How Does One Approach the Patient With an Opioid Use Disorder?

The intersection between opioid misuse, opioid use disorder (OUD), pain, and serious illness is only projected to grow in the context of the ongoing overdose epidemic, earlier palliative care referral, and increasing advances in cancer treatment and survival. Thus a knowledgeable approach to the patient with suspected opioid misuse or OUD has become an essential skill in modern palliative care practice. This chapter provides a brief overview of the chronic brain disease of addiction, reviews DSM-5 criteria for diagnosing OUD, summarizes evidence-based treatments in OUD including buprenorphine and methadone, discusses approaches to patients with OUD and palliative care needs, and describes how to develop a treatment plan for pain by assessing and balancing a patient’s pain, prognosis, and properties of the patient’s OUD (disease severity and activity).