Meeting at the Crossroads of Pain and Addiction: An Ethical Analysis of Pain Management with Palliative Care for Individuals with Substance Use Disorders (original) (raw)
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Cancer-related pain affects a majority of patients with advanced cancer and is often undertreated. The treatment of this pain is largely reliant on the use of opioids, which are essential medicines for symptom management and the maintenance of quality of life (QoL) for patients with advanced cancer. While there are cancer-specific guidelines for the treatment of pain, widespread publication and policy changes in response to the opioid epidemic have drastically impacted perceptions of opioid use. This overview therefore aims to investigate how manifestations of opioid stigma impact pain management in cancer settings, with an emphasis on the experiences of patients with advanced cancer. Opioid use has been widely stigmatized in multiple domains, including public, healthcare, and patient populations. Physician hesitancy in prescribing and pharmacist vigilance in dispensing were identified as barriers to optimal pain management, and may contribute to stigma in the context of advanced ca...
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Opioid analgesia is a mainstay of the treatment of cancer pain. Treatment of pain in patients with cancer with an ongoing substance abuse disorder can be difficult. We report the ethical challenges of treating a patient with cancer with a concomitant substance abuse disorder in an outpatient palliative care setting. We present an analysis of ethical considerations for the palliative care physician and strategies to aid in the successful treatment of such patients. We argue that there are select patients with cancer for whom exclusion from treatment with opioid therapy is warranted if their health is endangered by prescription of these medications.
Journal of Pain and Symptom Management, 2021
Context.-The opioid epidemic spurred guidelines intended to reduce inappropriate prescribing. Although acute cancer-related pain was excluded from these recommendations, studies demonstrate reduced opioid prescribing for patients hospitalized with advanced cancer. Objectives.-We performed a matched case-control analysis to determine how a history of opioid use disorder (OUD) affects inpatient management of cancer pain. Methods.-Charts of patients with OUD admitted for cancer pain from 2015-2020 were retrospectively reviewed. Hospitalizations were matched 1:1 by patient age and sex. Home milligram-morphine equivalent per day (MME/day) was calculated from the home medication list. Admission MME/day was the average MME/day administered during hospitalization. Results.-A total of 80 hospitalizations (40:40) were matched for 25 patients with a history of OUD and 31 patients with no history of OUD. Cancer was metastatic/relapsed for 70% of admissions. The median overall survival was 2.3 months (95% CI 0-5.21, P = 0.13). Patients with OUD had a significantly lower change from Home to Admission MME/day (−3 vs. 37, P < 0.01) and were less likely to have any increase in Admission MME/day (OR 0.1, 95% CI 0.02-0.43, P < 0.01). When considering opioids administered after pain specialty consultation, there was no difference between groups.
Dignitas , 2022
Palliative care (PC) has the ability to enhance quality of life for people who are diagnosed with a life-limiting, serious illness. However, there are populations whose experience of PC may not measure up to the standard of care that most palliative patients receive. Individuals with substance use disorders (SUD) often encounter barriers to optimal care. The World Health Organization (WHO) defines SUDs as “a group of conditions related to alcohol or other drug use,” all of which include the use of psychotropic substances that may or may not have been prescribed clinically.[i] These include alcohol, opioids, cannabinoids, sedatives, hallucinogens, cocaine, and other stimulants such as tobacco. This paper will focus on more stigmatized SUDs related to alcohol, opioids, and illicit substances, as many PC programs do not have adequate knowledge on how to care for these individuals and their unique concerns. This paper will examine common barriers to PC in the general population and discuss those exclusive to those with an SUD. Recommendations on improving access to PC for both populations are also discussed.
Perceived healthcare stigma among patients in opioid substitution treatment: a qualitative study
Substance Abuse Treatment, Prevention, and Policy
Background People with substance use disorders (SUD) including patients in opioid substitution treatment (OST) are subject to stigma, and have generally poor health and barriers towards seeking healthcare. Experience of stigma might negatively affect healthcare seeking, but this topic is sparsely investigated. The aim of this study was to explore OST patients’ past and present experiences of substance use stigma in healthcare settings, in order to provide insight into the challenges that people with opioid use disorder may face when using health services, and the strategies they use to cope with them. Methods Six focus groups with 23 OST patients were moderated by OST staff, and conducted with a questioning route focusing on health literacy. Experiences associated with stigma and its consequences that were spontaneously brought up by participants were assessed in a secondary analysis using a thematic approach. Results Experiences of stigma from a wide range of healthcare settings we...