Substance Use Disorder in Serious Illness-SUD in Serious Illness

SUD in Serious Illness_Slides

Pdf Summary

This document discusses the challenges and strategies for managing substance use disorders (SUD) in patients with serious illness, particularly focusing on patients with cancer who require palliative treatments. The case study presented is of a 58-year-old man with metastatic lung cancer and a history of SUD, who is requesting an increase in his oxycodone dosage. The document emphasizes the importance of maintaining a therapeutic alliance, avoiding stigmatizing language, and utilizing a harm reduction approach. It suggests validating the patient's symptoms and suffering, asking directly about substance use, expressing concern about harm, setting clear limits, and expressing commitment to ongoing treatment.<br /><br />The document also provides approaches for treating pain in patients with SUD. It suggests optimizing non-opioid analgesia, using split dose sublingual buprenorphine or methadone for pain control, and coordinating with outpatient prescribers or opioid treatment programs (OTPs). It also suggests establishing functional goals, regular appointments, boundaries on opioid prescribing, and prescribing naloxone nasal spray for patients with active opioid use disorder (OUD). The document highlights the importance of addressing withdrawal symptoms, utilizing symptom-focused medications, and providing support through recovery programs, therapy, and mental health services. It also discusses the potential risks and benefits of prescribing opioids for patients with stimulant use disorder and emphasizes the importance of balancing benefits and risks through harm reduction strategies.<br /><br />The document includes additional information on fentanyl purity, early evidence of using higher doses of oxycodone for patients with fentanyl dependence, and opioid withdrawal symptom-focused medications. It also provides information on low-dose buprenorphine induction and different formulations of buprenorphine. The document concludes with references to relevant studies and resources for further information.

Keywords

substance use disorders

serious illness

patients with cancer

palliative treatments

therapeutic alliance

harm reduction approach

pain management

non-opioid analgesia

methadone

naloxone nasal spray