Creating a Palliative Care Clinic for Patients with Cancer Pain and Substance Use Disorder

Sachin S Kale; Gennaro Di Tosto; Laura J Rush; Justin Kullgren; Deborah Russell; Martin Fried; Blessing Igboeli; Julie Teater; Katie Fitzgerald Jones; Devon K Check; Jessica Merlin; Ann Scheck McAlearney

doi:10.1016/j.jpainsymman.2024.04.011

Creating a Palliative Care Clinic for Patients with Cancer Pain and Substance Use Disorder

J Pain Symptom Manage. 2024 Apr 25:S0885-3924(24)00720-6. doi: 10.1016/j.jpainsymman.2024.04.011. Online ahead of print.

Authors

Affiliations

¹ Division of Palliative Medicine(S.S.K., J.K., D.R.), The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. Electronic address: Sachin.kale@osumc.edu.
² Center for the Advancement of Team Science(G.D.T., L.J.R., A.S.M.), Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA.
³ Division of Palliative Medicine(S.S.K., J.K., D.R.), The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
⁴ Division of General Internal Medicine(M.F.), The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
⁵ Department of Psychiatry and Behavioral Health(B.I., J.T.), The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
⁶ New England Geriatrics Research(K.F.J.), Education, and Clinical Center (GRECC), VA Boston Healthcare System, Jamaica Plain, Massachussetts, USA.
⁷ Department of Population Health Sciences(D.K.C.), Duke University School of Medicine, Durham, North Carolina, USA.
⁸ CHAllenges in Managing and Preventing Pain (CHAMPP) clinical research center(J.M.), Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
⁹ Center for the Advancement of Team Science(G.D.T., L.J.R., A.S.M.), Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA; Department of Family and Community Medicine(A.S.M.), College of Medicine, The Ohio State University, Columbus, Ohio, USA.

PMID: 38670295
DOI: 10.1016/j.jpainsymman.2024.04.011

Abstract

Background: Opioids are a first-line treatment for severe cancer pain. However, clinicians may be reluctant to prescribe opioids for patients with concurrent substance use disorders (SUD) or clinical concerns about non-prescribed substance use.

Measures: Patient volume, 60-day retention rate, and use of sublingual buprenorphine to treat opioid use disorder.

Intervention: We created the Palliative Harm Reduction and Resiliency Clinic, a palliative care clinic founded on harm reduction principles and including formal collaboration with addiction psychiatry.

Outcomes: During the first 18 months, patient volume increased steadily; 70% of patients had at least one subsequent visit within 60 days of the initial appointment; and buprenorphine was prescribed for 55% of patients with opioid use disorder.

Conclusions/lessons learned: The formal collaboration with addiction psychiatry and the integration of harm reduction principles and practices into ambulatory palliative care improved our ability to provide treatment to a previously underserved patient population with high symptom burden.

Keywords: Cancer pain; Harm reduction; Opioid use disorder; Palliative care; Quality improvement; Substance use disorder.