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

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.

Fig. 1.

SWOT analysis prior to initiation of PHRR clinic.

Fig. 2.

Monthly completed patient encounters September 2020-Februrary 2022 ^aTelemedicine visits were offered for established patients. ^bClinic grew from ½ day per week for full day to accommodate more patients. ^cClinic grew to 1.5 days per week.