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Drug Abuse and Cancer: Concerning Connections

The links between substance abuse and various forms of cancer are multiple and multidirectional. Just as many drugs pose real cancer risks, cancer patients are often particularly vulnerable to developing chemical dependence.

In some cases, these troubling ties have been exhaustively researched over several decades.

Alcohol abuse, for example, is associated with a staggering array of cancer concerns. In other areas, these connections are the subject of ongoing controversy.

Against the backdrop of the opioid epidemic, debates rage on about cancer patients’ access to painkillers.

In this article, we’ll survey the latest medical findings related to connections between substance abuse and cancer. First, we’ll discuss why cancer patients often face particular risks related to compulsive drug use. Next, we’ll explore how specific substances leave users vulnerable to developing cancer, especially when used over extended periods of time.

Ultimately, we hope this information will help more individuals embrace healthy approaches to recovery – from substance abuse, cancer, or both.

Part I: Why Individuals with Cancer May Struggle with Substances

Cancer is a strikingly diverse illness, encompassing a vast array of related conditions across the human body.

At a fundamental level, cancer refers to out-of-control cell division. As cells rapidly reproduce and grow, they cause tumors, immune system issues and other types of bodily harm.

Unfortunately, cancer is also disturbingly prevalent.

According to the American Cancer Society, an estimated 1,735,350 new cancer cases were diagnosed in the U.S. in 2018.

Additionally, the organization estimates that 609,640 cancer deaths occurred in that year.

Thankfully, however, new preventative approaches and treatment technologies have radically improved many cancer patients’ odds of recovery.

Today, among American adults diagnosed with cancer, the five-year survival rate is 68 percent. For some of the most common variants, such as breast or prostate cancer, the survival rate is far higher. Relative to decades past, these data represent huge leaps in modern healthcare.

us cancer

Yet for cancer patients and survivors, the repercussions of their illness are often quite serious. And while the symptoms associated with various kinds of cancer differ, many report considerable pain in treatment and remission.

Real Pain, Real Risks

For individuals actively receiving cancer treatment, pain can be virtually constant.

In one massive literature review of 122 existing studies conducted in 2016, researchers established the following estimates for pain prevalence:

  • 55 percent of patients reported pain during anticancer treatment.
  • 39 percent of patients reported pain after curative treatment.
  • 66 percent of patients reported pain in the advanced, metastatic or terminal stages of their disease.

Additionally, 38 percent of these cancer patients reported that their pain was a five or higher on a scale ranging from 1 to 10. This pain could stem either from the effects of the disease itself, or various treatments (such as chemotherapy) intended to halt its progress.

In recent decades, the medical establishment has attempted to aid cancer patients facing debilitating pain each day.

Whereas physicians had previously avoided painkillers whenever possible, pain relief emerged as a new priority in 21st century medical care. As a result, patterns in opioid prescribing shifted rapidly, driven by the aggressive marketing efforts of major pharmaceutical companies.

In many cases, cancer patients and survivors found much-needed relief in opiods, using them as prescribed in order to meet the demands of their daily lives. Indeed, some experts assert that cancer pain remains widely undertreated, and that increased access to pain medication would alleviate unnecessary suffering.

Yet alongside these success stories, darker narratives emerged as well.

First, much research cautions against opioids as a primary treatment option for chronic pain. Other methods can prove more effective and carry significantly fewer risks.

More importantly, experts observed a massive tragedy unfolding. Using opioids for extended periods on ever-higher doses, a significant portion of cancer patients were becoming dependent upon these drugs.

opioid use abuse and cancer

Substance Abuse Among Cancer Patients: Troubling Trends

Relatively little research has explored the prevalence of substance use disorders among cancer patients and survivors. Yet experts in oncology report that substance abuse is a growing concern across their field.

Much like those with other kinds of pain, cancer patients find themselves requiring increasingly potent doses as their tolerance grows over time.

Over time, physical and psychological dependence deepens, resulting in excruciating withdrawal symptoms whenever opioids are removed. Cravings for chemical relief may lead patients to take painkillers more often than recommended, or snort or inject them for maximum effect.

troubling trends

In one 2013 study of 522 cancer patients, medical researchers found that 29 percent were at high risk for misusing opioids. A 2015 experiment evaluated 432 patients, finding that 18 percent were “chemically coping” – using opioids or other substances in response to stressful events, rather than as prescribed.

More recently, leading voices in the field of oncology have begun to address risks associated with opioids.

In a 2018 article in the New England Journal of Medicine, Dr. Alison Loren, a professor at the University of Pennsylvania School of Medicine, described witnessing her patients become hooked on painkillers. Noting the complexity of these cases, Dr. Loren called opioid use disorder in cancer patients “harder to treat than leukemia.”

For some experts, substance abuse is the predictable byproduct of widespread cancer pain and increased opioid availability. According to Judith A. Paice, director of the Cancer Pain Program at Northwestern University, “Two public health crises, the epidemics of chronic pain and of opioid misuse, are creating challenges for cancer pain management.”

As Paice notes, the medical community overlooked the potential for abuse and dependence among cancer patients. “Many people have assumed that people with cancer are not at risk for addiction,” she said in a recent interview. “When in fact they may have the same risk as, or possibly even a greater risk than the general population.”

Chemical Coping: Additional Risk

Among cancer patients and survivors, the risks of substance abuse don’t end with opioids.

Indeed, the psychological impact of a cancer diagnosis can be staggering, combining physical pain with mental turmoil. Because cancer treatment entails much uncertainty and many difficult outcomes, patients may seek solace in intoxicating substances of any kind.

In fact, clinical depression is roughly four times more common among cancer patients than in the general population. Anxiety is more prevalent among those with cancer as well.

clinical depression
Moreover, experts say that the mental health challenges associated with a cancer diagnosis can often occur after treatment has ended. That is, once the crisis seems over, distress sets in.

These data points are relevant because of the undeniable links between depression, anxiety and substance abuse. Because depressed or anxious thinking can cause, complicate or exacerbate substance abuse, cancer patients may face additional risks of chemical dependence.

Seeking Treatment – and Pain Management Alternatives

Thankfully, cancer patients and survivors who become addicted to substances are not doomed to continual dependence. With the right medical supervision and complementary support, even those with severe chronic pain can detox safely and pursue lasting recovery.

At the outset, however, it’s important to convey just how intensive and extended some of these treatment approaches can be. Weaning off drugs safely is no overnight matter, especially for those with recurring cancer pain.

According to CDC guidelines, patients who wish to reduce or eliminate their opioid consumption should taper their use strategically over a considerable period of time.

This approach can be highly incremental. While some may succeed by reducing their dose by 10 percent each week, others may need a 10 percent decrease each month, instead.

The CDC’s guidelines are also explicit about the necessity of psychosocial support. Without therapy or other forms of substance abuse treatment, the taper is unlikely to succeed.

Additionally, these resources may offer cancer patients an opportunity to explore the issues underlying their use, whether directly related to their illness or otherwise.

In light of these guidelines and our own expertise in chronic pain, our treatment team provides patients medical and therapeutic support throughout the detox process.

Unlike those who attempt to reduce their dosage on an outpatient basis, individuals in our detox facilities benefit from constant supervision and support. That means they can detox more quickly, safely and with significantly less discomfort.

Of course, even once substance abuse issues are treated, cancer pain may remain. Accordingly, it is essential to explore non-addictive alternatives for managing pain moving forward.

While each patient’s needs will necessarily differ, there are many proven alternatives to opioids worth exploring. These solutions include holistic and high-tech options with varying costs, such as:

  • Over-the-counter pain medications like ibuprofen or acetaminophen.
  • Physical therapy.
  • Massage.
  • Acupuncture.
  • Steroids.
  • Surgery.
  • Injection of local anesthetics.
  • Radio waves.
  • Nerve blocks.
  • Electrical signals.
  • Spinal cord stimulation.
  • Pain pumps.
  • Stem cell harvesting.

While we can’t offer precise medical advice, cancer patients should discuss these options with their own physicians, determining which are most likely to yield relief.

Additionally, the array of evidence-based treatments for chronic pain is continually expanding, presenting cancer patients with greater choice than ever before. In this regard, it’s important to seek supportive medical help.

Your doctor should help you evaluate your pain management strategy, rather than insist on pain medication from the outset.

Part II: How Substance Abuse Raises Cancer Risks

Intoxicating substances affect the body in distinct and dangerous ways. Accordingly, it’s imperative to explore the specific cancer risks associated with several drugs, noting the physical harms inflicted by each intoxicant.

Below, we’ll enumerate the particular kinds of cancers associated with the use or abuse of multiple substances. While we’ll primarily emphasize established connections, we will also note some instances in which ties seem probable or possible. We do so in order to help users understand the potential health risks associated with their behaviors – and perhaps seek treatment as a result.

The Cancer Risks of Tobacco

  • The association between tobacco products and multiple forms of cancer has been exhaustively established. Smoking causes approximately 30 percent of all cancer deaths nationwide, and 80 percent of lung cancer deaths specifically.
  • Of the 480,000 premature deaths caused by smoking each year, more than a third are from cancer.
  • Smokeless tobacco  products are also highly dangerous, containing dozens of chemicals linked to cancer. Every year, over 2,300 Americans are diagnosed with oral, esophageal or pancreatic cancers caused by smokeless tobacco.

heavy drinkers

The Cancer Risks of Marijuana

  • Connections between marijuana and cancer have not been definitely established in existing medical literature. However, health researchers note that marijuana often contains many of the same carcinogenic substances as tobacco products and advise against smoking it accordingly.
  • Additionally, a number of studies have suggested a connection between marijuana consumption and testicular cancer in adolescents. Specifically, cannabis use is correlated with a highly aggressive form of testicular cancer that largely affects young males.
  • Moreover, marijuana users often consume tobacco products as well: As many as 70 percent also use tobacco in some form, according to experts. Accordingly, individuals who use marijuana are likely to be exposed to cancer risks related to smoking tobacco.

smoking causes

The Cancer Risks of Alcohol

  • A large and long standing body of research suggests definite connections between alcohol consumption and many forms of cancer. Additionally, cancer risk increases with the volume of alcohol an individual consumes, so that those who drink alcoholically are especially vulnerable.
  • According to existing research, heavy drinkers are:
    • 5 times more likely to develop oral cavity or pharynx cancers.
    • 2.6 times more likely to develop larynx cancers.
    • 5 times more likely to develop esophageal cancer.
    • 2 times more likely to develop liver cancer.
    • 1.6 times more likely to develop breast cancer.
    • 1.5 times more likely to develop colorectal cancer.
  • Cancer is especially prevalent among those who drink heavily and use tobacco. In fact, the risk of developing cancer for those who drink and smoke is substantially higher than for individuals who use either substance alone.
  • In addition to these established cancer connections, alcohol may also increase the likelihood of acquiring melanoma, prostate or pancreatic cancer. Large-scale research to substantiate these associations is ongoing.

cancer and marijuana

The Cancer Risks of Opioids

  • While more research is necessary to assert or refute a connection between cancer and opioid use, some recent studies suggest a grim correlation. One 2016 study did find “a significant association between opiate use and risk of cancers” and urged more research in this area.
  • Much like marijuana, opioid use correlates with tobacco use in concerning ways. According to one recent study conducted in two American cities, 84 percent of individuals who reported opioid misuse in the past year regularly used tobacco.

The Cancer Risks of Benzodiazepines

  • Though research regarding the carcinogenic effects of benzodiazepines continues, several large-scale studies have provided disconcerting data. One 2016 review of existing research declared that “benzodiazepine use was associated with an increased risk of cancer,” but encouraged further controlled studies to confirm this finding. A 2017 study reached a similar conclusion.
  • Interestingly, some researchers have observed that certain benzodiazepines are less correlated with cancer risk than others. Unfortunately, many of the benzos deemed most dangerous, such as Klonopin, Ativan and Xanax, are also the most commonly prescribed.

The Cancer Risks of Sleeping Pills

  • Though millions of Americans take sleeping pills on a daily basis, some studies show that regular use may increase the risk of several kinds of cancer, including of the lungs, colon and prostate.
  • One challenge relates to the way these medications are prescribed. While the makers of these drugs intend them for short-term use, they are frequently used for months or years on end. Accordingly, long-term side effects, including serious health concerns, are not well understood.

The Cancer Risks of Steroids

  • Though not all steroids are associated with cancer concerns, anabolic steroids most definitely are. According to the National Institute on Drug Abuse, anabolic steroids can increase the risk of testicular cancer, particularly when combined with another substance popular among bodybuilders, insulin-like growth factor.
  • These effects are typically associated with long-term use, though damage can occur over a relatively short period as well. For example, college athletes can experience difficult side effects after using steroids for just a few seasons – and the true cost may not be clear until much later in life.

Recovery and Prevention: Effective Treatment

We hope this article illuminates the ties between substance use disorders and cancer, detailing how each illness might contribute to the other.

Ultimately, both conditions are complex and chronic, re-emerging across the lifespans of many patients. At an individual level, cancer and substance abuse may repeatedly entwine, raising difficult questions.

Is a cancer patient’s reliance upon pain medication evidence of addiction? Should individuals with histories of substance abuse avoid using opioids to treat cancer pain? What is the best pain management approach, even if it fails to eliminate suffering entirely?

These questions cannot be dealt with in general terms. Appropriate determinations must be made by individual patients and healthcare professionals.

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