Painkillers can provide a significant amount of relief for people with cancer pain, and often, they’re considered vital in preserving a person’s quality of life. But painkillers can also be intensely strong, and issues of addiction are a concern in some people with cancer.
Painkillers and Cancer Pain
Cancerous cells can cause a remarkable amount of pain. Tumors can grow and grow until they displace vital organs, and sometimes the tissues grow so quickly that they cause bones, muscles and skin to bend and stretch in unusual ways. Opioid-based painkillers can block signals of pain, and when they’re in place, people with serious medical conditions might feel well enough to spend time with their families, enjoy the fresh air and otherwise revel in the life that they have.
When compared to other people who have chronic pain conditions, people who have cancer present a low risk of painkiller addiction. For example, in a study in the Clinical Journal of Pain, researchers compared incidence of painkiller abuse among people who had cancer and among people who had AIDS, and they found that those with AIDS had more problematic pain behaviors.
It’s possible that this level of risk comes about due to the high mortality rates associated with specific types of cancer. When cancer cells can’t be obliterated or controlled, people who have these conditions are encouraged to use medications to control the pain in order to make the rest of life bearable. Practitioners rarely worry about addictions in end-stage cancer patients, as people with these conditions don’t face additional difficulties due to substance abuse. Providing them with appropriate pain control is vital when the end of life is approaching.
However, there are some cancers that can be safely moved into remission, and there are some people with cancer who choose to abuse their medications.
For example, in a study in Medscape, researchers examined patients dealing with a variety of different types of cancers, including:
- Multiple myeloma
- Ear, nose or throat
In this study, researchers found that 21 of 46 patients displayed behaviors that were “strongly suggestive” of an addiction process. Some went to multiple doctors for prescriptions, some added alcohol to their painkillers and some used illegal drugs. This is a small study, but it does seem to demonstrate that some people develop addictions in tandem with cancer.
Understanding the Risk
While addictions can sometimes appear in those who have a cancer diagnosis, almost everyone who uses prescription painkillers will develop symptoms associated with physical dependence. To outsiders, these symptoms can look like addiction, but in reality, they’re just part of the process of taking these powerful drugs.
Opioids attach to receptors inside the brain, triggering the responses that can kill pain and boost a feeling of euphoria. With each dose a person takes, the brain amends its chemical responses and shifts its internal processes. In time, a person who takes painkillers habitually will need to take very large doses of those drugs to achieve the same level of relief, and this same person might feel physically ill without access to painkillers. That’s a natural process, and it’s part of the deal for people who take painkillers.
Those who have addictions might have symptoms of physical dependence, but they also have a psychological compulsion to use and abuse drugs. People like this might:
- Crush drugs and snort them to feel a bigger high
- Chew their pills to break down time-release capabilities and feel a bigger immediate high
- Transition from painkillers to heroin
- Take pills even when they’re not in pain or don’t feel ill
While anyone could develop these behaviors, they’re most common in people who have a prior history of an addiction issue. People like this may have struggled with alcohol early in life or dealt with an opiate issue in the recent past. They can still obtain help with painkillers, but they might need targeted help from their doctors. For example, an article in the Clinical Pain Journal suggests that people with a history of addiction might be required to sign a formal medication agreement drawn up by a doctor, which lists appropriate drug levels and pain goals. These clients might also be required to deal with regular drug screening tests and pill-counting appointments, so doctors can ensure that an abuse issue isn’t taking place.
If you’re not certain if the person you love is using pain medications appropriately, a visit to the person’s doctor might be in order.
This professional should know how much of a medication the person needs, and this professional can provide screening tests that could accurately diagnose an abuse disorder. This isn’t the sort of thing you should diagnose alone. Letting a doctor help might be a wonderful way to soothe your mind and ensure that the person gets the right kind of help. And if you do discover that an addiction is in play, please contact us. Our admissions coordinators can direct you to a Foundations Recovery Network treatment program that can help.
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton