Substance abuse and cancer. 

Pain is often a symptom that we see in patients who have any life limiting illness, different types of pain can present in different ways and we can treat pain through different ways such as medications, physiotherapy, psychological therapies like CBT or meditation, acupuncture and distraction techniques. 

Often there are a large calibre of patients who don’t always fit the one mould when it comes to pain relief. Everyone’s pain differs, peoples pain tolerances vary and different types of pain are easier to soothe than others. 

What happens when you treat a patient who has a history of substance abuse in the past or even presently, like mentioned previously when discussing pain, each patient who has faced substance abuse issues in the past also so not always fit one mould. One particular lady, she is 42 years old  I care for has an active heroin addiction, she has been diagnosed with stage 4 lymphoma and she comes to my clinic on a weekly basis where we discuss her symptoms and how we can manage them. Caring for her has been an eye opener in the how she sees her cancer, how she responds to pain, when she visits me she lets me knows all of her symptoms but interestingly at the end of her discussing her symptoms she doesn’t always want them to be treated. 

She is extraordinary to speak to and I am in awe at her at how brave and surprisingly organised and level headed she comes across when she discusses how she manages being an active heroin user and also a cancer patient managing her treatments and pain medications. I know that sounds like I applaud her for being a heroin user and I don’t, we have spoke in length in aiding her addiction but she explains this has been her life since the age of 17 now and trying to deal with her heroin addiction at the same time as dealing with a cancer diagnosis she explains is just too much at once. Strangely enough I can sort of empathise with that. 

 When we talk about her pain, she describes a sharp stabbing pain in her left rib and left side of her neck, she always then goes on to say its for all the pain I caused. For the ignorant  disregard I had for the beauty of life when I decided being high on drugs was better. She alway discuses about her relapses she’s had from age 17-42, she believes every times she relapsed , it was another day closer to her being diagnosed with cancer as it is was what she deserved. She talks about rehab as she has been there 3 times, she takes an interesting approach to the term ‘rehab’ and she feels that the term “rehab” grew from obscurity to take on the kind of fashionable status that makes household names of clinics like the Priory and spawn a vast and profitable industry. When you want to go to rehab, of the public sector variety, she explains that you are asked to prove your devotion to the cause for a time by attending so many meetings and making so many phone calls (side note from patient: ‘not easy if you’re living out of a parked-up stolen car and your priority is feeding addictions to heroin rather than wishing your social worker and palliative nurse a  good morning a quick run down of the day, so thats why I don’t always come to these catch ups’) 

I always like when she calls it a catch up rather than an appointment. 

Her pain is presently being controlled by a port in her chest and she receives weekly infusions as her pain tolerance to standard opiates is extremely high. 

Trying to tackle her pain isn’t always successful and I’m sure the symptoms I try and control I don’t really do a fantastic job at all really, but active talking and I know it sounds like I’m defending myself for not being very good at controlling her pain at all, but actively talking can tackle ‘total pain’, I’ve asked her what has her experience on symptom control throughout her cancer and she explains ‘if you’re going to get cancer, and undergo chemotherapy, the experiences of addiction, withdrawal and treatment do have their uses. Trouble sleeping on the chemo? Try 2 weeks withdrawing in rehab with the scum of the earth, that will send you mad, Chemo drugs making you feel a bit queasy – anti-emetics not quite hitting the spot? Try dry-heaving your way through the worst days of heroin withdrawal. Bones aching on chemo? Nothing is as bad as withdrawal aches, like every bone in your body is the pencil led.

We discuss what we can do as the health care team to treat her pain or any symptoms to make this process more bare able. She often explains that she feels the weight of an expectation to learn something from my experiences. What does it mean to have been a “heroin addict”, and now to be a “cancer victim”? The truth is I still don’t know. She struggles that we always try and strive to find out why and how do you feel, when sometimes patients don’t know and they frankly don’t care they just want to get through it as easy as possible.

As much as I know I’m never going to change her drug addiction over night and it will take years to try and aid someone’s addiction as I know that I do not have the skills or qualifications to even attempt this, she once mentioned this which always sticks with me and I think applies to any type of additions.  ‘Drugs don’t make you happy, they don’t bring joy. But they are fun and the fun becomes routine. They bring mess in your life, but they do provide you with a clear and present purpose. From morning to night, your life becomes very simple. Find money to buy drugs. That’s it. Now my life has become simple once again. 

Chemotherapy is my new purpose. Keep taking those drugs and hope that they keep me alive. That’s all I have to do. I don’t think there’s any causal connection between my drug addictions and my cancer, but having had my mind suitably concentrated by cancer, I’ve had to make time for the heroin elsewhere, and trusts I still find the time to do it but even time managing it must shows some level of self control which gives me hope for what I could achieve in the future.