| Abstract: |
(from the chapter) Substance abuse and addiction are among the most serious and complicated challenges faced by clinicians in an oncologic setting where opioid analgesics and other controlled substances are the cornerstones of care. For a small subset of cancer patients, exposure to opioids in the setting of their cancer care can potentially lead to the exacerbation or development of a set of problems that are becoming more and more common. This may be especially true for younger patients whose genetic and other vulnerabilities to addiction are not fully expressed by the time of their first opioid exposure during cancer treatments. The integration of pain management and addiction medicine has been slow in coming, and many psycho-oncologists lack specific training in these areas. There is a need to develop programs for managing the small, but labor intensive and difficult subset of higher addiction risk patients in cancer centers. Individualizing care for these patients is essential. Similarly, alcohol abuse complicates cancer care. For example, postsurgical withdrawal and delirium tremens (DTs) can be life threatening. Unfortunately many patients are recognized before surgery. Screening for alcoholism and doing offering detoxification ahead of surgery is an ongoing problem. This chapter will summarize and characterize the prescription opioid problem, clarify the relationship between opioid prescribing and prescription drug abuse, address the clinical aspects of alcoholism and cancer, examine issues of adherence in cancer pain patients and discuss some strategies for the higher risk subgroups. Furthermore, the need to address the high-risk problem by institutionalizing screening and employing recent improvements in urine screening and prescription monitoring programs, now commonplace in noncancer pain management, is discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved). |
