Ideally, outpatients who currently abuse drugs should be enrolled in a drug rehabilitation program; however, patients with advanced medical illnesses may not be able to be enrolled. The health care provider may outline for the patient the role of the treatment team, what is expected of the patient, and the consequences to the patient should he or she continue to abuse drugs while receiving treatment for medical illness. Patients must receive detailed instructions for taking prescribed drugs responsibly. They must be seen frequently so symptom control may be maintained and drug abuse may be monitored. Frequent visits also avoid the need to prescribe large amounts of drug at one time, and may help the patient stay on the treatment schedule and attend appointments with the physician. Some patients may find that a "twelve-step" program is helpful in stopping illegal drug use while they are receiving treatment.

Outpatients may be required to undergo periodic drug testing. The patient should be informed in advance of the consequences of a positive test. A urine test that indicates the patient is using illegal drugs may result in the need to visit the outpatient department more frequently, smaller quantities of prescribed drugs, referral to a drug rehabilitation program, or other restrictions.

If the patient lives with family members who are substance abusers, the family members can be encouraged to enroll in a drug treatment program to help the patient avoid illegal drugs and alcohol. The patient should also be aware that friends and family members may attempt to buy or steal the prescribed drugs. It is very helpful to identify people who will be supportive of the patient.

A treatment team that includes a specialist in addiction medicine may be able to provide more effective treatment for the outpatient with a progressive medical disease and a history of substance abuse than can a single physician.

Patients who have successfully stopped abusing drugs or alcohol may be reluctant to begin using prescribed drugs for their medical illness for fear of developing an addiction. They may fear rejection from friends and family members who will object to their use of prescribed drugs, and they may fear that others will attempt to buy or steal the drugs. The health care provider should help the patient resolve these concerns and assure the patient that use of opioids to control symptoms of progressive disease does not result in the euphoria experienced by opioid abusers who do not have a medical illness.

If the patient is very reluctant to begin opioid therapy, the physician may develop strict guidelines for use of the prescribed drug to provide the patient with a sense of control. The patient may also be provided with counseling to help identify situations in which he or she is likely to abuse drugs or alcohol, and to develop strategies for avoiding future abuse of illegal or prescribed drugs.

Glossary Terms

Uncontrollable craving, seeking, and use of a substance such as a drug or alcohol.

A chemical substance found in beer, wine, and liquor. Alcohol is also found in some medicines, mouthwashes, essential oils (scented liquid taken from plants), and household products.

The process by which a professional counselor helps a person cope with mental or emotional distress, and understand and solve personal problems.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

The use of illegal drugs or the use of prescription or over-the-counter drugs for purposes other than those for which they are meant to be used, or in large amounts. Drug abuse may lead to social, physical, emotional, and job-related problems.

A feeling of great happiness or well-being. Euphoria may be a side effect of certain drugs.

Refers to the practices and procedures used for the prevention, treatment, or relief of symptoms of a diseases or abnormal conditions. This term may also refer to a legal drug used for the same purpose.

In medicine, to regularly watch and check a person or condition to see if there is any change. Also refers to a device that records and/or displays patient data, such as for an electrocardiogram (EKG).

A substance used to treat moderate to severe pain. Opioids are like opiates, such as morphine and codeine, but are not made from opium. Opioids bind to opioid receptors in the central nervous system. Opioids used to be called narcotics. An opioid is a type of alkaloid.

A patient who visits a health care facility for diagnosis or treatment without spending the night. Sometimes called a day patient.

Medical doctor.

A doctor's order for medicine or another intervention.

Cancer that is growing, spreading, or getting worse.

In medicine, a process to restore mental and/or physical abilities lost to injury or disease, in order to function in a normal or near-normal way.

The use of illegal drugs or the use of prescription or over-the-counter drugs or alcohol for purposes other than those for which they are meant to be used, or in excessive amounts. Substance abuse may lead to social, physical, emotional, and job-related problems.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of symptom management is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, palliative care, and supportive care.

Treatment.

Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.