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Addiction In Cancer Patients

Dr. Richard Foster, LICDC-CS

Medically reviewed by

Dr. Richard Foster, LICDC-CS

March 1, 2019

Cancer patients are often confronted with a host of overwhelming emotions and even mental disorders. Anger, fear, worry, loneliness, intense stress, anxiety, and/or depression are among those which may lead an individual to self-medicate, increasing the risk of developing an addiction.

A staggering 39.6 percent of Americans will face a cancer diagnosis within their lifetime. Cancer patients are commonly prescribed opioid medications which create a potential for misuse and addiction. Further, those who are in recovery from addiction face specific concerns pertaining to pain management. Various drugs of abuse can actually decrease the effectiveness of certain cancer treatments, interact dangerously with medications, and deplete a person’s general state of health.

What Is The Risk Of Opioid Addiction In Cancer Patients?

Continued exposure to opioid analgesics (painkillers) is considered by many to be one of the greatest risks associated with cancer care. The pain attributed to cancer treatment can become very intense. For this reason, opioid painkillers are often the primary analgesics and may, at the height of pain concerns, be used around-the-clock. Unfortunately, these are also some of the most addictive prescription drugs on the market.

According to the American Cancer Society, the following are the most commonly prescribed opioids during cancer treatment:

  • Codeine
  • Fentanyl
  • Hydrocodone
  • Hydromorphone
  • Levorphanol
  • Methadone
  • Morphine
  • Oxycodone
  • Oxymorphone

The good news is that the risk of a substance use disorder (SUD) may be less than we think. Experts believe that when patients properly use their medication and have no personal or familial history of addiction or serious co-occurring mental disorders, the risk declines. This risk, however, may increase for those who have one or more of these factors.

While it was not made clear if the patients had any of these risk factors, an Oncology article examined this concern. The authors report that an SUD occurred in less than five percent of cancer center patients. But they do note that the percentage may be higher within the general cancer population. On the other hand, a second publication authored by Erica Weinberg, MD, a doctor who specializes in pain management, paints a somewhat different picture. She asserts that “chemical coping — maladaptive use of opioids (and other substances) to self-treat emotional distress…is common in the cancer population (11% to 28%).”

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Tolerance, Dependence, And The Connection To Addiction

Tolerance and dependence can occur within prescribed use or addiction; however, in the latter, they are not the sole defining factors.

  • Tolerance — occurs when a person requires an increased dosage to maintain the same effects, whether they be analgesic (within prescribed use) or euphoric (within abuse).
  • Dependence — arises when your body and brain begin to rely on the drug. As your body drastically decreases its own production of natural opioids it instead becomes reliant on the version provided by the medication.
  • Addiction — is marked by tolerance and dependence; however, it is also accompanied by compulsive drug-seeking and -using behaviors, among other things.

Speaking of this, the Oncology article writes that “extensive clinical experience with opioid drugs in the medical context demonstrates that tolerance does not cause substantial problems….while the opioid-treated cancer patient who develops analgesic tolerance typically does so without evidence of abuse or addiction.” However, if a tolerant individual seeks to self-medicate their symptoms by taking more of the drug without a physician’s guidance, they experience a greater risk of developing an addiction.

Should you or your loved one find that your pain becomes more than you can bear, you should promptly speak to your doctor. Only a physician should make any changes to the type or dosage of your medication(s). Working closely and honestly with your physician during this time is key to the prevention of substance abuse.

What Is Pseudoaddiction?

The Oncology article outlines what could become a concern for some within treatment—pseudoaddiction. The authors write that “clinical experience suggests that inadequate pain/symptom management can be a trigger for aberrant drug-related behaviors.” Because of this, a person may exhibit distress and drug-seeking which can appear to mimic addictive behaviors. Interpreted incorrectly, pseudoaddiction could stop an individual from receiving the pain management which they so direly need.

To determine the source of these characteristics and better ensure a person receive effective care, professionals need to thoroughly evaluate their patient’s state. The defining feature of pseudoaddiction is that these behaviors are alleviated once proper pain management is administered.

What If I’m A Cancer Patient In Recovery?

For an individual with a history of an SUD, even aside from opioids, concerns of pain management during cancer care can be a very daunting prospect. This situation presents unique concerns for a previously opioid-addicted individual. In some circumstances, these individuals’ treatment plans may still recommend opioid medications.

Because of this, the entire care team should proceed with utmost caution. The Indian Journal of Palliative Care suggests that “opioids with slower onset or longer duration may be more appropriate choices; and the oral route is preferred.” To accompany these, certain non-opioid pain medications may be discussed as potential options.

If you’ve struggled with an SUD, it is important to be honest and communicate these concerns to your doctor. In doing so, together, you can be preemptive in working to prevent a relapse. In these cases, comprehensive cancer treatment necessitates collaboration and communication between various medical specialists. This better supports your continued sobriety and pain management. Most importantly, this is a time to draw upon the coping and relapse prevention techniques you learned within recovery. In addition:

  • Keep your loved ones and support system close
  • Communicate your doubts, worries, and any thoughts of relapse
  • Enlist the aid of someone you trust in overseeing your medications
  • Keep a pain journal—record the intensity and duration of pain
  • Attend self-help groups
  • Consider counseling sessions
  • Seek treatment for any co-occurring disorders
  • Maintain close contact with medical professionals, especially those who manage concerns of addiction.
  • Report any misuse of medications immediately
  • Don’t use other people’s medications

Many of these may also be useful for an individual who has never had a substance use disorder. In either case, these tips offer you a means to better protect yourself against drug abuse and addiction.

How Do I Prevent Painkiller Abuse?

While doctors typically have a working knowledge of addiction, many oncologists may not be overly familiar with the important concerns surrounding addiction. Addiction treatment requires a medical professional who is well-versed in addiction medicine. Also, to counter these risks, Dr. Weinberg recommends:

  • Screening for opioid misuse/abuse potential.
  • Screening for chemical coping and/or any emotional or mental health issues.
  • “A multidimensional bio/psycho/social/spiritual approach to pain management.”
  • A risk-benefit calculation for all medications and treatment approaches.

Other experts recommend integrating a pain psychologist within your care team. He or she will help you to evaluate these risk factors and proceed accordingly. Thorough care should also include preventative and protective measures.

Are There Other Concerns Of Drug Abuse?

Concerns of drug abuse and addiction within cancer patients is not limited only to opioid drugs. The span of time between a cancer diagnosis, treatment, and recovery is exceedingly trying. This period places immense stress on a person physically, mentally, and emotionally.

Anxiety and depression are two mental health disorders which often affect cancer patients. Subsequently, they are quite commonly linked to substance abuse. As a person confronts the reality of their cancer diagnosis, the emotions and symptoms brought upon by these co-occurring disorders may become unbearable. To counter these and other concerns, such as fear or a sense of isolation, some individuals may turn to other drugs or alcohol as a means to dull the pain.

The Oncology article documents that 20 percent of patients admitted for palliative care (adjunct comfort-care which aims to improve a patient’s quality of life) had signs which were indicative of alcohol abuse. Other studies document benzodiazepine abuse. Any drug of abuse may be abused during this time.

Does Drug Abuse Interfere With Cancer Treatment?

In addition to the direct risks and harm associated with addiction, drug abuse may complicate your cancer treatment. Certain drugs of abuse may cause adverse symptoms, such as nausea and vomiting. These are also side effects of various cancer treatments; drug abuse may worsen them even more.

Some may actually interact with various treatments or therapies, lessening their effectiveness. Others, like benzodiazepines, may combine in such a way that could become life-threatening. This is due to the way these drugs interact with opioid painkillers to depress your central nervous system.

Drug abuse depletes a person’s physical health and may lead to states of dehydration, malnourishment, and a weakened immune system—all of which can be very detrimental to an individual who is combating an aggressive disease like cancer. Lastly, SUDs increase the risk for certain types of cancer; this could potentially worsen an existing form.

Can You Get Addiction Treatment While Undergoing Cancer Treatment?

Cancer and addiction treatment are intimidating on their own. Together, this combination may seem unmanageable. Fortunately, some hospitals provide referrals to other departments, allowing an individual to get on-site treatment for both. In other cases, cancer treatment may make it more difficult to enter an inpatient program. However, depending on an individual’s health, a person may be able to take part in outpatient treatment. When a person progresses to a certain point within their cancer recovery, and they are well enough to do so, they may be able to enter an inpatient drug rehab center. can locate a personalized addiction treatment based on your needs. Contact us today.

Cancer Network - Prevalence of Substance Abuse Disorders in Cancer Patients

Hot Spot - Evolving issues in the use and prescribing of opioids for cancer pain

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