Substance abuse issues in oncology: What the ED professional needs to know

Abstract

Historically, problems related to the prevalence and impact of substance use disorders of all kinds have been underestimated in psych-oncology. This is ironic, because if one practices outside the confines of the tertiary care academic medical center, the rate of SUDs that is likely to be encountered is shockingly high. And the impact of unchecked substance and alcohol abuse on adherence with potentially lifesaving and life-extending cancer treatments can be among the most profound of any psychiatric comorbidity emergency department physicians are likely to confront. The growing problem of prescription drug abuse has shined a light on the need for the application of addiction medicine techniques and interventions when opioids are used in people with pain in general, and now that the differences between the treatment of cancer and non-cancer pain are narrowing, oncologic professionals need to learn to employ strategies learned from colleagues working in the field of chronic pain. And pain and symptom management are hardly the only areas of oncology affected by SUD. Yet, members of virtually every discipline of providers working in oncology lack specific training in the addictions, and so there is an enormous gap between the prevalence of these problems and the expertise available to assist these patients. It is hoped this chapter will help to begin to fill this gap.