Planned approaches can help to ensure the safety of hospital staff and patients with current substance abuse histories. These approaches can help control manipulative behaviors by patients, maintain surveillance of illicit drug use, avoid conflicts surrounding the use of medications appropriately used for pain and symptom control, and communicate knowledge of pain and substance abuse management.

If possible, patients with current substance abuse issues who are scheduled for surgical procedures should be admitted to the hospital several days early to permit stabilization of the drug regimen. This period can be used to prevent withdrawal and provide an opportunity to judge the need for alteration of the plan established on admission.

A variety of actions can be considered in developing appropriate guidelines for the specific concerns posed by a patient. Some patients may be given a private room close to the nursing station to allow for monitoring. Patients may be restricted to their rooms or floors until the danger of withdrawal or illicit drug use is judged to be diminished. It can be appropriate to require a patient to wear hospital pajamas to reduce the risk of departure from the hospital to buy drugs. A patient’s visitors can be limited to family and friends known to be drug-free. Visitors can be told that check-in with the staff is required before contact with a patient is made.

Some patients should undergo one or more searches of their hospital rooms. If illicit drugs, previously prescribed medications, or alcohol are discovered, the items should be removed and discarded in accordance with hospital protocol. Packages brought to the hospital by family members and friends can be searched by responsible staff to ensure that they do not contain illicit drugs or alcohol.

In some cases, it is useful to require periodic urine drug screening. To simplify this process, the patient can be instructed to provide a daily specimen. Some of these specimens are sent for analysis, and others are discarded. The frequency of screening depends on the behaviors observed in the hospital. This approach establishes the concept of regular surveillance for the patient, without excessive use of the laboratory.

Again, this plan must be tailored to reflect the degree of risk perceived by the staff. In some cases, no special requirements are needed, and in others, the severity of recent abuse indicates the need for maximal caution. In discussions with patients, staff can emphasize that the implementation of these guidelines is in the best interests of the patient and institution. Aggressive medical management unencumbered by doubts about the history and concerns about ongoing drug use is possible only if the staff can be reassured that drug abuse is not occurring.

Once a structure is established to control drug use, the medical management of the active abuser must proceed attentively. Frequent visits are usually needed to assess and manage symptoms. Drug withdrawal should be prevented, and prescribed drugs for symptom control should be administered regularly, to the greatest extent possible. This avoids frequent encounters with staff that focus on the patient’s desire to obtain a drug.[1,2]

References

1. Passik SD, Portenoy RK, Ricketts PL: Substance abuse issues in cancer patients. Part 1: Prevalence and diagnosis. Oncology (Huntingt) 12 (4): 517-21, 524, 1998.  [PUBMED Abstract]
   
   
2. Passik SD, Portenoy RK, Ricketts PL: Substance abuse issues in cancer patients. Part 2: Evaluation and treatment. Oncology (Huntingt) 12 (5): 729-34; discussion 736, 741-2, 1998.  [PUBMED Abstract]
   
   

Back to Top

< Previous Section  |  Next Section >