Title : Beyond relief: Updates on opioid use disorder in cancer patients – A narrative review by experts

Background: Opioids are central to cancer pain management due to their potent analgesic effects. However, Opioid Use Disorder (OUD) is a growing concern, especially with rising cancer survival rates leading to more patients experiencing chronic pain. Opioid misuse may begin before diagnosis or during/after treatment, affecting patients and society.

Methods: A comprehensive literature review was performed using databases including PubMed, Medline, Scopus, ScienceDirect, and EBSCO to evaluate OUD prevalence and risk factors in oncology. Zoom meetings were held with a multidisciplinary team—including medical and radiation oncologists, an internist, a pharmacist, and nursing staff—to prepare this narrative review.

Findings: Nineteen percent of patients develop Nonmedical Opioid Use (NMOU) within eight weeks of initiation. Abnormal behaviors include altering dosage or administration routes. Pain guidelines, like the World Health Organization (WHO) stepladder, often overlook cancer-related pathophysiology, reinforcing the need for thorough pain assessments.

Prolonged opioid use is linked to immunosuppression and possibly increased cancer risk. Excessive use may impair bowel function, cognition, breathing, and physical activity, potentially leading to fatal overdose. Stigma also influences patient decisions on pain control.

Key contributors to OUD include pre-diagnosis opioid use and genetic predisposition, which may account for 50% of addiction risk. Recommendations for prevention strategies include:

• Using the Opioid Risk Assessment Tool

• Patient education and prescription monitoring

• Starting with non-opioid therapies like Cognitive Behavioral Therapy (CBT), physiotherapy, relaxation techniques, radiotherapy, and acupuncture

• Exploring newer options such as Suzetrigine (approved in the United States in January 2025), antispasmodics, non-steroidal anti-inflammatory drugs, neuroleptics, cannabinoids, immunotherapy, and other active treatments targeting the underlying cancer.

• Tailoring narcotics to individual needs.

Conclusion: Comprehensive pain evaluation and early adoption of multimodal interventions are critical to minimize opioid dependence. Future research should explore gene-targeted pain relief, refine risk prediction, and clarify long-term opioid impact in oncology.

Dr. Yasmeen Idrees is a medical graduate of Fatima Jinnah Medical University Lahore, Pakistan. Following her graduation, she pursued postgraduate training in General Internal Medicine and completed MRCP (UK) as her postgraduate qualification. She is keen to explore research in medical field and collaborated with Professor Patricia Tai in Canada for the same.