Opioids and Cancer: A Complicated Danger

There’s no question that Americans take too many opioids. I’m sure you’ve seen plenty of news reports about our epidemic of addiction to these drugs and the dangers of overdosing.

But there are other questions about opioids that don’t get as much publicity. Many of them surround the legitimate use of prescription opioids to treat the pain connected with cancer.

There are the usual questions such as when and how much should be used – as well as the danger that cancer patients can also suffer from addiction. But at the same time, researchers are worried that opioids can make some cancers more deadly.

One of the most fearsome symptoms of cancer and its many treatments is pain. According to a review of cancer pain management published in the journal Therapeutics and Clinical Risk Management, more than half of all cancer patients find it hard to control their pain.

In addition, a quarter of these patients die in pain.¹ So, it’s no surprise that powerful opioids have become the pain treatment of choice prescribed by many oncologists and pain specialists to their cancer patients who have chronic, severe pain.

Do opioids influence cancer?

Some studies on opioids have turned up evidence that they may make you more liable to develop cancer and, if you already have cancer, they can speed tumor growth.

For example, research at the Rush University Medical Center in Chicago indicates that your risk of pancreatic cancer may be increased if you used opioids.²

While this study was a population study – looking at data connected to overall opioid use and then comparing it to the rates of pancreatic cancer – researchers found a significant link between each state’s opioid use and pancreatic cancer rates.

Now, a study like this paints with a very broad brush, but evidence exists at a more micro level to suggest the link is real. The researchers note how other studies demonstrate that when people with pancreatic cancer take larger doses of opioids to cope with pain, their survival time is considerably shortened.³

Opioids affect immune cells

Meanwhile, researchers at California Southern University in Irvine, along with scientists at the Albert Einstein College of Medicine in New York, completed a large review of investigations into how opioids influence cancer, and they warn that, so far, the effects remain difficult to predict.⁴

On the one hand, they explain, “opioids negatively affect immune cells.” This means that these drugs generally make it harder for immune cells to do their job eliminating cancer when it grows in the body and also hamper the immune system’s ability to ward off infection.

Plus, opioids can stimulate cancerous processes by decreasing apoptosis (a process that leads cancer cells to kill themselves), triggering angiogenesis (the growth of new blood vessels that feed cancer cells the nutrients they need to grow) and enabling cancer to metastasize (spread to organs around the body).

On the other hand, they note, studies indicate opioids sometimes seem to have anti-cancer effects.

For instance, both morphine and oxycodone (a synthetic opioid) can slow the growth and metastasis of certain types of lung cancer.⁵

And researchers in China say their work shows these opioids can probably either slow cancer growth or stimulate it depending on the growth factors that the cancer cells possess on their cell membranes.⁶

The message: Even the experts aren’t sure, in all cases, what effects opioids may have on cancer and the survival of patients.

Uncontrolled pain is dangerous, too

British researchers at the Hull York Medical School who have also reviewed the research into opioids and cancer conclude that pain itself can compromise the immune system and render it less functional for fighting off cancer.

So, controlling pain is important not only for a cancer victim’s comfort, but also for helping the body fight off any malignancy. It’s also important to note that when it comes to controlling pain, the researchers imply that it’s always important to use the smallest possible dose of an opioid to keep the pain under control and minimize problematic side effects.⁷

Breast cancer and opioids

Adding to these concerns, a study at New York-Presbyterian/Columbia University Irving Medical Center in New York shows that women suffering from breast cancer who undergo mastectomy and reconstructive surgery are at high risk of developing an opioid addiction. “Patients with cancer are at particularly high risk of becoming dependent on opioids post-operatively,” warns researcher Jacob Cogan.

The study found that 17.5 percent of the women in the study who took opioids for the first time in their lives after surgery became “new persistent users” of opioids.⁸

"I hope that our study can increase awareness that these are addictive medications, and a brief exposure for surgery-related pain or anxiety can lead to long-term use," says Mr. Cogan. "Both patients and providers should be aware of this issue, and of the risk factors that elevate an individual patient's risk."

Natural pain relievers

If you want to reduce, or perhaps remove all together, your dependence on opioids when dealing with pain from cancer surgery, a study at the Detroit Medical Center indicates it can help to have acupuncture before your operation.

In this research, performed on veterans undergoing surgery at the John D. Dingell VA Medical Center in Detroit, patients received either traditional acupuncture (the insertion of thin needles at trigger points around the body) or what’s called “battlefield acupuncture,” a technique created by a U.S. Air Force doctor to fight pain on the front lines without drugs. Battlefield acupuncture uses tiny needles that are inserted at trigger points in the ear.

The results show that those receiving either type of acupuncture before surgery experienced less pain, needed fewer opioids to deal with their discomfort and were more satisfied with their pain control than people who didn’t get acupuncture.

The people getting acupuncture used from one-half to about one-third the amount of pain medication used by a control group.⁹

“Acupuncture is easy, patients love it,” says researcher Brinda Krish. “It's not just another medicine and it's very safe.”

Adding to the problem is opioid use in pain management over the long-term.

The longer you use them, the greater the risks

According to pain researchers at the University of Washington School of Medicine, when you end up using opioids for cancer pain or any other type of pain for an extended period of time, the drugs can eventually make your situation worse.¹⁰

A critical complication, they say, stems from the fact that both physical pain and emotional pain activate the same limbic brain centers. And when you take opioids for a prolonged period, you damage the brain systems that interact with your body’s own natural opioids that enable you to feel pleasure and rewards.

And that means your “social and emotional functioning is messed up under a wet blanket of opioids," says researcher Mark Sullivan.

"Rather than helping the pain for which the opioid was originally sought, persistent opioid use may be chasing the pain in a circular manner, diminishing natural rewards from normal sources of pleasure, and increasing social isolation.”

In a commentary on opioid use, Dr. Sullivan and his colleague Jane Ballantyne conclude, "Long-term opioid therapy that lasts months and perhaps years should be a rare occurrence because it does not treat chronic pain well, it impairs human social and emotional function, and can lead to opioid dependence or addiction."

My takeaway

As you can see, there are no clear-cut answers about how to best use opioids in cancer treatment. Everybody’s situation is different and requires close consultation with your cancer care team. Whatever you decide, be very careful with the use of opioids for cancer pain – or any pain for that matter.

Best regards,

Lee Euler,
Publisher

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Opioids and Cancer: A Complicated Danger

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