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Addiction Worries:

Understanding Opioid Addiction and Dependence

With so much in the news about the opioid epidemic, many people worry about taking opioids to manage their cancer pain. “Addiction” is often top on peoples’ list of concerns, but there can be a lot of confusion about this word and what it means.

Opioid addiction is very different from becoming tolerant to opioids or physically dependent on them. Opioid use disorder (the technical name for opioid addiction) is a serious medical condition that is RARE among people who need opioids to manage cancer pain.

In contrast, tolerance and dependence are common and are part of the body’s normal reaction to using opioids regularly over many weeks to months. Tap on the words below to see their definitions:

Dependence happens when a persons’ body naturally adjusts to opioids over time. If that person stops taking opioids suddenly, they will have withdrawal symptoms like achiness, belly cramps, nausea, and diarrhea. These symptoms are temporary and usually go away after a week or so. Your care team can help you avoid withdrawal by slowly tapering your opioid medications, instead of suddenly stopping them.

Dependence, tolerance, and the bathtub analogy

Think of dependence and tolerance as signs that your body has become “used to” opioids – similar to how you might become used to the temperature of a hot bath. At first the bath feels very hot, but after several minutes you will be comfortable and might even need more hot water feel warm. When you finally get out of the tub, you will probably feel very cold – even if the room felt pleasant before.

Getting used to the hot bath water is like becoming tolerant to opioids. At first you may notice big effects from one dose of your breakthrough opioid. Over a long time, you may not notice as much pain relief from that dose. Side effects like sleepiness may also become less over time.

Feeling cold when you get out of the tub is similar to the withdrawal symptoms that can happen when a person is physically dependent on opioids. Just like shivering when you get out of the tub, a person who suddenly stops taking opioids may have achiness, cramps, nausea, and diarrhea.

Just like your body’s reaction to a hot bathtub, tolerance and dependence are normal PHYSICAL reactions to opioids. They DO NOT mean that you are addicted. Tolerance and dependence go away when a person is no longer taking opioids.

Opioid addiction is a treatable medical disease caused by many factors including genetics, family history, trauma, psychological health, and prior substance abuse. Taking opioids for cancer pain is unlikely to cause addiction by itself. People with opioid use disorder often have strong cravings to use opioids, even if their pain is under control. They often use more opioids than they need to control their pain, and opioids often cause problems with their life at home or at work. People with opioid addiction continue using opioids despite serious harm to themselves and others close to them.

Taking more opioids than prescribed
Taking opioids in order to feel “high,” relaxed, or happy – not simply for pain relief
Borrowing or taking opioids from other people
Buying opioids illegally (online or on the street)
Craving opioids or the good feelings it causes
Continuing to take opioids even when it causes serious problems like losing a job, an important relationship, or getting into trouble with the law

Talk to your care team about your worries. They can help you understand your personal risk and come up with a plan to lessen any risks of opioid pain medications.
If you find yourself turning to opioids or other medications to manage difficult emotions, reach out to a social worker or therapist for support. They can help you find better coping strategies.
Make sure to talk to your doctor if you have a history of addiction or problems with opioids, alcohol, cocaine or other substances. Being open about your history can help your care team come up with the safest and best plan for your pain management.
People with a history of opioid addiction may have cancer pain and need pain management. Having a specialized pain management team, such as through palliative care, can be helpful in coming up with the best pain management approach. This may include opioids, or it may not.
Addiction isn’t always so black and white. If you feel concerned about your opioid use, talk to your doctor or ask to meet with a psychologist. They can help you find tools to find pain relief while staying safe with opioids.

Sometimes friends and family members worry about addiction, even when their loved one isn’t showing any signs of addiction. These worries may cause friends or family to try to limit how much pain medicine their loved one takes. This can be a difficult experience for everyone. If your friends or family’s worries about addiction are making your pain management more challenging, have an open conversation with your care team. They can work with your family and friends to understand your situation and better support you.

More about opioid addiction

Summary

People who need opioids to manage cancer pain RARELY become addicted to them.

Tolerance and dependence are common when opioids are taken regularly for many weeks to months. This is not the same as addiction. These are normal physical reactions to opioids that go away if a person tapers off of opioid medications.

Try not to let fears of addiction prevent you from getting good pain management. Opioids can be a safe and effective part of pain management for the vast majority of people with cancer pain.

If you have a personal history of addiction, be open with your care team. Specialists in palliative care, pain management, or psychology can work with you to find good pain control while managing worries of addiction.