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Clin J Pain. 2002 Jul-Aug;18(4 Suppl):S99-107.

Ethical perspectives: opioid treatment of chronic pain in the context of addiction.

Author information

  • 1Pain Medicine Program, Department of Psychiatry and Human Behavior, Jefferson Medical College, Philadelphia, Pennsylvania 19107-4414, USA. Mitchell.J.Cohen@mail.tju.edu


The authors apply eight ethical domains of analysis to the question of treatment of chronic pain with opioids in patients with histories of substance use disorders: autonomy, nonmaleficence, beneficence, justice, medical condition, patient preference, quality of life, and consideration of specific individual or sociocultural issues. These eight domains are drawn from principle-based and case-based ethical perspectives. The domains are developed by review of available literature and through application to a specific presented case. Factors that interfere with rational, ethical decision-making regarding opioid pain management are identified. Chronic pain and substance use disorders share a history of stigmatization, underdiagnosis, and undertreatment. Using the presented case as a point of departure, the authors discuss principles for prescription of opioids for treatment of chronic noncancer pain in the setting of history of substance use disorders.

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