Ethical perspectives: opioid treatment of chronic pain in the context of addiction

• Published in: The Clinical journal of pain Vol. 18; no. 4 Suppl; p. S99
• Main Authors: Cohen, Mitchell J M, Jasser, Samar, Herron, Patrick D, Margolis, Clorinda G
• Format: Journal Article
• Language: English
• Published: United States 01.07.2002
• Subjects: Chronic Disease; Clinical Medicine; Decision Making - ethics; Diabetes Complications; Diabetes Mellitus - drug therapy; Double Effect Principle; Ethics, Medical; Humans; Male; Middle Aged; Narcotics - therapeutic use; Neoplasms - complications; Neoplasms - drug therapy; Opioid-Related Disorders - etiology; Pain - complications; Pain - drug therapy; Personal Autonomy; Principle-Based Ethics; Professional Patient Relationship
• DOI: 10.1097/00002508-200207001-00012
• ISSN: 0749-8047

The authors apply eight ethical domains of analysis to the question of treatment of chronic pain with opioids in patients with histories of substance use disorders: autonomy, nonmaleficence, beneficence, justice, medical condition, patient preference, quality of life, and consideration of specific individual or sociocultural issues. These eight domains are drawn from principle-based and case-based ethical perspectives. The domains are developed by review of available literature and through application to a specific presented case. Factors that interfere with rational, ethical decision-making regarding opioid pain management are identified. Chronic pain and substance use disorders share a history of stigmatization, underdiagnosis, and undertreatment. Using the presented case as a point of departure, the authors discuss principles for prescription of opioids for treatment of chronic noncancer pain in the setting of history of substance use disorders.