USE AND ABUSE OF NARCOTICS IN CANCER PATEITNS: A SURVEY OF PATIENTS TREATED IN TEHRAN CANCER INSTITUTE

Abstract

Considering the importance of adequate analgesia for the quality of life of the patient with advanced cancer, and considering the consequences of opioids abuse, we decided to evaluate the proper and improper usage of narcotics in our cancer patients. Prescription of narcotics by the responsible physician and procurement through the legal channels was defined as "use"; otherwise it was defined as "abuse". From a total number of 300 patients who were interviewed, 21 (7%) used narcotics prescribed by the responsible physician (use) and 30 (10%) used narcotics without the prescription or approval of the responsible physician (abuse). The male-to-female ratio, though similar in the "use" and "no narcotics" patients, was very much higher in the "abuse" group. Also income was significantly lower in the "abuse" patients. Disease extent was significantly higher in the "use" but not in the "abuse" group. In addition, the level of pain was very much higher in the "use" and "abuse" groups than the "no narcotics" patients. Both the extent of disease and level of pain were significantly higher in the "use" than the "abuse" group. In multifactorial analysis, pain had a very significant effect for "use" of narcotics and extent of disease was close to statistical significance. For "abuse" of narcotics, sex and pain had significant effects. Pain was the most significant factor leading to both use and abuse of narcotics, and a striking male predominance was seen in narcotic abusers. Nearly half of cancer patients with significant pain were not receiving opioids for adequate analgesia.