Mr. D. is a 25-year-old male who has struggled with heroin addiction since his late
teens. He had initially completed a 30-day rehabilitation program but relapsed immediately
and entered another 2-week program. It was during this hospitalization that laboratory
abnormalities were noted, and he was subsequently diagnosed with acute myeloid leukemia.
He received high-dose induction chemotherapy with cytarabine and daunorubicin but
did not achieve remission. He was reinduced, achieved remission, and subsequently
underwent stem cell transplantation with his younger sister as a donor. Throughout
this prolonged 8-week hospitalization and treatment, he suffered from severe mucositis
as well as abdominal pain of unclear etiology requiring patient controlled analgesia
(PCA), delivering, at 1 point, over 600 mg of hydromorphone in a 24-hour period. By
the time of discharge, the mucositis had resolved, the opioid gradually titrated downward,
and he was transitioned to a 100-mcg fentanyl patch, which was weaned down as an outpatient
over a 2-week period. Two weeks after titration off of fentanyl, the patient reported
agitation, sweats, and nausea that continued. Mr. D’s parents accompanied him to each
appointment; the patient continued to live with his parents so they could closely
monitor him and they dispensed his medications due to the history of drug abuse. Less
than 6 months from his transplant, his parents discovered evidence of an attempted
transaction to purchase heroin, and the patient subsequently admitted to continued
heroin use throughout his treatment including during his hospitalization. He continues
to struggle with addiction; more than 300 days past transplant, he is currently at
an inpatient drug rehab facility.
Key words
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Article info
Footnotes
Address reprint requests to Dr J. A. Paice, Northwestern University Medical School, 676 North St Clair Street, Suite 850, Chicago, IL 60611-2927. E-mail: [email protected]
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© 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.
