Opioid pain control for recovering addicts.
What is the RPPEO stance on this? It could be severely detrimental to introduce opioids to someone currently in recovery of opioid addiction. It is not contraindicated. I often don’t bring up the possibility of opioid pain relief when presented with a recovering addict in pain. Should we be offering it anyway? What if they are on methadone currently? What is the standard here? Of course, it is detrimental to not treat pain but sending someone back into the depths of addiction while in recovery is possibly a death sentence. I have discussed this with tons of medic’s colleges teachers no one remembers ever having clear direction from anyone.
Of course you should never assume that someone is not in real pain and it is very important to treat pain. Having said that there are circumstances we run into when it is very strongly apparent a person is seeking opioids. If they state they have pain what is the direction on this?
Where opioid use disorder (OUD) is suspected, nonpharmacological (heat/cold packs, immobilisation, dressings, repositioning, reassurance) and non-opioid pharmacological therapies (NSAIDs and acetaminophen) should be maximised before addition of opioids.
For short transport times or where the pain is manageable we suggest not administering opioid analgesics.
For long transport times with severe, unmanageable pain, consider the information below and consider consulting with a BHP.
Patients who are in remission/recovery from OUD without methadone or other other opioid agonists
Patients with OUD controlled with methadone or other other opioid agonists
Patients with untreated OUD
If you do elect to administer opioids to a patient with OUD, ensure that the patient has provided explicit informed consent. This means that you should inform the patient, and make sure they understand, that
Then obtain clear, unambiguous consent from the patient, making sure that you document the informed consent process that you followed.
Carr, D. 2022. Management of acute pain in adults with opioid use disorder. UpToDate https://www.uptodate.com/contents/management-of-acute-pain-in-adults-with-opioid-use-disorder
Shah P, et al. Informed Consent. 2022. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK430827/