ABSTRACT
Substance abuse disorder (SUD) can affect all dimensions of palliative care; therefore, appropriate identification is important to allow the consideration of support and management options. For palliative care providers who manage patients who have transitioned to cancer survivorship, there may be additional challenges in creating a long-term pain management plan in the setting of comorbid SUD. As with much of medicine, the definition of SUD is evolving. In the update from the DSM IV to the DSM 5, the definitions of substance abuse and substance dependence were merged into a new term of SUD, which was then clarified into severity depending on the number of criteria met. The actual use of screening tools in palliative care is unfortunately low, perhaps in part due to a lack of guidelines for opioid prescribing among people with SUD or alcohol abuse. Technology may offer more opportunities over time for non-pharmacologic management of substance abuse and symptoms including pain in palliative care patients.
