Opioids for Treating Cancer Pain

What are opioids?

Opioids are a type of medicine used to treat pain. Opioids may also be called opiates or narcotics. You need a prescription from a healthcare provider to get opioids. Opioids are:

• Oxycodone.
• Hydrocodone.
• Morphine.
• Tramadol.
• Fentanyl.

The illegal drug heroin is also an opioid. Prescription opioids come in short-acting (start working right away) and long-acting (slowly release over 12-24 hours). There are also medicines that mix an opioid with acetaminophen or a non-steroidal anti-inflammatory (NSAID).

Opioids are controlled substances. Your provider must be registered with the DEA (Drug Enforcement Administration) to write prescriptions for controlled substances. These prescriptions and the provider are checked to make sure the medicines are being used the right way and safely.

How are opioids used for cancer patients?

Cancer and its treatments can cause pain. Opioids can be used to treat this pain. They are most often used to treat chronic (life-long) pain. Chronic pain is pain that lasts at least 12 weeks or longer. Sometimes opioids are used for a short amount of time to treat pain caused by cancer treatments.

What is tolerance?

Tolerance is when, over time, your dose of opioids stops managing your pain. When this happens, you will need a higher dose to help your pain. Most people who take opioids long-term will develop tolerance. Your provider may prescribe a higher dose or change your medication to help your pain. Do not take more pain medicine than has been prescribed without talking to your provider. Talking with your team can prevent unwanted side effects and make sure you are safe.

What is dependence?

Dependence is the body getting used to taking the medication. When you take a regular dose of opioids, even for as little as a week, your body gets used to the medication. Dependence is your body’s normal response to taking opioids long-term. If you are taking opioids for more than a few weeks, “dependence” may cause you to have symptoms of withdrawal when you stop taking them. Your provider can help you stop the medicine safely.

How is dependence different from addiction?

It is normal for cancer patients taking opioids long-term to develop tolerance and dependence. This does not mean you are addicted. Most people who take pain medicines use them to treat their pain. When they are no longer needed for pain, they can stop taking the medicines. Addiction is a disease that causes people to crave the medicine even when they do not have pain. They are not able to control their urge to take the medicine even when it causes them harm.

Some patients who are using prescribed opioids worry that they could become addicted to the medication. This can cause people to avoid using pain medicine even when they have severe pain. There is a small risk of addiction with the use of opioids for pain. If you use them as prescribed to treat your pain, your risk of addiction is very low.

If you are worried about addiction or have a history of substance use/abuse and are worried about your sobriety, be sure to talk with your cancer care team and your substance use support systems/treatment center.

What are some of the side effects of opioids?

If you start taking opioids:

• Opioids may make you feel sleepy. This may go away.
• You may have constipation. Ask your provider if you should take medications to manage this.
• You may have nausea and vomiting.

Talk to your care team if you are concerned about these side effects.

How can you stay safe while taking opioids?

Some ways you can stay safe are:

• If you see many care providers, make sure they have your current medication list.
• Never share your medication with anyone.
• Let your provider know if you use alcohol or any medications that make you sleepy.
• Keep all your medications in a safe place.

Can I stop taking opioids?

If you have been taking opioids for more than a few weeks, you will feel very sick if you suddenly stop taking the medication. This is called withdrawal. Withdrawal symptoms can start hours after stopping the medication and can last for many weeks. Withdrawal symptoms can make you feel very sick. Symptoms of withdrawal include:

• Nausea and vomiting.
• Diarrhea.
• Sleep troubles.
• Anxiety and worrying.
• Increased body temperature.
• Racing heart.
• Muscle and bone pain.
• Sweating.
• Chills.
• High blood pressure.

If you want to stop taking a prescribed opioid, talk with your cancer care team to come up with a plan to slowly lower your dose. This will help prevent withdrawal symptoms. How much time it takes to wean off opioids depends on how long you have been taking them, your dose, and other factors. If you stop taking opioids and have leftover or expired medication, make sure to get rid of them safely by taking them to your pharmacy or FDA safe disposal site.

Resources for More Information

Safe Use of Controlled Substances at Home