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Dying with dignity: the challenges of end-of-life care in patients with substance use disorders
  1. Prasun Datta,
  2. Jeffrey S Kruk,
  3. Kylie Jordan and
  4. Karen A Fisher
  1. Centre for Addiction Medicine, Nepean Hospital, Penrith, New South Wales, Australia
  1. Correspondence to Dr Jeffrey S Kruk; jeffrey.kruk{at}


Substance use disorder is a chronic disease carrying a high risk of morbidity and mortality. We report a case of a patient on long-term opioid agonist treatment who was diagnosed with metastatic cholangiocarcinoma and was referred to palliative care services almost contemporaneously with this diagnosis. In this report, we explore the challenges posed in offering holistic care during the end of life of a patient with a history of opioid dependence. A coordinated approach by addiction medicine and palliative care teams can allow patients from this complex cohort to ultimately die with dignity.

  • medical management
  • oncology
  • pain (palliative care)
  • end of life decisions (palliative care)
  • drug misuse (including addiction)

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  • Contributors PD, JSK and KAF provided direct medical care to the patient in both our outpatient clinic and in our inpatient unit. KJ provided social work care in both our outpatient clinic and in our inpatient unit. All authors contributed to the writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.