Opioids for Treating Cancer Pain
What are opioids?
Opioids are a type of medicine used to treat pain. Opioids may also be called narcotics. You need a prescription from a healthcare provider to get opioids. Opioids include:
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 monitored to make sure the medicines are being used correctly 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 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 relieve your pain. Most people who take opioids long-term will develop tolerance. Your provider may prescribe a higher dose or change your medication to relieve 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 ensure your safety.
What is dependence?
Dependence is the body becoming 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. However, if you use them as prescribed to treat your pain, your risk of addiction is very low.
If you are concerned 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.
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 several weeks. Withdrawal symptoms can make you feel very sick. Symptoms of withdrawal include:
- Nausea and vomiting.
- Sleep troubles.
- Anxiety and worrying.
- Increased body temperature.
- Racing heart.
- Muscle and bone pain.
- 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 individual factors.
Resources for More Information
American Cancer Society. Opioids for Cancer Pain. 2019. Found at: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/pain/opioid-pain-medicines-for-cancer-pain.html
Dalal, Shalini MD and Bruera, Eduardo MD. Pain Management for Patients with Advanced Cancer in the Opioid Epidemic Era. American Society of Clinical Oncology Educational Book. Volume 39. 2019. Found at: https://ascopubs.org/doi/full/10.1200/EDBK_100020
MedLine Plus. Opioid Overdose. Found at: https://medlineplus.gov/opioidoverdose.html
National Institute on Drug Abuse. The Science of Drug Use and Addiction: The Basics. 2018. Found at: https://www.drugabuse.gov/publications/media-guide/science-drug-use-addiction-basics
Page, Ray DO, PhD and Blanchard, Elizabeth MD. Opioids and Cancer Pain: Patients' Needs and Access Challenges. Journal of Oncology Practice. 2019. Found at: https://ascopubs.org/doi/pdf/10.1200/JOP.19.00081