The team at Rush University Medical Center have conducted the first US investigation into opioid use and pancreatic cancer – how could this change prescriptions?
In the UK, there are reports of a 400% increase in opioid prescription. The north of the country sees more opioid prescriptions given out than the south, highlighting regional health inequalities.
Dr Li-Chia Chen, a Senior Lecturer at Manchester, said: “Chronic pain is difficult to manage and unfortunately, because their workload pressures are so stringent, GPs have limited capacity to counsel patients with persistent pain.”
“This might explain why drug therapy is the main way how GPs manage pain.”
“There’s no guarantee that long term use of opioid analgesics can resolve chronic pain. Indeed the risk of opioids’ side-effects such as dependency, respiratory depression and immunosuppression may sometimes outweigh the potential benefits.”
For some with chronic pain, there is no alternative. This is a difficult situation for patient and doctor, knowingly navigating into the dangerous waters of potential addiction – in order to give the patient some amplified quality of life.
In the US, opioid misuse has evolved into a public health crisis – of which 47,600 people died in 2017. Despite the fact that opioids are never intended as a long-term solution, addiction rates for those with chronic pain have increased, and the US handed out 191 million prescriptions in 2017.
What does opioid addiction to do with cancer though?
In West Central Asia, recent data showed that opium use is a possible risk factor for pancreatic cancer there. Opioids in general have been known to have a harmful effect on various cancers, and dose dependency is a factor in how severe that effect is.
First author Faraz Bishehsari, MD, PhD, and his team looked at data between 1999 to 2016. Usman Barlass, MD, Ameya Deshmukh, PhD, and Todd Beck, MD, worked with Bishehsari on this investigation.
Using the Center for Disease Control’s Wonder online data, the team extracted the opioid death rate as a surrogate for prescription and illicit opioid use. Incidence of pancreatic cancer was gathered from the US Cancer Statistics Working Group. Using this information, they could build a picture of lifestyle and behaviour that potentially increases the risk of contracting pancreatic cancer.
What did the US-based study reveal?
The team saw that pancreatic cancer and opioid death rates rose over time – at both state and national levels. If they looked at the opioid-based death rate in a state, this number predicted the future prevalence of pancreatic cancer – years after the spike in opioid deaths.
This means that more work needs to be done, to figure out this pattern and solidify it with more data. What the team found could impact how alternative pain control approaches could benefit these patients – the ones who have yet to experience pancreatic cancer, but are living the lifestyle of someone at risk of such a cancer.
Bishehsari further commented: “Our mechanistic studies could provide further insights on the pathways that opioid could potentially impact progression of cancer.”
What alternatives are there to opioids?
Dr Ganesan Baranidharan, consultant in anaesthesia and pain medicine at the Leeds Teaching Hospitals NHS Trust, explains: “Neuromodulation is a highly targeted treatment used to reach specific areas within the body to reduce pain.
“In the majority of cases, a medical device is implanted directly in to the problem area and either works by stimulating the nerves to produce the body’s own natural response, or by emitting small amounts of analgesia.
“The huge advantage is the ability to target the therapy to the individual patient and the reversibility if it fails. It can dramatically improve people’s quality of life and comprehensive evidence is now needed to show its effectiveness, so more people can benefit from this alternative to popping pills.”