Trust Violated: Analgesics for Addicts

Penson, Richard T.; Nunn, Catherine; Younger, Jerry; Schaeffer, Nancy; Chabner, Bruce A.; Fricchione, Gregory L.; Quinn, Thomas E.; Lynch, Thomas J.

doi:10.1634/theoncologist.8-2-199

Cited by 5 publications

(6 citation statements)

References 20 publications

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“…If patients have tried, through established substance-use treatment programs or otherwise, to stop using the substance, literature suggests that relapses are inevitable (1). When these relapses do occur, they must not be taken personally by those on the treatment team; instead, it is important to explore and challenge the reasons for the noncompliance or relapse (9). Providing support for the patient even when relapses occur is encouraged, in the hope that the frequency and severity of the relapses will decrease (6).…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, communication within the multidisciplinary team is also important. Patients need to be offered a consistent approach, since inconsistency leads to mistrust (6,9). Regarding Mr.…”

Section: Discussionmentioning

confidence: 99%

“…While it allows for a more meaningful clinical relationship, it is challenged when trust is breached. Penson et al (9) described, in 2003, a case of a patient who broke the trust of her health care team, but how the trust was re-established by including the help of a substance-use clinic and by using contracts. The team was able to support and even empower the patient as they provided care in this manner (9).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Cancer Pain Control in the Setting of Substance Use: Establishing Goals of Care

Burton-Macleod

Fainsinger

2008

J Palliat Care

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Mr. I.M. was a 62-year-old man with a presumptive diagnosis of non-small-cell lung cancer. He also had a long history of alcohol and street drug use, including cocaine and morphine. His other comorbidities included: COPD, liver disease secondary to alcohol use, hepatitis C, peptic ulcer disease, degenerative disc disease, and chronic pain after a remote traumatic episode. A left upper lobe lesion was first noted on chest x-ray in October 2002. Over the following year, he was investigated on two different admissions for weight loss and hemoptysis, but each time he refused biopsy of the lung mass. During the second admission, appointments were made for the patient to follow up with oncology, but he did not attend these appointments. Three years after the initial abnormal chest x-ray, he was assessed for hospice placement. At this time, Mr. I.M. was staying at a single men's shelter in the inner city area. Each day he had been dispensed eight tablets of MS Contin 60 mg and eight tablets of Percocet by the nurse at the single men's shelter. He was assessed by the regional palliative care team (5). It was felt that he would benefit from admission to the tertiary palliative care unit for further workup and symptom control prior to transfer to a hospice. The patient agreed to this and was admitted the following day. On arrival, when asked what his expectations were of this stay, he stated only that he just needed a place to stay. When assessed on admission, he complained of pain, his description of which was vague in location and nature. He also had shortness of breath on exertion, cough, and hemoptysis. Drowsiness and myoclonus suggestive of opioid-induced neurotoxicity were observed. It was suggested that he be rotated to methadone. He agreed and a three-day methadone rotation was begun.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Secondly, communication within the multidisciplinary team is also important. Patients need to be offered a consistent approach, since inconsistency leads to mistrust (6,9). Regarding Mr.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cancer Pain Control in the Setting of Substance Use: Establishing Goals of Care

Burton-Macleod

Fainsinger

2008

J Palliat Care

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“…2005 ;Schieffer et al 2005 ;Zeigler 2005 ;Vukmir 2004;Atluri et al . 2003;Penson et al 2003;Schnoll & Weaver 2003;Cohen et al 2002;Nedeljkovic, Wasan & Jamison 2002;Prater, Zylstra & Miller 2002;Weaver & Schnoll 2002a, b;Aronoff 2000;Longo et al 2000;Thomas & Weiss 2000;Chahal et al 1997;Haddox et al 1997;Dunbar & Katz 1996;Wesson, Ling & Smith 1993).…”

Section: Literature Reviewunclassified

Managing Acute and Chronic Pain in a Substance Abuse Treatment Program for the Addicted Individual Early in Recovery: A Current Controversy

Markowitz

Francis²,

Gonzales-Nolas³

2010

Journal of Psychoactive Drugs

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Patients early in recovery from addictive disorders are in a tenuous position and when these individuals are stressed from acute or chronic pain they face even more challenges. Physicians are often conflicted by the desire to help the patient achieve pain control and maintain sobriety. While there have been a handful of studies examining patients in either active addiction with pain or with a more remote history of addiction with pain, there have been very few, if any, that look at treating patients during their addiction recovery process who suffer from pain. This article will examine the issue of whether it is ever appropriate to use opioid pain medications on such patients and, if so, what guidelines can be used to maximize the chances of a good outcome while minimizing the chances of causing a recurrence or exacerbation of addiction.

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“…The management of pain, particularly the chronic non‐malignant variety and pain in those with pre‐existing narcotic tolerance, is extremely challenging 10 . Chemically dependent patients have high levels of pain 11 and are disproportionately represented in trauma caseloads 12 .…”

Section: Intra‐hospital Relationshipsmentioning

confidence: 99%