Opioids, if they are appropriate, should not be withheld from patients with pain who also have addictive disease (May, White, Leonard-White, Warltier, & Pagel, 2001; Mitra & Sinatra, 2004; Oliver et al., 2012). The acute setting is not the optimal time to attempt detoxification or rehabilitation of a patient who is abusing opioids or other substances (Mitra & Sinatra, 2004). Clinicians often fear that by providing opioids for pain they are feeding the addiction; however, no research shows that providing opioid analgesics to a person with addictive disease will worsen the disease. Conversely, there is no research to show that withholding opioid analgesics when needed will increase the likelihood of recovery (Compton, 1999). In fact, withholding opioids in this situation may cause significant pain, increasing the patient’s level of stress, and may lead to increased craving for drugs of abuse. The patient may make efforts to obtain the drug that has been abused, or a patient in recovery may relapse. In the inpatient setting, the patient may make efforts to bring in illicit drugs. Clearly, on many levels, providing pain relief to the patient with addictive disease, even when it includes opioids, is preferable to withholding opioids (Pasero, Quinn, Portenoy, McCaffery, & Rizos, 2011).
An excellent resource for pain management in the patient with pain and addictive disease was developed by the American Society for Pain Management Nursing: ASPMN Position Statement: Pain Management in Patients with Substance Use Disorders (Oliver et al., 2012) available at http://www.aspmn.org. It covers patients actively abusing substances, patients in recovery, and those receiving medical management for opioid addictive disease. The ASPMN paper states that “every patient with pain, including those with substance abuse disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management” (Oliver et al., 2012, p. 169).