Cancer and the Opioid Epidemic

Adequately addressing cancer-related pain, resulting from the disease itself or from treatments, is an integral part of healing. Media attention regarding the opioid epidemic has led to concerns about how these powerful drugs, relied upon for alleviating moderate to severe cancer pain, may complicate the recovery of patients coping with cancer.

Indeed, recent research suggests that a significant minority of cancer patients are susceptible to opioid overuse once they are prescribed it for their pain.¹ Among patients who had not been taking opioids previously and were prescribed them following cancer surgery with curative intent, 10 percent were continuing to use them either daily or intermittently a year later. One of the predisposing factors was being treated with adjuvant chemotherapy. These study findings are of interest, because previously the focus of research on opioid overuse following medical treatment had been on surgical patients who were not treated for cancer, and their rates were found to be somewhat lower, around 6 percent.² This potential for persistent use represents an additional burden for cancer patients, suggesting the need for prescribing guidelines, physician education, and patient counseling.

The authors of the study noted that the psychosocial distress cancer patients experience might also be a contributor to their subsequent persistent use of opioids. Other authors have noted that psychological and behavioral interventions for pain, such as cognitive behavioral psychotherapy, physical therapy, and yoga, are less often prescribed,³ despite the fact that they have been found useful for some types of cancer pain, such as that experienced during bone marrow transplant.⁴ These types of approaches may also help patients cope with the stress associated with their cancer.

Adequate relief from cancer-related pain is a priority, but other factors, such as the fact that cancer patients are typically treated by a team of providers who may provide multiple prescriptions, may contribute to their risk of overuse. Patients who have leftover medication are susceptible to overuse, and leftover medications can also pose a risk of abuse or overdose by those close to patients. In an effort to address this, cancer organizations are getting the word out about National Prescription Drug Take-Back Day.⁵ This is a nationwide effort to educate the public on how to store opioids and prescription drugs safely, and how to dispose of them responsibly. On Take-Back Day, patients can visit collection sites near them to turn in medications, but there is also information how to handle them throughout the year. Helpful information for cancer patients taking medication for their pain is also available.⁶