Trust violated: analgesics for addicts.
Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery that provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. Addiction among cancer patients on strong analgesics is a rare but difficult management challenge. The case is presented of a 28-year-old woman with breast cancer and painful bone metastases, suffering with dysfunctional social chaos and addicted to Percocet (oxycodone and acetaminophen). Having broken the trust of her health care team, trust was rebuilt by incorporating the substance abuse clinic and enforcing a contractual agreement. With open and honest support, the team was able to both care for and empower the patient. Issues of trust, liability, opioid tolerance, and barriers to optimal analgesia for cancer pain are discussed.
Penson
Richard T
RT
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114-2617, USA. rpenson@partners.org
Nunn
Catherine
C
Younger
Jerry
J
Schaeffer
Nancy J
NJ
Chabner
Bruce A
BA
Fricchione
Gregory L
GL
Quinn
Thomas E
TE
Lynch
Thomas J
TJ
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000523:psychology / Q000556:secondary; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000523:psychology*; D002055:Burnout, Professional; D003657:Decision Making; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000523:psychology / Q000556:secondary; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000523:psychology; D010817:Physician-Patient Relations; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy / Q000523:psychology; D013315:Stress, Psychological; D019966:Substance-Related Disorders / Q000209:etiology / Q000523:psychology; D035502:Trust / Q000523:psychology*
D000701:Analgesics, Opioid