Opioid Use Disorder Care Supports Cancer Treatment
COLLABORATIVE management of opioid use disorder, cancer care, and severe medical comorbidity helped one patient complete treatment despite profound clinical and social instability.
A case report described a 41-year-old female with depression, anxiety, intravenous drug use, and opioid use disorder who presented with frostbite after living outdoors. Her admission quickly evolved into a prolonged and highly complex hospitalization that included left brachial artery occlusion requiring embolectomy, ST elevation myocardial infarction, heart failure with reduced ejection fraction, stroke, deep vein thrombosis, pyelonephritis, acute hypoxic respiratory failure, and a new diagnosis of stage IV vulvar and anorectal squamous cell carcinoma requiring ostomy placement.
Opioid Use Disorder and Cancer Care Required Constant Reassessment
The central challenge was not only cancer care, but also how to safely manage opioid use disorder, pain, cravings, and withdrawal across repeated admissions. The patient had a 20-year history of opioid use and reported smoking 1 g of fentanyl daily at presentation. Methadone was started first, but concern over QTc prolongation prompted a switch to buprenorphine. After discharge, however, she relapsed on fentanyl and reported uncontrolled pain while receiving buprenorphine/naloxone as an outpatient.
That led to renewed multidisciplinary discussion. Cardiology reassessed the QTc in the setting of right bundle branch block and supported a return to methadone, recognizing that effective opioid use disorder treatment was essential to the patient’s recovery and engagement with cancer care. She was ultimately stabilized on methadone alongside gabapentin and duloxetine, with additional therapies used as needed for neuropathic, postoperative, and cancer related pain.
Housing Instability Shaped Treatment Success
Housing instability was a decisive factor throughout the case. The patient was readmitted nine times within 6 months, often within days of discharge, underscoring how fragile outpatient follow up had become. Functional decline from frostbite, severe ongoing pain, the need for daily methadone access, and barriers to transportation made discharge planning exceptionally difficult.
In the end, advocacy from addiction medicine, palliative care, and oncology teams helped secure permission for the patient to remain hospitalized for radiation and chemotherapy. The report argues that in patients with opioid use disorder, advanced malignancy, and unstable housing, individualized planning, shared decision making, and coordinated multidisciplinary care may be critical to preventing treatment disruption and loss to follow up.
Reference
Abrams EA et al. Collaborative Management of Opioid Use Disorder and Cancer Care in a Patient With Medical Complexity and Housing Instability. Cureus. 2026;18(3):e105337.
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