Managing pain in patients with disorders of substance use in palliative care

Managing pain in patients with palliative care needs who have disorders of substance use is complex; seek early advice from a specialist palliative care service. Advice on managing disorders of substance use is available from drug and alcohol services by phone; contact details are available in Clinician resources for substance use and addictive behaviours.

Note: Seek early advice from a specialist palliative care service when managing pain in patients with disorders of substance use.

Take a nonjudgmental, flexible and compassionate approach when working with patients with disorders of substance use, based on trauma-informed care and awareness of stigma as a barrier to accessing treatment.

If a patient starts displaying drug-seeking behaviour, review their pain management and consider whether analgesic therapy could be suboptimal—see Key questions to assess poor response to pain management in palliative care for key questions to assess poor response to pain management.

Do not withhold analgesics (including opioids) when needed for effective pain management in patients with disorders of substance use. However, consider strategies to support adherence (eg defined intervals between prescription requests or dispensing, more frequent prescribing of smaller doses of opioid). Consider the principles of written opioid agreements in the Pain and Analgesia guidelines. For information on prescribing in disorders of substance use, including real-time prescription monitoring, see Legal considerations in prescribing in substance use.

The Pain and Analgesia guidelines provide advice on managing acute pain in the following patient groups that can be used to inform pain management in palliative care: