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:
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Always follow the instructions on your prescription bottle.Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take. For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
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Take them when you have pain and need quick relief.These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
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If you don’t have pain, don’t take them.If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
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Take them before your pain gets severe.Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for breakthrough pain.
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Choose the dose that matches your pain level.Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed. If your pain is severe, start with the higher dose (for example: 2 tablets). If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
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Take them about 30 minutes before painful activities.Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
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If your short-acting opioid is not working well, talk to your care team.Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.
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.
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Always follow the instructions on your prescription bottle.Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take. For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
-
Take them when you have pain and need quick relief.These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
-
If you don’t have pain, don’t take them.If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
-
Take them before your pain gets severe.Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for breakthrough pain.
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Choose the dose that matches your pain level.Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed. If your pain is severe, start with the higher dose (for example: 2 tablets). If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
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Take them about 30 minutes before painful activities.Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
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If your short-acting opioid is not working well, talk to your care team.Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.
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.
