CASE STUDY: My patient with opioid use disorder (OUD) has terrible cancer pain.

Identifying challenges when treating patients with concurrent substance use disorders and cancer pain

Stigma surrounding substance use creates significant barriers for people who use drugs (PWUD), particularly cancer treatment and palliative care.
Undertreatment of cancer pain is a fundamental problem because healthcare providers commonly do not believe patients’ self-reports of pain and worry about feeding their addiction
Providers may be more concerned about diversion and licensure issues and avoid providing opioids until patients who use drugs are actively dying

Based on his Cancer Pain and Opioid Use Disorder (CPOUD) quality improvement pilot program in Vancouver, Canada, Dr. Greatheart recommends:

A non-stigma, multidisciplinary team involving primary care, medical and radiation oncology, palliative care, social work and other allied team is essential
Use existing palliative approaches to cancer pain by providing short- and long-acting formulations of opioids. Patients on methadone can receive split dosing BID/TID for analgesia benefit, or use buprenorphine or fentanyl patches.
Risk mitigation strategies can include an opioid agreement, frequent monitoring and shorter prescriptions, and strategic use of UDS. Ensure naloxone co-prescription for all patients.

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