Special Considerations for Treating Pain in a Patient with Metastatic Cancer and Cocaine Use Disorder: A Case Report
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Description
Patients with substance use disorders who are subjected to abrupt discontinuation of opioids for chronic cancer related pain are at increased risk for withdrawal, overdose, suicide, and hospital visits. Palliative care focused on harm reduction and patient retention strategies can lead to more optimal outcomes for these patients.
The patient is a 67-year-old female with a history of metastatic cholangiocarcinoma undergoing chemotherapy, chronic lumbar back pain, chronic hepatitis C, and substance use disorder in remission. She was referred to palliative care who assumed cancer pain management. While under their care, she tested positive for cocaine on a urine drug screen resulting in her opioids being abruptly deprescribed over safety concerns. Uncontrolled pain led to increased cocaine use, frequent ED visits, and recurrent hospitalizations for pain crises and risk of nosocomial infections.
Despite the need for palliative care in this unique patient population, the perceived risk of prescribing opioids is often viewed as too high by providers. As evidenced by this patient, pain management focused on harm reduction and patient retention philosophy may mitigate those risks. This presentation reviews clinical and social challenges in delivering palliative care to a cancer patient with active substance use disorder, and identify areas of future research, including methods of safe monitoring for high-risk patients requiring opioids for cancer-related pain.
Publication Date
5-8-2026
Recommended Citation
Leach E, Rauch G, Abraham J. Special considerations for treating pain in a patient with metastatic cancer and cocaine use disorder: A case report. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.
Comments
2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1874