PCSS-MOUD Clinical Roundtable: Substance Use Disorder and Palliative Care-Roundtable Slides for Download

Roundtable Slides for Download

Pdf Summary

This presentation, led by Jenna L. Butner, MD, MPH, FASAM, AAHIVS, examines the intersection of palliative care and substance use disorders (SUD), especially opioid use disorder (OUD). It emphasizes that palliative care is holistic care for people with serious illness and health-related suffering, focused on improving quality of life for patients, families, and caregivers.<br /><br />Key themes include the overlap between palliative care and SUD populations, shared challenges such as stigma, undertreated pain, complex symptom burden, and pharmacologic issues involving opioids and benzodiazepines. The talk highlights workforce gaps and clinician discomfort that can lead to avoidance or overly restrictive care, worsening outcomes for patients with SUD at the end of life.<br /><br />The presentation also introduces tools for risk stratification and staging, such as the Karnofsky Performance Status, Palliative Performance Scale, ECOG, and DSM-5 SUD severity criteria. It encourages a dynamic, patient-centered, biopsychosocial approach rather than a one-size-fits-all model, and suggests that palliative principles can be integrated across the full disease trajectory, including screening, diagnosis, remission, return to use, and bereavement.<br /><br />A case study of a 58-year-old man with end-stage liver disease, chronic pain, OUD on methadone, and ongoing fentanyl/cocaine use illustrates the clinical complexity. The priorities are pain control, safety assessment, goals of care, and treatment planning that balances symptom relief with substance use treatment.<br /><br />Overall, the session calls for compassionate, individualized care that centers autonomy, dignity, harm reduction, and multidisciplinary collaboration.

Keywords

palliative care

substance use disorders

opioid use disorder

harm reduction

end-of-life care

chronic pain

stigma

methadone

biopsychosocial approach

serious illness