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Opioids for Childhood Cancer Pain: What You Should Know

Opioids have an important role in treating cancer-related pain in children.

Pain is common during and after cancer treatment. Pain management is part of patient care. But parents of pediatric cancer patients may have concerns about their child taking opioids. Their widespread use and misuse has led to a nationwide opioid crisis.

However, opioids can be an effective treatment for some pain caused by cancer and certain cancer treatments.

How Are Opioids Used in Childhood Cancer Patients?

Opioids are a class of pain relievers available legally by prescription. These drugs include hydrocodone, oxycodone, morphine, fentanyl, and methadone.

Opioids bind to and activate opioid receptors on cells located in many areas of the brain, spinal cord, and other organs in the body, especially those involved in feelings of pain and pleasure. When opioids attach to these receptors, they block pain signals sent from the body to the brain and release dopamine in the brain. Blocking the pain signals can relieve pain and the release of dopamine can make people “feel good” and produce a “high.” The user may want to repeat the experience. This desire may lead people to take opioids for non-medical reasons.

Prescription opioids are used to reduce acute or chronic moderate to severe pain. They may be prescribed for visceral pain. This type of pain is caused by a response to a physical stimulus such as a surgical procedure or a tumor pressing against an organ. Opioids may also be used to control pain during end-of-life care.

Read more about types of pain and pain management.

While important tools in treating cancer-related pain, opioids are not the only ones in the toolbox. A multidisciplinary approach is highly recommended. It may include other medicines and other types of therapies that don’t involve medicine.

Will My Child Become Addicted to Opioids?

Opioids can be highly addictive. However, the care team will take precautions to help prevent addiction. For example, the care team may prescribe opioids for a short period of time to reduce the patient’s exposure to them.

The care team may also assess risk factors for addiction and decide if the patient is low-risk, moderate-risk, or high-risk. The care team can use this information in developing a pain treatment plan.

Risk Factors for Opioid Misuse and Addiction

  • Adolescents and young adults — Risk for abuse typically increases during teenage years and peaks during young adulthood.
  • Exposure to opioids — Long-term opioid use and/or taking multiple types of opioids can increase risk.
  • Personal, peer group, or family history of substance abuse
  • Behavioral and academic problems
  • Childhood sexual abuse
  • Depression and anxiety

If opioids are prescribed, many pediatric centers require patients and parents to sign a substance use contract or agreement before starting opioids. This document has statements about the patient’s and family’s roles and responsibilities, the conditions under which opioid treatment may be ended, and the responsibilities of the care provider.

Contracts can help care providers and patient families have conversations about opioid treatment and resolve questions and concerns.

Screening to Monitor Opioid Use

The care team can use different methods to monitor patients to make sure opioids are used correctly.

  • The care team may conduct pill counts. A team member may count pills periodically to ensure patients are not taking more pills than prescribed or that pills are not being stolen from the patient’s supply.
  • Patients may also have urine drug tests, so the care team can monitor the medications and other substances taken.
  • The care team may ask patients and families to keep a pain diary to record how many pills the patient takes each day and when he or she takes them.

Signs of Opioid Misuse

The care team will watch patients closely for signs of opioid misuse. Parents should speak to the care team if these signs are observed:

  • Decreased ability to function normally because of opioid use
  • Use of pain medications to treat non-pain symptoms
  • Third party showing concern about the patient’s opioid issue
  • Hoarding of medications
  • Illicit drug use
  • Stealing or selling prescription drugs
  • Prescription forgery or other tampering
  • Getting opioids from non-medical sources
  • Pill count discrepancy
  • Patient not keeping appointments with pain care provider
  • Patient seeking pain treatment from multiple doctors
  • Frequent attempts to get refills without an appointment
  • Lost/ stolen medication
  • Requesting medication by brand or street name
  • Resisting changes in pain treatment plan
  • Unauthorized changes or combinations of substances
  • Use of other substances for pain relief
  • Taking medication to get a “high”

If misuse occurs, the care team can work with the patient’s family to come up with solutions.

If you have concerns about opioids, talk openly about them with care team members.


Reviewed: January 2019