Chronic pain, mental health and substance use disorders: How can we manage this triad in our healthcare system and in our communities?

Abstract

e use of opioid analgesics for the treatment of chronic non-cancer pain has become a topic of intense debate in the medical community. Over the last decade there has been a signi�耀cant rise in the morbidity and mortality associated with the use of these medications. In patients with mental health and substance use disorders, prescribing opioid analgesics for chronic non-cancer pain is perhaps even more challenging. De�耀cits in training for clinicians, together with a lack of clinical guidelines, make the management of these patients even more difficult. �怀is article serves to provide insight into the clinical management of these patients based on personal experience as well as current established guidelines. It also highlights some of the roles that we can play to help manage this societal problem. As a physician practicing in the �耀eld of pain medicine, I am charged with the daily responsibility of caring for people with chronic, severe pain conditions who are also living with substance use and mental health disorders. Providing safe and effective care for these people is challenging at best. Prescription opioid analgesics are commonly used to treat moderate to severe chronic pain in this patient population. With the prevalence of prescription opioid abuse, and the degree of morbidity and mortality caused by this problem ,, the medical community is now trying to 123