Treatment of cancer pain in a former opioid abuser: Fears of the patient and staff and their influence on care

Abstract

A 48-yr-old man with an extensive history of polysubstance abuse (opioids, cocaine, amphetamines, and marijuana) presented with neck and shoulder pain associated with lung cancer. The history included intravenous heroin abuse from 18 to 36 years of age, at which time he entered a methadone maintenance program as part of a legal agreement to avoid imprisonment for selling heroin. During the next year, he stopped all drug abuse and subsequently withdrew from the methadone maintenance program. In the years that followed, he became professionally involved in social work programs with drug abusers, completed college, and married. At the time of presentation, he had been “drug-free,” except for cigarette smoking and social alcohol use for 12 years. The cancer was metastatic to bone at the time of diagnosis. There was destruction of the C6 and C7 vertebral bodies, paravertebral soft tissue