Cancer Pain and Addiction ? Managing a Dual Diagnosis

In this manuscript, we present a series of four patients treated for cancer pain, all of whom had prior or concurrent substance use disorders. We describe our clinical experience creatively balancing pain relief with harm reduction for at-risk patients and introduce three strategies to augment the ‘universal precautions' for opioid prescribing. This manuscript illustrates the need for establishing an external structure, utilizing the skills of the entire care team and practicing meticulous inter- and intra-team communication when caring for these patients. By utilizing the entire team and its associated resources, including consultation with colleagues in addiction medicine, we demonstrate strategies for successfully treating cancer pain in patients with substance use disorders.