title: Ethical perspectives: opioid treatment of chronic pain in the context of addiction.
abstract: The authors apply eight ethical domains of analysis to the question of treatment of chronic pain with opioids in patients with histories of substance use disorders: autonomy, nonmaleficence, beneficence, justice, medical condition, patient preference, quality of life, and consideration of specific individual or sociocultural issues. These eight domains are drawn from principle-based and case-based ethical perspectives. The domains are developed by review of available literature and through application to a specific presented case. Factors that interfere with rational, ethical decision-making regarding opioid pain management are identified. Chronic pain and substance use disorders share a history of stigmatization, underdiagnosis, and undertreatment. Using the presented case as a point of departure, the authors discuss principles for prescription of opioids for treatment of chronic noncancer pain in the setting of history of substance use disorders.
authors.affiliation: Pain Medicine Program, Department of Psychiatry and Human Behavior, Jefferson Medical College, Philadelphia, Pennsylvania 19107-4414, USA. Mitchell.J.Cohen@mail.tju.edu
authors.forename: Mitchell J M
authors.initials: MJ
authors.lastname: Cohen
authors.forename: Samar
authors.initials: S
authors.lastname: Jasser
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Herron
authors.forename: Clorinda G
authors.initials: CG
authors.lastname: Margolis
mesh_terms: D002908:Chronic Disease; D015510:Clinical Medicine; D003657:Decision Making / Q000941:ethics; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy; D034723:Double Effect Principle; D004992:Ethics, Medical; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D009293:Opioid-Related Disorders / Q000209:etiology*; D010146:Pain / Q000150:complications / Q000188:drug therapy*; D026684:Personal Autonomy; D028662:Principle-Based Ethics
chemical_list: D009294:Narcotics