Opioids in Cancer Care

This is a timely and important topic. Later in this posting, I will give you the link to Cancer Net's excellent piece about this. I surely cannot summarize or explain the complex issues better than they do, but I want to write about the ways that I hear about this problem.

The biggest picture is that everyone is now aware of the national opioid crisis. Almost all of us know someone who has a personal story, often of heartbreak. This filters down to active cancer patients in several ways. First, people are more aware of the potential addiction risk. I have known a number of people who, after surgery, were very reluctant to take the prescribed pain medications. Even with an anticipated course of only a few days, they were worried about addiction. Next, people who do take these important pain drugs, whether after surgery or in a longer term way for pain control. often have real issues with side effects. The one that I hear the most about is constipation. That may sound like not such a big deal, but, if you have ever experienced it, you know that it can be a very big and painful problem.

Finally, I work with a number of people who have a substance abuse history. Many of them have been sober for years, even decades, but they remain vigilant and very concerned about taking any drugs that can be addictive. In addition to their worries, they often struggle with doctors who seem poorly informed or, worse, indifferent to these issues. I think of one woman who, after being sober for more then fifteen years, relapsed after surgery when her doctors have her drugs that she knew she could not safely handle. Fortunately, she also knew what to do, and quickly returned to rehab and her program--but this could have and should have been avoided.

This is a remarkable article by Seth Mnookin about this problem. Note that he is not a cancer patient, but the addiction history and need for pain control is the same:

t was roughly halfway into a Saturday evening flight from Miami to Boston when I began to wonder if I was going to survive the night. What had started as a sharp pain on the right side of my abdomen now felt as if my gut was being hacked at with a phalanx of rusty chisels. The only explanation I could think of was that my appendix had burst and I was dying of sepsis.

t was roughly halfway into a Saturday evening flight from Miami to Boston when I began to wonder if I was going to survive the night. What had started as a sharp pain on the right side of my abdomen now felt as if my gut was being hacked at with a phalanx of rusty chisels. The only explanation I could think of was that my appendix had burst and I was dying of sepsis.

t was roughly halfway into a Saturday evening flight from Miami to Boston when I began to wonder if I was going to survive the night. What had started as a sharp pain on the right side of my abdomen now felt as if my gut was being hacked at with a phalanx of rusty chisels. The only explanation I could think of was that my appendix had burst and I was dying of sepsis.

t was roughly halfway into a Saturday evening flight from Miami to Boston when I began to wonder if I was going to survive the night. What had started as a sharp pain on the right side of my abdomen now felt as if my gut was being hacked at with a phalanx of rusty chisels. The only explanation I could think of was that my appendix had burst and I was dying of sepsis.

Here is the link to the Cancer Net article:

Benefits and Risks of Opioids in Cancer Care

In this podcast from the ASCO Educational Book, Dr. Judith A. Paice discusses the risks and benefits of using opioids to treat cancer-related pain in patients and survivors. She also discusses alternatives to opioid use for pain reduction.

Pain is a common side effect of cancer and its treatment. More than half of people with cancer experience pain. Pain management often includes a variety of treatment options, from prescription medications to physical therapy and meditation.

Opioids are a category of pain-relief medications that includes fentanyl, hydrocodone, morphine, and oxycodone. These medications are essential for helping patients with pain from advanced cancer. At the same time, because opioids have a potential for misuse or abuse, doctors are careful about prescribing them for long-term use. And, long-term use of opioids can have significant side effects

Read more: http://www.cancer.net/blog/2017-08/benefits-and-risks-opioids-cancer-care