Cases Of Substance Use Disorders Research Articles

Deux cents ans d’histoire des usages et mésusages du protoxyde d’azote

Deux cents ans d’histoire des usages et mésusages du protoxyde d’azote

The Impact of Family Relations on a Sample of Egyptian Patients with Substance Use Disorder

Abstract Background Substance use disorders (SUD) present a complex condition characterized by uncontrolled substance use despite adverse consequences, often intertwined with social and family problems. Dysfunctional family relationships, including violence, stress, parental drug use, and poor communication, have been linked to adolescent drug use. The current study investigates the association between family relation dysfunction and substance use, aiming to understand the quality of this connection. Aim of the Work This case - control study aims to examine the relationship between family relations and substance use, assessing the impact on the type and severity of substance abuse. Specific objectives include exploring the association between family dysfunction and SUD, comparing family interaction in SUD patients and normal individuals, and evaluating variations in family interaction based on sociodemographic factors. Patients and Methods Seventy participants, comprising 35 SUD patients and 35 healthy controls, were recruited from EL-Abbsia Mental Health Hospital. Participants were assessed using socio- demographic data sheets, Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Quality of Family Relationships Scale (KOBI), and Addiction Severity Index. Urine tests were conducted for psychoactive substances. Statistical analysis involved various tests, including t-tests, Mann-Whitney, chi-square, and correlation analyses. Results The study revealed a significant prevalence of smoking among SUD patients compared to controls, along with longer smoking duration and higher daily cigarette consumption. SUD patients exhibited increased medical issues and higher incidences of substance use, particularly cannabis and heroin. Family rejection and non-acceptance were significantly higher in SUD cases, correlating with the severity and duration of substance abuse. Conclusion The findings underscore the significant connection between family relationship dysfunction and substance use. Rejection and non-acceptance within the family environment emerge as crucial predictors of addiction. The study highlights the need for comprehensive interventions addressing family dynamics in substance abuse treatment.

Structural instability and linear allocation control in generalized models of substance use disorder

Substance use disorder (SUD) is a complex disease involving nontrivial biological, psychological, environmental, and social factors. While many mathematical studies have proposed compartmental models for SUD, almost all of these exclusively model new cases as the result of an infectious process, neglecting any SUD that was primarily developed in social isolation. While these decisions were likely made to facilitate mathematical analysis, isolated SUD development is critical for the most common substances of abuse today, including opioid use disorder developed through prescription use and alcoholism developed primarily due to genetic factors or stress, depression, and other psychological factors. In this paper we will demonstrate that even a simple infectious disease model is structurally unstable with respect to a linear perturbation in the infection term — precisely the sort of term necessary to model SUD development in isolation. This implies that models of SUD which exclusively treat problematic substance use as an infectious disease will have misleading dynamics whenever a non-trivial rate of isolated SUD development exists in actuality. As we will show, linearly perturbed SUD models do not have a use disorder-free equilibrium. To investigate management strategies, we implement optimal control techniques with the goal of minimizing the number of SUD cases over time.

Multidimensional Nature of Substance Use Disorder: Explorations in Gangtok

ABSTRACT The study investigates the prevalence of substance use disorder and role of institutions in preventing it in Gangtok, a capital city of the northern Indian state of Sikkim. A survey of 816 respondents was undertaken using a short and easy-to-understand questionnaire. Results reveal that 64% of respondents identified persons with harmful drug use in their immediate families or in their neighborhoods and nearly same percentage of people conceal the actual cause of death in cases where death occurred due to drug overuse. The paper uncovers that cases of substance use disorder have increased and a considerable number of people are reported dying due to it, but families often hide the actual cause of death. The role of institutions is found to be limited in preventing it, as the process of knowledge transmission among families and patients with heavy drug use is abysmally slow. The study argues to empowering society with a potential tool, that is, knowledge transmission, and enabling them to devise meaningful tools to tackle rising cases of substance use disorder.

Impaired cognitive control moderates the relation between the attribution of incentive salience and severity of consumption in patients with methamphetamine dependence

BackgroundCognitive control and the attribution of incentive salience are two key neuropsychological processes proposed to explain substance use disorder (SUD). However, little is known about how they interact to influence the severity of drug use in people with SUD. ObjectiveTo determine if cognitive control exerts a moderating effect on the relation between the attribution of salience to drug/reward-related cues and the severity of drug use in SUD cases. MethodSixty-nine SUD cases with methamphetamine as the main drug of consumption were selected and evaluated. Participants performed the Stroop, Go/No-Go, and Flanker tasks to identify a latent cognitive control factor, and the Effort-Expenditure for Reward task, as well as answering the Methamphetamine Incentive Salience Questionnaire to measure the attribution of incentive salience. Severity of drug use was determined by the KMSK scale and an exploratory clinical interview. ResultsAs expected, higher incentive salience attribution predicted greater severity of methamphetamine use. Unexpectedly, however, we found a moderating effect of impaired cognitive control on the relations between higher incentive salience scores and higher monthly drug use, and between younger age at onset of systematic drug use and higher incentive salience scores. ConclusionResults show the moderating role of cognitive control on the relation between incentive salience attribution and severity of drug use in SUD cases, and help explain the chronic, relapsing nature of addiction, knowledge necessary to develop more precise prevention and treatment strategies.

Spectrum of Skin Dermatoses among Patients of Substance Use Disorder: A Hospital-based Study

Introduction: Various substances of abuse are known to cause specific cutaneous manifestations. Cutaneous manifestations are associated with the use of cocaine, methamphetamine, heroin, marijuana, alcohol, anabolic steroids, and general signs of drug abuse, including the stigmata of injection drug use, infectious complications, and vascular complications. However, the literature on the same is very limited from the Indian subcontinent. The purpose of the study is to find out various dermatoses in patients of substance use disorder.Materials and Methods: In the present study, 46 Diagnosed cases of substance use disorder as per the Diagnostic and statistical manual of mental disorder-5 (DSM-5)1 and confirmed by a qualified psychiatrist, were taken. The cutaneous examination was performed accordingly. Laboratory investigations were done as per need.Results: Mean age was 42.21 ± 16.64. The majority of the patients were illiterate (41.3%) and 26.1% were either graduate or postgraduate and 21.7% were high school pass and 6.5%were in middle school and the minority had primary school education (4.3%). The majority of the patients had complaints of raised lesions (56.5%) and followed by redness (23.9%), pain (19.6%), burning (13%) and oozing (13%) discomfort and flaking of skin (10.9%), rash (8.7%), light spots (6.5%) and fluid-filled lesions (4.3%).Conclusion: Few substances were associated with specific dermatoses. However, there is very little data, so this study will add upon the minuscule literature on this topic.

A qualitative analysis of internal medicine residents’ experience with substance use disorder education and training: a pilot study

Background Lack of education and training on caring for patients with substance use disorder (SUD) is common among healthcare providers, often resulting in clinicians feeling unprepared to treat patients with SUD. Objectives This study explored resident physicians’ experiences with SUD education throughout medical school and residency and qualitatively evaluated whether a SUD initiative improved resident’s knowledge and efficacy of treating various SUDs. Methods We implemented a brief (seven hours total) educational initiative focused on treating SUDs virtually over the course of an academic year for residents enrolled in the University of Southern California Internal Medicine Residency program. Semi-structured interviews were conducted with residents after completion of the initiative. A thematic analysis was conducted to identify common themes that emerged from the qualitative data. Results Every resident noted receiving insufficient training for the treatment of SUDs prior to the initiative. The initiative was viewed favorably, and participants particularly appreciated having an introduction to prescribing medication for the treatment of SUD such as buprenorphine. Despite the perceived success of the initiative in increasing awareness of treatment modalities for SUD, residents expressed a lack of comfort in handling SUD cases and desired additional practical lectures and application of knowledge through increased experiential training. Conclusions SUD education and training appears to be a useful constituent of resident training and should be included in the standard curriculum and rotations. Residency programs should consider including formal education, hands-on practice, and providing adequate resources for residents to develop their capabilities to care for patients with SUD.

Change in attitude and help-seeking pattern of caregivers and patients with mental disorders in the community - Recent findings from India.

The researchers utilised a cross-sectional study design. A face-to-face interview was used to collect data using the WHO Encounter Form. Using a successive sample technique, patients with various diagnoses of mental illness undergoing Psychiatry outpatient therapy at a tertiary care medical college were included in the study. In terms of gender, ladies (53.3%) were seen to use psychiatric services more than males (46.7%) from an urban or semi-urban background. For dissociative disorders, the median time from onset to first contact with a care provider was 0.1 years; 0.3 years for mood episodes; 0.6 years for anxiety disorders; one year for psychotic disorders; and seven years for Substance Use Disorders (SUD). However, interaction with current psychiatric services took an average of six months for dissociation; 3.5 years for mood disorders; three years for anxiety disorders; six years for psychotic disorders; and a maximum of seventeen years for SUD. Participants in the study who had a family history of mental illness sought care more quickly (OR = 4.3, 95 percent CI 1.19 to 7.11, P = 0.03). The fact that 73 percent of patients have a GP or mental health professional as their first point of contact for various mental diseases is good. Higher education status, urban background, dwelling closer to the mental health centre, and having a biological attribution model for psychological illness were the other clinical and demographic characteristics important for quicker paths to mental health treatment. In most cases of psychosis and SUD (substance use disorders), there is still a significant delay in receiving modern psychiatric therapy. The number of initial contacts with Native Healers ha s decreased. The majority of people said mental illness was caused by environmental or biological factors. Education and scientific information regarding mental health have aided the process of seeking treatment, and there should be a provision of training programmes for family physicians and community health professionals to facilitate the process of help-seeking behavior of psychiatric patients in the Indian subcontinent.

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Background:Substance use disorder (SUD) is a global public health concern. National Mental Health Survey 2015-2016 brought out that 22.4% of adult Indian population was addicted to psychoactive substances A study by Raju et al estimated 15.53 % prevalence of Alcohol Use Disorder (AUD) cases amongst all psychiatric admissions in a year. Keeping in view, the relapsing nature of substance use disorder cases conflicting with the organisational requirements of having “combat-fit” armed forces, there was a necessity of having specialised centres for providing a well-structured de-addiction therapy to difficult cases.Aim:To highlight the journey of establishment of the first De-Addiction Centre (DAC) of Indian Army and its achievements.Development of a De-addiction Centre: In Nov 2017, under aegis of Director General of Medical Services (Army), the inception of 50 bedded DAC at Base Hospital, Barrackpore occurred. A dedicated de-addiction team was ear-marked, headed by a specialist in Addiction Psychiatry. A batch wise, six- week duration, structured de-addiction course was charted out for difficult to treat serving SUD cases posted in the Eastern sector of Indian Army. It was divided into 3 phases – Evaluation (1 week), De-addiction phase (04 weeks) and Post treatment protocol (1 week). The first structured de-addiction course commenced in Sep 2018.Results:10 batches with total of 345 patients have received benefit of de-addiction therapy. 94% of these were AUD cases, 4% cannabis and 2% were addicted to opioids. On the basis of feedback received from units, 58.4% were reported to be completely abstinent, 16.7% occasionally drinking with satisfactory vocational performance, 13.9 % had relapsed into substance use and 11 % were lost to follow up.Conclusion:The humble beginning of this DAC is in the process of growth wherein a lot still needs to be achieved in terms of building “state of art” SUD Laboratory harbouring specialised equipment for diagnostic and therapeutic purpose and initiate teaching and training curriculum in addiction psychiatry for Post Graduate residents, medical officers and paramedics.

The Relationship between Different Amounts of Physical Exercise, Internal Inhibition, and Drug Craving in Individuals with Substance-Use Disorders.

Purpose: To explore the relationship between different amounts of physical exercise and drug craving in individuals with substance-use disorders (SUD), and to reveal the mediating role of internal inhibition between physical activity and drug craving. Method: This study adopted the Physical Activity Rating Scale, Internal Inhibition Scale, and Drug Craving Scale to assess 438 cases of SUD in a compulsory isolation detoxification center in southwest China. Results: (1) The amount of physical exercise individuals with SUD engaged in was positively correlated with internal inhibition and negatively correlated with drug craving, while the amount of physical exercise was negatively correlated with drug craving. (2) The amount of physical exercise was able to negatively predict drug craving in addicts, the amount of physical exercise and internal inhibition were able to jointly predict drug craving, and internal inhibition played a mediating role between the amount of physical exercise and drug craving (the mediating effect was 0.22). (3) There was a dose-effect relationship regarding different amounts of physical exercises and drug craving. Internal inhibition did not mediate between a low amount of physical exercise and drug craving, it played a partial mediating role between a moderate amount of physical exercise and drug craving (the mediating effect was −0.19), and it played a partial mediating role between a high amount of physical exercise and drug craving (the mediating effect was −0.15). Conclusions: Physical activity has a positive effect on reducing drug craving in individuals with SUD. Moreover, in the process of sports rehabilitation for SUD, medium or high amounts of physical activity were required in order to effectively reduce and alleviate drug cravings.

Strong and weak cross-inheritance of substance use disorders in a nationally representative sample.

Substance use disorders (SUDs) are moderately to highly heritable and are in part cross-transmitted genetically, as observed in twin and family studies. We performed exome-focused genotyping to examine the cross-transmission of four SUDs: alcohol use disorder (AUD, n = 4487); nicotine use disorder (NUD, n = 4394); cannabis use disorder (CUD, n = 954); and nonmedical prescription opioid use disorder (NMPOUD, n = 346) within a large nationally representative sample (n = 36,309), the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). All diagnoses were based on in-person structured psychiatric interview (AUDADIS-5). SUD cases were compared alone and together to 3959 "super controls" who had neither a SUD nor a psychiatric disorder using an exome-focused array assaying 363,496 SNPs, yielding a representative view of within-disorder and cross-disorder genetic influences on SUDs. The 29 top susceptibility genes for one or more SUDs overlapped highly with genes previously implicated by GWAS of SUD. Polygenic scores (PGS) were computed within the European ancestry (EA) component of the sample (n = 12,505) using summary statistics from each of four clinically distinct SUDs compared to the 3959 "super controls" but then used for two distinctly different purposes: to predict SUD severity (mild, moderate, or severe) and to predict each of the other 3 SUDs. Our findings based on PGS highlight shared and unshared genetic contributions to the pathogenesis of SUDs, confirming the strong cross-inheritance of AUD and NUD as well as the distinctiveness of inheritance of opioid use disorder.

Attitude of Health Care Professionals Toward Patients With Substance Use Disorders

Objectives: Substance use disorder (SUD) is a chronic relapsing disease with multiple general health and behavior deterioration making it vulnerable to discrimination. As health care professionals play a crucial role in the identification and feasibility of access to treatment of such patients, negative attitudes can reduce the quality of the medical service provided. The purpose of our study is to measure and compare stigma variables toward SUDs among different professions of the health care staff. Patients and Methods: In all, 300 participants were enrolled in the study distributed equally into physicians from different specialties, nurses, clerical work employees, manual workers, and early career medical interns. A predesigned semistructured sheet was used to screen the occupation, previous contact SUD cases, family history of substance use problems; they also answered the general health questionnaire, and 4 scales concerning the attitude toward addicts including the level of familiarity, perceived dangerousness, and fear, social distance scales. Results: Women showed higher perceived dangerousness and desired social distance from polysubstance use disorder than men. Social distance was significantly more away from polysubstance in staff below the age of 30 years, and from alcohol in the group above 30 years. The level of familiarity with and a desired social distance away from polysubstance abuse among physicians were significant. There was a highly significant fear of benzodiazepine, tramadol, and polysubstance among physicians. Perceived dangerousness for polysubstance among physicians was significantly evident as well as for alcohol among manual workers, for benzodiazepine among house officers, and for heroin among clerical workers. Conclusion: Stigma of medical field professionals toward patients with SUDs is common and may contribute to underqualified health care service for these patients, which mandates dissemination of model educational programs starting from college medical curricula to postgraduate ones.

Addiction Medicine After COVID-19: The Imperative of a Trained Workforce

Addiction Medicine After COVID-19: The Imperative of a Trained Workforce

Acceptance of e-consult for Substance Use Disorders during the COVID 19 pandemic: A study from India.

The COVID 19 pandemic has created challenges in providing timely care for patients and families with Substance Use disorders (SUDs). With the difficulties in face-to-face consultations because of social distancing measures, telepsychiatry services can be beneficial. The study proposes implementing an e-consult for SUD management and measuring its acceptability among the health care providers (HCPs) in India. The mobile-based e-consult for SUD, connecting HCPs with addiction specialists, was implemented during the COVID lockdown period in India from 25 March to 31 May (71 days). A total of 153 HCPs, i.e., doctors, nurses, counselors, consulted for 110 cases of SUD. Sixty-eight provided feedback by filling the survey form derived from the Service User Technology Acceptability Questionnaire (SUTAQ). More than 60% of HCPs reported overall high satisfaction. More than 98% providers reported high acceptability concerning"access to specialist care," "trusted to work appropriately", "saving time," "would like torecommend to others," easier to get touch with a specialist." The doctors reported significantly high acceptability about "access to specialist care," "satisfied with recommendations,"recommend to others" compared to other HCPs. During COVID 19 pandemic lockdown in India, e-consult was an acceptable tool in managing SUDs. The majority of HCPs could discuss their cases with addiction experts. There is a need to expand this further in other mental health conditions.

Treatment Seeking Pattern of Relapse Cases of Substance Use Disorder in Bangladesh

Background & objective: Despite the high prevalence and numerous adverse health consequences, manyindividual with substance uses don’t seek proper treatment. Therefore, this study was aimed to explore thetreatment seeking pattern of relapse cases of substance use disorder in Bangladesh.Method: Cross-sectional study was conducted among 911 relapse cases from all over Bangladesh duringJanuary to December 2018. Data were analyzed by SPSS v 23. Descriptive statistics were performed andresults were expressed by number and percentage.Results: Majority (48.0%) of the substance users were young adult (19-30 years). Most of them werebusinessman (35.0%) or unemployed (29.7%) and lived with family (96.3%). In multiple response, 70.0%of them received money to purchase drug from parents and 56.1% their own. 70.0% of relapse cases cameto treatment center unwillingly and mostly with family (63.2%) and majority (98.9%) received residentialtreatment. Individual (68.4%) and group counseling (61.3%), psycho-social session (50.5%), life-skillsession (48.0%), medical treatment (45.9%), family counseling (36.6%) and couple counseling (11.1%)was treatment approaches. Detoxification and rehabilitation alone or combination was most commonrehabilitation.Conclusion: Combination of treatment is common in Bangladesh for relapse cases of substance use disorder.Long term follow up is needed to see the ultimate outcome.

Case Study: Naltrexone for the Treatment of Nitrous Oxide Use

Using a clinical case example, we describe and discuss the use of oral naltrexone as a novel treatment strategy for nitrous oxide use. Nitrous oxide is an inhalant drug that is readily available and legally obtained. Though frequency of reported cases of substance use disorder for nitrous oxide is low, previous case reports have described severe neurological and psychiatric harms associated with chronic use. Despite this, evidence for pharmacotherapy is currently lacking. Clinical studies have shown variable efficacy for naltrexone across a number of substances including alcohol, nicotine, and stimulants. We present here a case of a 41-year-old man with a substance use disorder for nitrous oxide who was reportedly using of up to four hundred 8 g canisters of nitrous oxide per day. Oral naltrexone was initiated at 50 mg daily in an attempt to decrease cravings. The dose was subsequently titrated to 100 mg daily, resulting in a decrease in nitrous oxide use to less than sixty 8 g canisters per week over a 1-month timeframe. Previous literature surrounding naltrexone provides both a plausible mechanism of action for craving reduction as well as a precedent for its use across a number of substances. To our knowledge, use of naltrexone for nitrous oxide use has not been previously described. While clinical studies are currently lacking, this case highlights naltrexone as a possible treatment strategy for nitrous oxide use, with potential to reduce significant harms associated with chronic use.

Covid-19 Impact on Mental Health of Egyptians Patients

The current study is aimed to examine the rates of mental disorders in a sample of Egyptian patients due to environmental factors associated with the COVID-19 pandemic crisis which interacted with the historical and religious background of the Egyptian people. The research was performed in four different districts in Cairo and Giza before and during the outbreak of a pandemic. The Control group consisted of 1600 patients and extended from the first of October till the end of December 2019. The experimental group consisted of 1200 patients during the first four months of 2020. Mood disorders were the main psychiatric disorders that appeared during this period in the form of depression and anxiety disorders. Also, the cases of substance use disorder (SUD) and obsessive-compulsive disorders (OCD) were presented more in psychiatric clinics. The percentage of male patients was slightly higher in depressive cases, while it was significantly higher in SUD cases. On the other hand, the percentage of female patients was a little higher in anxiety disorders and OCD cases. The percentage of SUD cases was significantly higher among highly educated patients and also in OCD cases. Medium educated patients presented with depression and anxiety disorders were slightly higher than high educated patients and significantly higher than low educated ones.

Cross-national patterns of substance use disorder treatment and associations with mental disorder comorbidity in the WHO World Mental Health Surveys.

To examine cross-national patterns of 12-month substance use disorder (SUD) treatment and minimally adequate treatment (MAT), and associations with mental disorder comorbidity. Cross-sectional, representative household surveys. Twenty-seven surveys from 25 countries of the WHO World Mental Health Survey Initiative. A total of 2446 people with past-year DSM-IV SUD diagnoses (alcohol or illicit drug abuse and dependence). Outcomes were SUD treatment, defined as having either received professional treatment or attended a self-help group for substance-related problems in the past 12months, and MAT, defined as having either four or more SUD treatment visits to a health-care professional, six or more visits to a non-health-care professional or being in ongoing treatment at the time of interview. Covariates were mental disorder comorbidity and several socio-economic characteristics. Pooled estimates reflect country sample sizes rather than population sizes. Of respondents with past-year SUD, 11.0% [standard error (SE)=0.8] received past 12-month SUD treatment. SUD treatment was more common among people with comorbid mental disorders than with pure SUDs (18.1%, SE=1.6 versus 6.8%, SE=0.7), as was MAT (84.0%, SE=2.5 versus 68.3%, SE=3.8) and treatment by health-care professionals (88.9%, SE=1.9 versus 78.8%, SE=3.0) among treated SUD cases. Adjusting for socio-economic characteristics, mental disorder comorbidity doubled the odds of SUD treatment [odds ratio (OR)=2.34; 95% confidence interval (CI)=1.71-3.20], MAT among SUD cases (OR=2.75; 95% CI=1.90-3.97) and MAT among treated cases (OR=2.48; 95% CI=1.23-5.02). Patterns were similar within country income groups, although the proportions receiving SUD treatment and MAT were higher in high- than low-/middle-income countries. Few people with past-year substance use disorders receive adequate 12-month substance use disorder treatment, even when comorbid with a mental disorder. This is largely due to the low proportion of people receiving any substance use disorder treatment, as the proportion of patients whose treatment is at least minimally adequate is high.

The TCU drug screen 5: Identifying justice-involved individuals with substance use disorders

The TCU Drug Screen II, a widely used instrument for identifying substance use problems, was originally developed based on Diagnostic and Statistical Manual of Mental Disorders III-R criteria. In 2013, the American Psychiatric Association revised the criteria and classification scheme for substance use disorders (SUDs) with the publication of the DSM-5. Subsequently, the TCU Drug Screen was modified to reflect the updated DSM-5. The current study examines the concordance of the TCU Drug Screen II and TCU Drug Screen 5 with adult and juvenile justice-involved samples. Both versions were administered to 305 adult male and 310 juvenile male justice-involved clients as part of standard intake procedures. Results revealed a high level of agreement between the two versions; however, the TCU Drug Screen 5 detected significantly more cases of SUDs, the majority of which corresponded to a mild SUD. Results documented appropriate discrimination in meeting diagnostic thresholds among both age groups, with fewer adolescents identified as having a disorder. Overall, the results suggest that the TCU Drug Screen 5 is comparable to the TCU Drug Screen II with the added potential benefit of DSM-5 conformity and severity specifiers.

Cancer pain management and the opioid crisis in America: How to preserve hard-earned gains in improving the quality of cancer pain management.

Cancer pain remains a feared consequence of the disease and its treatment. Although prevalent, cancer pain can usually be managed through the skillful application of pharmacologic and nonpharmacologic interventions. Unfortunately, access to these therapies has been hampered by interventions designed to contain another serious public health problem: the opioid misuse epidemic. This epidemic and the unintended consequences of efforts to control this outbreak are leading to significant barriers to the provision of cancer pain relief. Oncologists and other professionals treating those with cancer pain will require new knowledge and tools to provide safe and effective pain control while preventing additional cases of substance use disorders (SUDs), helping patients in recovery to maintain sobriety, and guiding those not yet in recovery to seek treatment. How do these 2 serious epidemics intersect and affect oncology practice? First, oncology professionals will need to adopt practices to prevent SUDs by assessing risk and providing safe pain care. Second, oncology practices are likely to see an increased number of patients with a current or past SUD, including opioid misuse. Few guidelines exist for the direct management of pain when opioids may be indicated in these individuals. Third, modified prescribing practices along with the education of patients and families are warranted to prevent the exposure of these medications to unintended persons. Finally, advocacy on behalf of those with cancer pain is imperative to avoid losing access to essential therapies, including opioids, for those who might benefit. Cancer 2018;124:2491-7. © 2018 American Cancer Society.