Substance Abuse In Cancer, Part 3

by National Cancer Institute

(Page 3 of 3)

Recognize drug abuse behaviors

While all patients who are prescribed drugs that may be abused must be monitored closely, monitoring is especially important for people who have a history of substance abuse. The patient may be reassessed frequently, and the patient's significant others may be asked to provide observations about the patient's drug use. The physician may find it appropriate to test the patient's urine for illegal or unprescribed drugs. If a patient is agreeable to drug testing and monitoring and uses prescribed drugs responsibly, a trusting relationship may be established with the physician. A physician who is confident that the patient will not abuse drugs is more likely to adjust therapies to control symptoms.

Use nondrug approaches

The patient may benefit from nondrug approaches, such as learning about the complexities of the medical system, communicating with the medical staff, and learning relaxation and coping techniques.

Taking a substance abuse history

To avoid offending a patient, a health care provider may choose not to ask about drug abuse. The health care provider may assume that the patient may become offended, angry, threatened, or may not tell the truth. Such attitudes are not helpful in establishing truthful communication between health care provider and patient and may cause problems in monitoring therapy.

A patient may withhold information about his or her drug use because of negative attitudes the health care provider may have about drug users. The patient may not trust the health care provider, or the patient may fear that if his/her drug abuse history is known, inadequate medication may be prescribed to control symptoms. The physician must know the patient's drug use history in order to control symptoms and to keep the patient comfortable by prescribing adequate medication to prevent withdrawal symptoms and reduce pain. The physician needs to know which drugs the patient has taken, the length of time drugs have been used, the frequency of drug use, and the situations that cause the patient to use drugs.

Inpatient Treatment

Patients with current substance abuse problems who are scheduled to undergo surgery should, if possible, be admitted to the hospital several days early in order to stabilize drug use to prevent withdrawal and to plan treatment. To prevent the patient from obtaining illegal drugs, he or she may be given a room in a location that can be easily monitored, and he or she may be restricted to the room or the floor. Restrictions may also be placed on the patient's visitors. The patient's room as well as packages brought by visitors may be searched periodically for drugs or alcohol. The patient's urine may also undergo regular testing. The restrictions placed on the patient are necessary to ensure that medical treatment will not be jeopardized by ongoing drug use. Treatment should include frequent monitoring to prevent withdrawal and to control symptoms.

Outpatient Treatment

Ideally, outpatients who currently abuse drugs should be enrolled in a drug rehabilitation program; however, patients with advanced medical illnesses may not be able to be enrolled. The health care provider may outline for the patient the role of the treatment team, what is expected of the patient, and the consequences to the patient should he or she continue to abuse drugs while receiving treatment for medical illness. Patients must receive detailed instructions for taking prescribed drugs responsibly. They must be seen frequently so symptom control may be maintained and drug abuse may be monitored. Frequent visits also avoid the need to prescribe large amounts of drug at one time, and may help the patient stay on the treatment schedule and attend appointments with the physician. Some patients may find that a "twelve-step" program is helpful in stopping illegal drug use while they are receiving treatment.

Outpatients may be required to undergo periodic drug testing. The patient should be informed in advance of the consequences of a positive test. A urine test that indicates the patient is using illegal drugs may result in the need to visit the outpatient department more frequently, smaller quantities of prescribed drugs, referral to a drug rehabilitation program, or other restrictions.

If the patient lives with family members who are substance abusers, the family members can be encouraged to enroll in a drug treatment program to help the patient avoid illegal drugs and alcohol. The patient should also be aware that friends and family members may attempt to buy or steal the prescribed drugs. It is very helpful to identify people who will be supportive of the patient.

A treatment team that includes a specialist in addiction medicine may be able to provide more effective treatment for the outpatient with a progressive medical disease and a history of substance abuse than can a single physician.

Patients who have successfully stopped abusing drugs or alcohol may be reluctant to begin using prescribed drugs for their medical illness for fear of developing an addiction. They may fear rejection from friends and family members who will object to their use of prescribed drugs, and they may fear that others will attempt to buy or steal the drugs. The health care provider should help the patient resolve these concerns and assure the patient that use of opioids to control symptoms of progressive disease does not result in the euphoria experienced by opioid abusers who do not have a medical illness.

If the patient is very reluctant to begin opioid therapy, the physician may develop strict guidelines for use of the prescribed drug to provide the patient with a sense of control. The patient may also be provided with counseling to help identify situations in which he or she is likely to abuse drugs or alcohol, and to develop strategies for avoiding future abuse of illegal or prescribed drugs.

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