you have a personal or family history of substance abuse. Do not take another person’s prescription, and do not use or seek out illegally obtained opioids like fentanyl or heroin as these are often laced with other chemicals and very dangerous.

Finally, if you have developed a tolerance to the medication prescribed by your doctor, bring it up with them at your next appointment. If you feel you have developed a dependency, this is incredibly important to address. In addition, it is important to dispose of unused medication appropriately, ideally through a medicine take-back program.

From the clinician standpoint, a 2016 clinical practice guideline for chronic pain management was published by the American Society of Clinical Oncology, which assesses pain. In the statement, oncologists are encouraged to assess a patient’s pain management goals, and also discuss with the patient the possible risks associated with opioid use. Shared-decision making is critical when it comes to pain management for cancer patients.

Pharmacists can help adjust opioid regimens and recommend adjunctive therapy to optimize pain control.  Pharmacists can also provide education on safe use, safe storage, and safe handling and disposal of opioid medications. - Dr. Glode

What's the bottom line?

If you’re a cancer patient experiencing pain, talk to your doctor. If you’re concerned about the use of opioids, ask your doctor what else you might try first, and seek a multifaceted approach to pain management. Make sure your caregivers or loved ones know what medications you’re on and keep the discussion open about pain management.

Cancer and Opioids: Patient Experiences With Stigma (COPES)—A Pilot Study
Bulls, Hailey W. et al. Journal of Pain and Symptom Management, Volume 57, Issue 4, 816 - 819

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