Hospice, Palliative Care, and Addiction Medicine: Common Ground (2025-2026 Recording)-Hospice, Palliative Care, and Addiction Medicine: Common Ground Recording

Video Transcription

Video Summary

This didactic session, hosted by the American College of Academic Addiction Medicine, explored the common ground between hospice/palliative care and addiction medicine. The speakers introduced the differences between palliative care and hospice: palliative care can be provided at any stage of serious illness alongside disease-directed treatment, while hospice is generally reserved for patients with a prognosis of six months or less and focuses on comfort.<br /><br />The presentation emphasized that serious illness and substance use disorder often overlap, with patients experiencing high symptom burden, trauma, psychiatric comorbidity, stigma, and prognostic uncertainty. A key concept was “total pain,” which includes physical, psychological, social, and spiritual distress—not just bodily symptoms. The speakers stressed that treating pain effectively requires a multidisciplinary approach and communication is itself a clinical intervention.<br /><br />A major section addressed how to think through opioid prescribing in patients with serious illness and opioid use disorder. Using case-based discussion, the speakers explained how to weigh pain type, substance use pattern, prognosis, performance status, and patient preferences when considering buprenorphine, methadone, or full opioid agonists. They highlighted that buprenorphine can provide analgesia and may be safer in many settings, while methadone and full agonists may still be appropriate in selected cases. They also discussed how to combine opioids with nonpharmacologic and interventional pain strategies, and how to counsel colleagues about opioid tolerance, hyperalgesia, and risk reduction.<br /><br />The final section focused on advanced care planning in patients with substance use disorder. Speakers encouraged clinicians to ask about values, identify trusted surrogate decision-makers, document contact information, and revisit these conversations over time. Overall, the session framed addiction medicine and palliative care as deeply complementary fields centered on whole-person care.

Keywords

palliative care

hospice

addiction medicine

serious illness

substance use disorder

opioid prescribing

buprenorphine

methadone

full opioid agonists

total pain

multidisciplinary care

pain management

advanced care planning

opioid tolerance

risk reduction