Cancer patients have been left in the lurch as the US cracks down on opioid use, experts warn.
The highly-addictive painkillers provide rare moments of relief from the debilitating pain caused by most types of cancer and the treatments used to fight it, such as chemotherapy.
One new study, published today, warns there are no clear guidelines to help cancer patients avoid getting hooked, meaning that more and more survivors are left grappling with a new disease: addiction.
However, another study presented at an international cancer conference in Lisbon on Monday warned cancer patients are struggling to get hold of the necessary pain relief amid the nationwide crackdown on opioid prescriptions.
It’s a Catch-22 situation that, experts say, is being ignored and demands urgent attention.
Today, more than two-thirds of people diagnosed with cancer are expected to survive at least five years or more – up from less than half in the 1970s. However, there are still major obstacles when it comes to improving the quality of life, and pain is the biggest challenge (file image)
Professor Eric Winer, director of the Breast Cancer Program at Dana-Farber and the Harvard Cancer Center, and co-chair of the Lisbon conference, said: ‘We acknowledge that the misuse of opioids is a big problem, particularly in the United States, but we need to make sure that in trying to deal with this problem we do not interfere with pain management in cancer patients.’
In the past few decades, cancer research has led to huge successes.
Today, more than two-thirds of people diagnosed with cancer are expected to survive at least five years or more – up from less than half in the 1970s.
However, there are still major obstacles when it comes to improving the quality of life, and pain is the biggest challenge.
More than half of cancer patients undergoing chemotherapy, radiation therapy, or similarly strenuous treatment experience pain.
Opioids seemed to be the antidote: the incredibly potent pills mask even extreme pain, and often carry a feel-good sensation as well.
What’s more, patients could be prescribed a few bottles of the stuff, meaning they would never be left in a tight spot again, suffering pain at night or on the weekend when the doctor’s office is closed.
But the addiction and overdose epidemic that has taken hold of the US in the last few years, killing hundreds of thousands of Americans, has exposed the danger of freely prescribing such potent medication, and panic has set in amongst the medical community.
Now, as opioid providers and prescription-happy doctors face federal lawsuits, clinics nationwide are scrambling to limit painkiller prescriptions.
And rightly so, says James D Murphy, an oncologist at La Jolla University in California, who was an author on today’s study published in the Journal of the National Cancer Institute.
‘Opioid use carries a risk of problems related to long-term use, or abuse,’ Dr Murphy said. ‘From a healthcare provider perspective, we need better approaches to identify cancer patients at risk of these opioid-related problems.’
There are guidelines to help cancer patients avoid opioid dependence, Murphy says, but they are vague.
More importantly, he says, little is done to identify the patients with the highest risk of post-treatment addiction.
Analyzing a cohort of 107,000 patients, Dr Murphy and colleagues found opioid dependence was more common among some cancer types than others. For example, 19.8 percent of patients with liver cancer developed dependence to painkillers after treatment, compared to 5.3 percent of prostate cancer patients.
They also found certain demographics had a higher risk. Much like the general population, patients had a higher risk of opioid dependence if they were white, young, unemployed or low income, and a smoker.
For Lucas K. Vitzthum, an author of the study, this shows hospitals could do a lot to prevent addiction by screening patients for these risk factors.
‘Ultimately, clinical tools such as ours could help providers identify which patients could benefit from alternative pain management strategies or referral to pain specialists,’ Vitzthum said.
Other ideas floated by the 1,500 experts at the Lisbon conference included improving access to cannabis for pain relief (though they stressed it should not be a wholesale replacement).
Regardless of the substance, it’s information that’s important, says Dr Paul Little, medical director at Laguna Treatment Hospital, a drug and alcohol detox center in Orange County.
‘The big issue is education,’ Dr Little, who was not involved in the study, told DailyMail.com.
‘Many patients tell me that their doctor did not educate them at all about the potential to develop dependence to these medications.
‘Time should be spent doing a thorough review of the patient’s past, including a family or personal history of addiction.’
David Craig, PharmD, a pharmacist lead at Moffitt Cancer Center who was not involved in either study but deals with patients’ access to opioids, says we first need to do away with aspirations of finding a perfect solution.
‘There are no “magic bullets” or “simple solutions” in finding that ideal balance between ensuring that those who need opioids can receive them while restricting access to those who do not. We must continuously work together to reach these goals,’ Craig told DailyMail.com.
‘It continues to be difficult for many of our cancer patients to find opioids to manage their cancer pain and unfortunately, I fear it will continue to get worse.’
He adds: ‘When opioids are necessary, they can have a significant positive impact on patients’ pain and quality of life; I see this every day. There are complementary approaches to manage pain such as yoga, acupuncture, massage and interventional approaches like nerve blocks. But unfortunately, not every intervention is effective for every patient, therefore, having multiple treatment options available for patients is important.’