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Addiction and recovery

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6880 (Published 24 November 2014) Cite this as: BMJ 2014;349:g6880
  1. James Bell, consultant physician, Addictions Clinical Academic group, South London and Maudsley NHS Foundation Trust, London SE5 8RS

I recently went to a hospice to say farewell to a long term patient of mine, now dying of disseminated cancer. When given the diagnosis and bleak prognosis 8 weeks earlier, he had declined palliative chemotherapy. He kept on working, but deteriorated rapidly, and developed gangrene and terrible pain. He was now in the hospice for a few days while equipment was installed at home to allow his wife to manage him for the remaining weeks.

I envisaged some difficulties managing his pain, as he had been maintained on prescribed heroin for several decades. He had been on quite a modest dose­—150 mg/day—but it was …

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