ETHICS OF MEDICAL MANAGEMENT OF CHRONIC PAIN IN PATIENTS WITH SUBSTANCE USE DISORDER

Substance use disorder has increasingly become a public health concern as the opioid crisis has become more prevalent in the last decade. For this reason, increased caution has been exerted by providers when prescribing medication for pain management. The opioid crisis has become particularly prevalent in the city of Philadelphia, where rates of overdose and drug-related fatalities have exceeded those around the nation. Treatment of pain becomes complex when we consider that many individuals with substance use disorder also experience some form of chronic pain. Pain management alone is complex and often multifaceted, thus, treating pain in patients with substance use disorder is no easy feat. The following paper reviews the literature regarding epidemiology of substance use disorder and chronic pain, reports of comorbidity between the two conditions, current regulations for management of chronic pain, and the role of socioeconomic disparities between both diagnoses. The literature revealed high rates of comorbidity between substance use disorder and chronic pain, with many patients endorsing intractable pain as a primary contributor to their early use of illicit substances. Furthermore, substance use disorder is more prevalent among patients from lower income backgrounds and those who have public health insurance. Prior studies have also found that racial and ethnic minority patients are less likely to receive adequate pain management. This work then explores patterns in treatment of patients with comorbid substance use disorder and chronic pain from a bioethical lens. This paper will argue in favor of the necessity to treat pain in the substance use disorder patient population, and will highlight bioethical concerns in failing to attempt to control these patients’ pain.