title: Trust violated: analgesics for addicts.
abstract: 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.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114-2617, USA. rpenson@partners.org
authors.forename: Richard T
authors.initials: RT
authors.lastname: Penson
authors.forename: Catherine
authors.initials: C
authors.lastname: Nunn
authors.forename: Jerry
authors.initials: J
authors.lastname: Younger
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Schaeffer
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Chabner
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Fricchione
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Quinn
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Lynch
mesh_terms: 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*
chemical_list: D000701:Analgesics, Opioid