Nonmedical opioid use at the end of life: A tale of addiction and a last wish.

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  • Additional Information
    • Source:
      Publisher: Cambridge University Press Country of Publication: England NLM ID: 101232529 Publication Model: Print Cited Medium: Internet ISSN: 1478-9523 (Electronic) Linking ISSN: 14789515 NLM ISO Abbreviation: Palliat Support Care Subsets: MEDLINE
    • Publication Information:
      Original Publication: Cambridge : Cambridge University Press, c2003-
    • Subject Terms:
      Opioid-Related Disorders*/complications ; Opioid-Related Disorders*/drug therapy ; Cancer Pain*/drug therapy; Child ; Female ; Humans ; Analgesics, Opioid/adverse effects ; Quality of Life ; Death
    • Abstract:
      Background: Nonmedical opioid use (NMOU) has been associated with opioid overdose deaths. This pattern of misuse can be seen in those using opioids for cancer-associated pain. We present a case that highlights the complexities associated with NMOU and a patient's care at the end of life.
      Cases Description: A patient with a metastatic solid tumor malignancy along with co-occurring history of polysubstance abuse was admitted to an acute palliative and supportive care unit (APSCU). The patient demonstrated behaviors concerning for NMOU during her hospital stay but had increased symptom expression concerning for worsening dyspnea while in the APSCU. Unfortunately, she used home opioids, which was unknown to the team at the time along with requesting for higher doses of opioids that were being prescribed. This caused a worsening respiratory status and affected her care. Using an interdisciplinary approach, the providers managed her symptoms and discharged her safely to see her child.
      Conclusion: This highlights the complexities of the alleviation of suffering in those with NMOU. It is important to continue to manage NMOU at the end of life due to its effects on quality of life. A multimodal approach is recommended to identify and care for these patients.
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    • Grant Information:
      UL1 TR003167 United States TR NCATS NIH HHS
    • Contributed Indexing:
      Keywords: Nonmedical opioid use; Opioids; Palliative care unit; Substance use disorder
    • Accession Number:
      0 (Analgesics, Opioid)
    • Publication Date:
      Date Created: 20221222 Date Completed: 20230511 Latest Revision: 20231202
    • Publication Date:
      20240829
    • Accession Number:
      PMC10175098
    • Accession Number:
      10.1017/S1478951522001717
    • Accession Number:
      36545767