Cancer and substance abuse

DEFINITION: Certain substances, such as tobacco, have an associated cancer risk. Illegal substances can contain carcinogenic additives. Some persons with cancer become addicted to illegal substances and prescription medications during their fight with the disease. Globally, between 9.5 and 10 million people die each year from cancer, most commonly from cancers of the breast, prostate, and lung.

Cancer Risks

Certain substances of abuse, including tobacco, marijuana, alcohol, methamphetamine, cocaine, and heroin, present special risks for the development of cancer.

Tobacco

Tobacco is a well-known carcinogen. Its use is the leading cause of preventable illness and death in the United States. In addition to causing lung, throat, and mouth cancer, it has been associated with cancers of the nasal cavity, esophagus, stomach, pancreas, breast, kidney, bladder, and cervix. Nicotine, which is contained in tobacco leaves, is highly addictive, but it is not carcinogenic. Nicotine is, however, a vasoconstrictorblood vessel constrictorso it increases the risk of cardiovascular disease.

The National Cancer Institute and the Centers for Disease Control report the following statistics related to cancer and tobacco use in the United States:

• Cigarettes cause over 480,000 premature deaths each year, including approximately 41,000 deaths from exposure to secondhand smoke.
• Lung cancer is the leading cause of cancer-related death among both men and women. Ninety percent of lung cancer deaths among men and approximately eighty percent of lung cancer deaths among women are caused by smoking.
• Middle-aged people who smoke are four to five times more likely to die of coronary heart disease than nonsmokers. The risk increases with the number of cigarettes smoked. Smoking also causes most cases of chronic lung disease. Women whole smoke are more likely to die of coronary heart disease than smoking males.
• In 1954, 45 percent of Americans smoked cigarettes, compared to between 11 and 12.5 percent in the early and mid-2020s.
• In 1991, over 70 percent of adolescents reported ever trying cigarettes, compared to between 18 and 14 percent in the early 2020s. However, the use of e-cigarettes increased drastically from the mid-2010s to the mid-2020s.
• Estimates in the early and mid-2020s indicated between 4.5 and 6.6 percent of US middle school students and between 12.6 and 16.5 percent of US high school students used a tobacco product, including electronic cigarettes, cigarettes, cigars, smokeless tobacco, pipe tobacco, and hookahs.
• In the early and mid-2020s, between 1.5 and three percent of US middle school students and between three and five percent of US high school students reported they used two or more tobacco products. Youth who use more than one tobacco product have a higher risk of becoming dependent on nicotine and of using tobacco as adults.

Smoking and chewing tobacco markedly increases the risk of cancers of the oral cavitymouth, lips, and tongue. Smoking tobacco weakens the immune system, which increases the risk of cancer and the risk of infection. Aside from its relationship to cancers of the oral cavity, chewing tobacco also increases the risk of many other cancers and health problems.

Marijuana

Smoked marijuana and smoked tobacco are chemically similar. Thus, like cigarettes, the greatest health hazard of marijuana is from smoking the substance. The psychoactive component of marijuana leaves, delta-9-tetrahydrocannabinol (THC), is a relatively safe drug.

Smoked marijuana, however, is a health risk. Thorough scientific analyses have identified at least six thousand of the same chemicals in marijuana smoke were also present in tobacco. The chief difference between the two plants is that marijuana contains THC and tobacco contains nicotine. Moreover, one of the most potent carcinogens in tobacco smoke, benzo[a]-pyrene, is present in larger quantities in marijuana smoke.

Another factor increasing the carcinogenic risk of marijuana is the way it is inhaled. Marijuana smokers frequently inhale and hold the smoke in their lungs, which increases the amount of tar deposited in the respiratory tract by a factor of about four. Approximately 20 percent of regular marijuana smokersthose who smoke three to four joints a dayhave problems with chronic bronchitis, coughing, and excess mucus.

An alternative to smoking marijuana is ingesting it in pastries, drinks, and lollipops. Marijuana leaves also can be baked into brownies and other desserts. Ingested marijuana has no known carcinogenic effect. However, it still has a psychoactive effect, which can result in myriad problems, including social problems, traffic accidents, and dependence.

A problem with ingesting rather than smoking marijuana is that the digestive process markedly slows the onset of psychoactive effects. This makes ingesting less attractive to users of the substance. Furthermore, because the onset of marijuana’s effect is slowed through ingestion, a large amount of the substance must be consumed, ultimately resulting in an unusually high level of THC in the body.

Alcohol

The combination of alcohol abuse and tobacco use markedly increases the risk of cancers of the oral cavity. Approximately 50 percent of cancers of the mouth, voice boxare associated with heavy drinking. Even in nonsmokers, a strong association exists between alcohol abuse and cancers of the upper digestive tract, including the esophagus, the mouth, the pharynx, and the larynx.

Alcohol abuse, either alcoholism or binge drinking, also has been linked to pancreatic cancer, particularly in men. The risk has been reported to be up to six times greater than in men who do not abuse alcohol. A possible association may exist between alcohol abuse and other cancers, such as liver, breast, and colorectal cancers. Between two to four percent of all cancer cases are caused either directly or indirectly by alcohol abuse. Alcohol abuse, like cigarette smoking, suppresses the immune system, which in turn increases the risk of developing cancer. These persons often do not seek treatment until the cancer is well advanced.

Methamphetamine

Several different chemical processes can be used to make methamphetamine, but most include using volatile organic compounds, which are emitted gases, some of which have carcinogenic effects. Also, other toxic substances can be produced through the production of methamphetamine. Some of these substances are carcinogenic. Specifically, pancreatic and liver cancer has been associated with methamphetamine use.

Cocaine and Heroin

Cocaine and heroin are weakly associated with an increased cancer risk, and substances added to cocaine are often carcinogenic. One example is phenacetin, which not only can cause cancer but also can induce kidney damage. While further research is needed to understand the causal link, individuals who use cocaine or heroin have higher rates of non-Hodgkin’s lymphoma (NHL), pancreatic cancer, and cancers of the head, neck, and throat.

Substances Used and Abused by Persons with Cancer

Cancer, particularly in advanced stages, can cause extreme pain, so persons with cancer are often prescribed opiates to lessen their pain. Marijuana is also used by persons with cancer for pain relief and to reduce the side effects of chemotherapy.

Opiates

An opiate is a drug derived from opium, which is the sap of the opium poppy (Papaver somniferum). Opium has been used by humans since ancient times. Many opiate options exist, including morphine, meperidine hydrochloride (Demerol), hydromorphone hydrochloride (Dilaudid), hydrocodone (Vicodin), and oxycodone (Oxycontin). Heroin is an excellent analgesic, but it is not prescribed for pain relief because of its highly addictive properties compared with other opiates. Another property of opiates is tolerance, which results in the need for increasingly higher doses to achieve the same effect.

Tolerance and addiction are not a major concern for a terminally ill person with cancer, but they are a concern for persons with cancer that is in remission. Pain is the most commonly reported symptom in patients with cancer, and many patients need drugs like opiates or other pain relief options to maintain a reasonable quality of life. However, after depending on opiates through chemotherapy, radiation, surgeries, and other treatments, many individuals struggle to stop taking them, and some individuals develop an opioid use disorder. Researchers believe that drug relapse is caused by the stress associated with cancer, combined with the high availability of prescription and illegal drugs. Most oncologists are ill-prepared to address opioid use disorders or other addiction issues in their patients, and an emphasis on training in this area of practice is needed.

Marijuana

Cancer and its treatment with chemotherapy is associated with side effects such as nausea, vomiting, anorexia (loss of appetite), and cachexia (muscle wasting). Marijuana is effective in reducing these symptoms; therefore, it has been recommended for persons with cancer.

However, scientists at the National Cancer Institute assert that several pharmaceuticals are superior to marijuana’s effects, including serotonin antagonists such as ondansetron (Zofran) and granisetron (Kytril), used alone or combined with dexamethasone (a steroid hormone), metoclopramide (Reglan) combined with diphenhydramine and dexamethasone; methylprednisolone (a steroid hormone) combined with droperidol (Inapsine); and prochlorperazine (Compazine).

Medical marijuana legislation has a long, controversial history in the US. Despite the controversy, medical marijuana outlets (dispensaries) increased in number throughout the country in the 2010s and early-to-mid-2020s. Their incidence depends on state and federal regulations. Many states have adopted marijuana statutes that are much more liberal than federal statutes, and some have legalized the recreational use of marijuana. Although there are legitimate medical uses for marijuana for persons with cancer and other conditions like glaucoma, many medical marijuana outlets supply the product to almost anyone for any reason.

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“Smoking Is Down, but Almost 38 Million American Adults Still Smoke.” Centers for Disease Control and Prevention, US Dept. of Health and Human Services, 18 Jan. 2018, archive.cdc.gov/#/details?url=https://www.cdc.gov/media/releases/2018/p0118-smoking-rates-declining.html. Accessed 20 Sept. 2024.

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