As a radiation oncologist, patients will sometimes ask me, “Is there a risk that I will get addicted to these medications?” and before I read this research, I would tell them the risk is very small. I now know that is the wrong thing to say.
More than two million people in the USA are dependent on prescription opioid pain relievers, a number that continues to grow as the rate of opioid prescriptions has skyrocketed in the last 25 years. While opioids can provide pain relief after surgery, their use comes with peril: Approximately six percent of patients who take opioids for the first time to relieve pain after surgery end up taking the medications for far longer than is clinically recommended, a University of Michigan study found earlier this year.
Now, a new study from that institution finds that for patients with cancer, the news is worse. More than 10 percent of those who had never taken opioids prior to curative intent surgery for cancer continued to be on the drugs three to six months later, a risk that appears to be even greater for those who receive chemotherapy after surgery, with 15 to 21 percent still on the opioids.
The researchers note that several factors come into play that can make cancer patients more vulnerable to opioid misuse, says Lee, including the emotional trauma of a cancer diagnosis, pain from invasive procedures and a large care team that may not be coordinating prescriptions.
We clinicians have to do a better job than leaving 1 in 10 as chronic opioid users. Doctors should strive to prescribe the appropriate amount of pain medications. Ongoing studies are looking at how much our patients are actually taking, so that we can prescribe lower amounts. My patients often take less than what I prescribe. I do ask them to get rid of unused medicines as soon as reasonably possible. We also have to do better with pain management education, during opioids only for severe pain. In addition, members of the care team must coordinate prescribing. We simply cannot leave so many as chronic opioid users. I am Dr. Michael Hunter.
- Jay Soong-Jin Lee, Hsou Mei Hu, Anthony L. Edelman, Chad M. Brummett, Michael J. Englesbe, Jennifer F. Waljee, Jeffrey B. Smerage, Jennifer J. Griggs, Hari Nathan, Jacqueline S. Jeruss, Lesly A. Dossett. New Persistent Opioid Use Among Patients With Cancer After Curative-Intent Surgery. Journal of Clinical Oncology, 2017; JCO.2017.74.136 DOI: 10.1200/JCO.2017.74.1363