'Opiophobia:’ a hidden epidemic

In recent years, patients with cancer and their families have developed significant concerns regarding the prescription and use of opioids, a phenomenon often referred to as "opiophobia." This widespread fear is primarily fueled by the opioid misuse and abuse crisis, which has led to numerous overdoses and a general mistrust of powerful medications. However, palliative care specialists emphasize that opioids, when used correctly, are indispensable tools in managing severe pain for patients with cancer.

Gina Mohr, MD, a palliative care specialist, said that opioids are highly effective in alleviating physical pain, a critical component of comprehensive cancer care. She often shares an analogy to explain to patients the importance of proper usage and medical supervision when administering these medications.

"Opioids are like a chainsaw," Mohr said. "If used correctly, they make the work efficient and effective. But if misused, they can cause significant harm."

Despite the efficacy of opioids in managing pain, many patients, as well as clinicians, hesitate to utilize them due to the stigma associated with opioid addiction and overdose. Mohr noted that this opiophobia extends beyond patients to their families, creating a significant barrier to effective pain management.

While family members can be strong advocates for the patient's well-being, they can also inadvertently contribute to opiophobia. Mohr encourages open communication and education to help families understand the appropriate use of opioids and their benefits in managing cancer pain.

In her practice, Mohr has observed that patients often decline opioid treatment and suffer needlessly due to these fears. She explained the importance of addressing these concerns through patient education and reassurance.

"For people with legitimate pain from cancer who use opioids as instructed, the risks are minimized," she said.

Changes in Guidelines:

The Centers for Disease Control and Prevention (CDC) updated its opioid prescribing guidelines in 2022, the first significant changes since 2016. These updates emphasize individualized patient care, removing the previously recommended ceiling on opioid doses while still encouraging non-opioid alternatives whenever possible. The guidelines also stress starting patients on the lowest effective dose of opioids and using immediate-release formulations over long-acting ones when starting on opioids​.

The guidelines highlight that opioid prescriptions are still crucial for certain conditions like cancer-related pain, palliative care, and end-of-life care. These situations often involve different therapeutic goals and ethical considerations, where the benefits of opioid use may outweigh the risks.

While the fear of opioids is understood by clinicians, given the current climate of misuse and abuse, they also understand their role in alleviating these fears and educating patients and families on the safe and effective use of these medications.

"Opioids, when used correctly, are a powerful tool we can use to control cancer pain, and overcoming opiophobia is crucial for improving the quality of life for patients living with cancer," Mohr said.

Palliative care aims to address not only physical pain but also emotional, social, and spiritual distress, which can exacerbate physical symptoms. Mohr stressed that listening to patients and understanding their comprehensive pain experience is crucial in providing adequate care.

"To stop the downward spiral of pain exacerbated by anxiety and depression, we must address these facets to get physical pain under good control," she said.

Our Palliative Care Program helps you find relief from the symptoms caused by illness or from the treatments for the illness.  We believe in treating the whole person by addressing their “total pain” with an interdisciplinary team that includes physicians, nurses, chaplains and social workers.