Ethical perspectives: Opioid treatment of chronic pain in the context of addiction

Mitchell J.M. Cohen, Samar Jasser, Patrick D. Herron, Clorinda G. Margolis, Robert N. Jamison

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


The authors apply eight ethical domains of analysis to the question of treatment of chronic pain with opioids in patients with histories of substance use disorders: autonomy, nonmaleficence, beneficence, justice, medical condition, patient preference, quality of life, and consideration of specific individual or sociocultural issues. These eight domains are drawn from principle-based and case-based ethical perspectives. The domains are developed by review of available literature and through application to a specific presented case. Factors that interfere with rational, ethical decision-making regarding opioid pain management are identified. Chronic pain and substance use disorders share a history of stigmatization, underdiagnosis, and undertreatment. Using the presented case as a point of departure, the authors discuss principles for prescription of opioids for treatment of chronic noncancer pain in the setting of history of substance use disorders.

Original languageEnglish (US)
Pages (from-to)S99-S107
JournalClinical Journal of Pain
Issue number4 SUPPL.
StatePublished - 2002
Externally publishedYes


  • Ethics
  • Medical decision-making
  • Principle of double effect
  • Pseudoaddiction
  • Quality of life

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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