Addiction

Certain medicines used to treat breast cancer and its side effects may be addictive, including opioids, anti-anxiety medicines, and sleep medicines.

Reviewed by Stephanie Ross, PhD

Addiction (also called substance use disorder) can occur in people who are diagnosed with breast cancer if they become dependent on a medicine used to help with the side effects of cancer or its treatment — such as pain, anxiety, or difficulty sleeping (insomnia). Sometimes people have existing addictions before they are diagnosed with breast cancer, which can become more noticeable when treatment starts. It’s also important to note that people can become addicted to many things, but the focus here is on medicines directly or indirectly related to breast cancer.

Addiction can be physical, meaning that the body or brain needs increasing amounts of a medicine to achieve the same effect. It also can be psychological, meaning that a person keeps turning to a medicine for relief from feelings such as anxiety and stress. 

Certain medicines that doctors prescribe during breast cancer treatment are more likely to lead to addiction, including opioids, anti-anxiety medicines, and sleep medicines.

It’s important to know that untreated pain can cause anxiety, depression, insomnia, and other issues, so it’s vital that you talk to your healthcare team about any concerns you have. They can refer you to palliative care teams and specialized pain management resources.

Doctors may prescribe opioids for pain after surgery or to treat pain from metastatic breast cancer. Some examples include:

  • morphine

  • codeine

  • oxymorphone

  • hydrocodone

  • oxycodone

  • fentanyl

Some anti-anxiety medicines include:

  • Xanax and Niravam (chemical name: alprazolam)

  • Valium (chemical name: diazepam)

  • Ativan (chemical name: lorazepam)

  • Librium (chemical name: chlordiazepoxide)

  • Klonopin (chemical name: clonazepam)

Some medicines that help with sleep (also called z-drugs) include:

  • Ambien (chemical name: zolpidem)

  • Lunesta (chemical name: eszopiclone)

  • Sonata (chemical name: zaleplon)

A recent study looking at people who had mastectomy and reconstruction found that, among the people who participated in the study and had not filled prescriptions for these types of medicines before, some became new persistent users of opioids and some became new persistent users of anti-anxiety or sleep medicines. 1

So, although these medicines can be helpful, it’s important to follow your doctor’s prescription exactly and take the prescribed dose only as often as directed. It’s also a good idea to store your medicines securely so other members of your household cannot access them. 

Your cancer care team can connect you with help if you have any risk factors that might increase your risk for addiction, such as:

  • a history alcohol or drugs misuse (which can increase your risk of addiction to alcohol and drugs after a breast cancer diagnosis)

  • a history of substance abuse among your family and friends

  • being diagnosed with cancer at a younger age

  • a history of mental health conditions such as depression or anxiety

  • having experienced childhood trauma

  • not having a strong support network of family or friends​​​​​

  • financial stress

If you’re concerned about being at risk for addiction, you can ask your doctor about alternatives for pain management, anxiety, and insomnia. For example, some people find medical cannabis helpful for these conditions; still, cannabis does pose some risk of addiction. 2 It may be possible to treat anxiety with mental health counseling. Although melatonin isn’t necessarily the best solution for everyone who has sleep issues, you may want to ask your doctor if it’s safe for you to try it. Other strategies to help reduce anxiety and sleep issues include gentle exercise, meditation, mindfulness-based stress reduction, physical therapy, and other complementary therapies. 

  People living with metastatic disease may have pain that is manageable only with opioids. If you’ve been diagnosed with metastatic breast cancer and pain is affecting your quality of life, it’s important to let your cancer care team know. Your cancer care team can recommend a palliative care specialist who specializes in managing the side effects of cancer and its treatment and can give you safe and effective pain relief. 

Symptoms of addiction

Signs that a person is becoming dependent on or addicted to medicine can include:

  • taking medicine more frequently than the doctor has prescribed

  • taking larger doses of medicine than the doctor has prescribed (for example, doubling up on pills)

  • using medicine for something other than for its prescribed purpose (for example, using opioids to feel less anxious rather than to relieve physical pain)

  • combining medicine with alcohol or illegal drugs to heighten their effect

  • feeling like you can’t function unless you can take more medicine than your doctor prescribed

  • trying to get more medicine — either from a different doctor or from a friend with the same or similar prescription — without letting your own doctor know

It can be very dangerous to suddenly stop taking certain medicines — even when there is no dependence or addiction. If you feel that you need to take a medicine more often than prescribed or you feel you need a higher dosage, it’s essential you talk with your cancer care team. You should not feel guilty or ashamed. Your cancer care team can help you safely reduce the dosage and frequency of a misused medicine over time, and recommend safer alternatives for treating anxiety or depression. 

Written by: Kristine Conner, contributing writer

References

  1. Cogan JC, Raghunathan RR, Beauchemin MP, et al. New and persistent controlled substance use among patients undergoing mastectomy and reconstructive surgery. Breast Cancer Research and Treatment. 2021. 189(2):445-454. Available at: https://doi.org/10.1007/s10549-021-06275-8

  2. Hampton T. Medical marijuana may trigger substance abuse. The Harvard Gazette. March 18, 2022. Available at: https://news.harvard.edu/gazette/story/2022/03/medical-marijuana-may-trigger-substance-abuse/

Posted in: In Treatment, Medical/Science, Risks, Side Effects