by Fitzgerald Jones, Ho, Sager, Rosielle and Merlin
Have you ever been so distressed by a perspective piece that it kept you up at night? The type of rumination that fills you with so much angst that you have no choice but to act.
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The column, which is structured as a sort of written debate in which two authors argue a clinical question, describes a case of a 45-year-old man with severe substance use disorder (SUD) recently diagnosed with extensive-stage small-cell lung cancer. He was offered aggressive chemotherapy and a referral to a clinic to address his opioid use disorder but did not follow up in the SUD clinic and later presented to an emergency department after a heroin overdose that reversed with naloxone. At his oncology follow-up, he expresses a desire to proceed with chemotherapy but a reluctance to take medication for addiction, stating he can manage his heroin use on his own. The case notes a history of long standing depression and recent homelessn