How do you optimize the clinical management of persons opioid use disorders (OUD) and co-occurring psychiatric disorders who are actively using opioids and are experiencing significant pain?

Patients with co-occurring SUD and non-SUD disorders often present with significant acute pain syndromes and actively using illicit opioids. This intersection of active illicit opioid use, acute pain and serious mental illness can be particularly challenging especially for generalist clinicians. The reasons for this phenomenology include shared risk factors between pain disorders, SUD and non-SUD psychiatric disorders, and the fact that opioid use disorders can lead to increased pain experiences while untreated pain increases the risk of relapse to opioid use. This CATCH-22 situation is best managed using a multi-prong approach involving:

– Outpatient management of acute pain

– Early involvement in addiction/pain specialist is recommended

– Ongoing monitoring for suicide

– Brief and targeted inpatient admissions as needed

– Collaborative treatment teams

Access “Managing Active Injection Opioid Use: Severe Depression and Acute Pain” at:

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