Special Considerations for Treating Pain in a Patient with Metastatic Cancer and Cocaine Use Disorder: A Case Report

Document Type

Conference Proceeding

Publication Date

6-2026

Publication Title

Journal of Pain and Symptom Management

Abstract

Ms. Z 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. She was referred by her initial palliative team to a palliative and addiction specialist at another clinic. There, she was prescribed a buprenorphine patch with hydrocodone as needed for breakthrough pain. A medication contract was signed, and harm reduction methods were employed which included more frequent clinic appointments, serial urine drug screens, telephone symptom assessments, pill counts, and weekly prescriptions. She was prescribed a Narcan kit and provided with fentanyl testing strips. The palliative clinic interdisciplinary team assisted the patient with developing healthier coping strategies for living with life-limiting illness, as well as housing resources for the patient’s housing insecurity. Ultimately, the patient experienced improved pain control, reduced hospital visits, and decreased cocaine use. 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 (5). As evidenced by this patient, pain management focused on harm reduction and patient retention philosophy may mitigate those risks. This presentation will review clinical and social challenges in delivering palliative care to a cancer patient with active substance use disorder, and aims to identify areas of future research, including methods of safe monitoring for high-risk patients requiring opioids for cancer-related pain.

Volume

71

Issue

6

First Page

e1185

Last Page

e1186

Comments

Annual Assembly of Hospice and Palliative Care, March 4-7, 2026, San Diego, CA

DOI

10.1016/j.jpainsymman.2026.04.529

ISSN

0885-3924

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