Opioids are vital for managing cancer-related pain, especially in advanced disease stages. However, growing global awareness of opioid use disorder (OUD) introduces ethical, clinical, and policy dilemmas within oncology care. This narrative review explores the intersection of cancer care and OUD, synthesizing recent literature and expert insights to promote responsible pain management practices. Our findings are summarized as follows. While cancer patients are often seen as exempt from OUD risk due to the necessity of opioid analgesia, emerging data and clinical experience challenge this assumption. Survivorship and chronic malignancies show patterns of misuse and behavioral addiction. Cases from Canada, France, Jordan, and Kosovo illustrate these complexities. Risk factors include prior substance use, psychological comorbidities, prolonged survivorship, and insufficient monitoring. Gaps in provider training and inconsistent screening contribute to underdiagnosis. The review examines current pharmacologic approaches—long-acting opioids, adjuvant therapies, and opioid-sparing techniques such as nerve blocks, cannabis derivatives, and non-opioid analgesics.

Expert commentaries support a patient-centered strategy that differentiates dependence from addiction. They call for nuanced judgment, interdisciplinary collaboration, and standardized tools to manage risk without compromising symptom control. Integrated care models—psycho-oncology, addiction consultation, telehealth—are recommended. In conclusion, a paradigm shift is needed: one that balances empathy with clinical vigilance. By embracing evidence-based practice, targeted education, and policy reform, oncology teams can address OUD risk while preserving compassionate pain relief.

Dr. Yasmeen Idrees is a medical graduate of Fatima Jinnah Medical University Lahore, Pakistan. Following her graduation, she pursued postgraduate training in General Internal Medicine and completed MRCP (UK) as her postgraduate qualification. She is keen to explore research in medical field and collaborated with Professor Patricia Tai in Canada for the same.