Concerns about Opioid Use
What are opioids?
Opioids are a class of medication used to treat pain. Opioids can also be referred to as narcotics. Opioids include oxycodone, hydrocodone, morphine, tramadol, and the illegal drug heroin, amongst others. They come in both short-acting and long-acting forms. There are also combination medications that combine an opioid with acetaminophen or another non-steroidal anti-inflammatory.
Opioids may also be referred to as controlled substances. Your provider must have a DEA (drug enforcement administration) registration certificate to prescribe these controlled substances. These prescriptions and the provider that write these prescriptions are monitored to ensure appropriate use.
How are opioids used for cancer patients?
Opioids are often prescribed for patients who have pain related to their cancer diagnosis. In the cancer population, they are most often used to treat chronic pain, meaning pain that lasts at least 12 weeks, often longer. They can also be used to treat acute toxicities associated with treatment.
What are addiction and compulsion?
Addiction is a psychological need for a drug. In cases of opioid use related to addiction, the medication causes euphoria and pleasure, also referred to as a "high.” Addiction causes a craving for this feeling, a lack of control over use of the medication, and a person addicted will continue to use the opioids despite the harm being caused. Compulsion, which can be a component of addiction, is an overwhelming need to obtain the substance. Compulsion can lead to a person doing whatever is necessary to obtain the substance, even if this behavior is risky.
Some patients who are prescribed opioids worry that they could become addicted to the medication. When these medications are used to treat physical pain, it is unlikely that you would become addicted to them.
What is tolerance?
Tolerance is the inability to get relief from pain with your prescribed dose of opioids. This can happen when you have been taking the opioid for an extended period of time. In this case, you will need a higher dose to relieve your pain. Tolerance is expected in most cases. If your pain is no longer controlled with your prescribed dose, it is important to talk to your care team about the proper dose for your situation. Do not take more pain medication than has been prescribed. Talking first with your team about this can prevent unwanted side effects and ensure your safety.
What is dependence?
Dependence is the body becoming used to taking the medication. When a person takes a regular dose of opioids, even for as little as a week, their body adapts to the medication. Dependence is a natural and physical effect that happens to anyone taking opioids long-term. Dependence is not the same as addiction.
Can you stop taking opioids?
Once a patient has become dependent on opioids, they will feel very sick if they suddenly stop taking the medication. This is known as withdrawal. Withdrawal symptoms can start within 2 days of stopping the medication and can last up to 2 weeks. Patients can feel very sick during this time of withdrawal. If the opioid dose is lowered gradually, usually over about a week or so, you can prevent withdrawal symptoms. This should be done under the guidance of your care team. The exact amount of time it takes to wean off of opioids depends on how long you have been taking them, your dose, and other individual factors.
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