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Some Patients Grow Wary of Opioids as Epidemic Looms


Last year alone, more than 33,000 people across the nation died from opioid overdoses, including prescription drugs and heroin. On Radio Times last month, Jeanmarie Perrone, MD, a professor of Emergency Medicine and director of Medical Toxicology, said Philadelphia is averaging nearly three overdose deaths a day – but the true toll of the problem also includes the many people who survive their overdoses and continue to struggle with addiction.

The trend is also causing an increased concern in patients battling serious illness, whose pain could be managed through the use of opioids.

When Rachel Levine, MD, Pennsylvania’s physician general, spoke to a crowded auditorium in October of last year, she talked about the pain caused by misuse of these vital drugs and what the state is doing to combat the problem. It’s “all hands on deck” at all agencies which can help, she said.

But the first question during the Q&A section that followed came from Erin McMenamin, MSN, CRNP, a registered nurse in Radiation Oncology who sees very sick patients, many of whom experience a great deal of pain. McMenamin told the physician general she remembered what it was like when she first started her career as a nurse, before opioids were readily prescribed. She recalled the pain she witnessed and how drastically things changed for the better when the painkillers became easier to prescribe.

Today, however, she said nearly all of the cancer patients she speaks with are afraid of the drugs, citing shocking statistics they’ve read about in the newspaper, tragic stories they’ve seen on the evening news or downright incorrect information they’ve read online.

I’ve written on this blog a bit about opioid abuse (here, here and here). I’m from this area and have seen people I know and love become addicted to painkillers. And as a news consumer, I too have felt anxieties around the drugs build up, so I spoke with McMenamin to learn more about the realities of opioid addiction to understand when it’s safe – and beneficial – to take the drugs, and when you might need to worry.

McMenamin said some cancer patients have always been wary of the drugs—some were naturally worried, and some had entered treatment as addicts and were fearful of relapse—but it was never like it is now.

“Nearly 100 percent of the patients diagnosed with cancer I see have concerns about addiction and are very hesitant to take opioids to treat their cancer or treatment related pain,” she said.

As the addiction is the root of the fears, McMenamin said it’s crucial that patients – and the general public – learn the appropriate definition of addiction and the distinction between addiction and dependence. Addiction is a psychological dependence that causes users to continue using, despite great harm the drug may cause them. Dependence, on the other hand, is purely physical and natural, and can be treated.

Cancer and chronic pain patients who use opioids as intended are categorically not addicts, McMenamin said.

“Addiction is a psychological need for the drug, presented through compulsive use, using it despite harm, and craving it—in essence, using it to get high,” she said. “That does not describe a typical cancer or chronic pain patient.”

Dependence is likely to occur in patients who take opioids regularly for even just a week, but medical professionals who prescribe the drugs are attuned to the risks and know how to appropriately wean patients when the time comes.

Education is vital to combatting patient anxieties around the drugs, according to the veteran nurse.

“We discuss with patients how opioids work, the correct definition of addiction and the importance of treating pain,” McMenamin said. “There is literature that demonstrates how the brain changes if pain goes untreated. Basically, when it experiences chronic pain, the brain makes sub-cellular changes that result in the awareness of pain at a lower threshold. It’s a concept called plasticity.”

While opioid abuse is a very real problem affecting innumerable people across the nation and here in the greater Philadelphia region, the medications remain a critical part of treatment for many patients, patients who are growing increasingly—and unnecessarily—afraid of their new prescription.

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