As oncol­ogy nurses on a post sur­gi­cal floor, we spend much of our time treat­ing pain. Pain comes in a mul­ti­tude of forms for a mul­ti­tude of rea­sons. Pain from the sur­gi­cal site, pain from the tumor’s pres­sure on organs or nerves, pain from body sys­tems shut­ting down . . . there are 101 rea­sons, and many patients, fam­i­lies, and even med­ical pro­fes­sion­als are ill informed on the how, the why, and the treat­ment of pain.

Often there is con­fu­sion around tol­er­ance ver­sus addic­tion of opi­oid med­ica­tions. Many patients with can­cer will require treat­ment from heavy hit­ters like oxy­codone, mor­phine, or hydro­mor­phone. They may become tol­er­ant due to the nature and chem­istry of the drug or advanc­ing dis­ease and require larger doses. With­out these strong pain med­ica­tions, the qual­ity of life for some patients would be unbear­able. But they should not be labeled as addicted, because requir­ing more med­i­cine to treat the pain does not meet the def­i­n­i­tion of addic­tion. Addic­tion means the per­son has crav­ings for the drug and engages in behav­iors that are coun­ter­pro­duc­tive to hap­pi­ness and suc­cess in order to get it and con­tin­ues to use the drug despite neg­a­tive con­se­quences. It is more of a behav­ioral dis­or­der that may or may not include phys­i­cal dependence.

As oncol­ogy nurses, we fully under­stand the need for acces­si­ble drugs to treat our patients’ pain, but that must be bal­anced with con­trol due to an increas­ing rate of abuse among the gen­eral pub­lic, the high­est increases seen in youth. Research and lit­er­a­ture is abun­dant on the under treat­ing of pain due to med­ical pro­fes­sion­als mis­con­cep­tions. Many phar­ma­cies don’t carry strong med­ica­tions for fear of crim­i­nal activ­ity. Yet, any­one who has caught an episode of the tele­vi­sion pro­gram Inter­ven­tion on A&E can rec­og­nize the mag­ni­tude of addic­tion in Amer­ica stretch­ing across all lines of race and class and our need for a full force attack to treat the prob­lem. The issue has gar­nered the atten­tion of the U.S. pres­i­dent, which is no small mat­ter. Some­thing that is needed so des­per­ately by some to make their can­cer jour­ney and life man­age­able has the abil­ity to destroy fam­i­lies and dev­as­tate lives.

Until a new, non­ad­dic­tive, effec­tive pain med­ica­tion is devel­oped, the only answer I can think of is edu­ca­tion. Infor­ma­tion early and often about pre­scrip­tion drug abuse and its effects deliv­ered to all age groups. We can inform our­selves about new guide­lines and treat­ments for pain, both phar­ma­co­log­i­cal and non-​​pharmacological, and then use them in prac­tice. Talk to your patients and col­leagues about the dif­fer­ences between addic­tion and tol­er­ance. Edu­cate patients about pro­tect­ing their own med­ica­tions and talk­ing to their chil­dren or other fam­ily mem­bers about the dan­gers of use with­out a pre­scrip­tion. Inform your­self, and call your con­gressper­son or sen­a­tor to advo­cate for your patients’ access to crit­i­cal med­ica­tions. We must hold up our oath to do no harm, either from under­treat­ing pain or con­tribut­ing to abuse in America.