Ethical Dilemmas and Approaches to Acute Pain Management in Patients With Substance Use Disorders

The opioid epidemic has intensified ethical dilemmas in acute pain management, particularly for patients with opioid use disorder (OUD). Clinicians face the dual responsibility of relieving pain while minimizing the risks of relapse and misuse. Historically, this population has been vulnerable to undertreatment due to stigma and fear of addiction, yet inadequate analgesia itself can worsen outcomes and undermine recovery. This review integrates ethical principles with clinical evidence to propose a framework for managing acute pain in patients with OUD. Ethical principles of autonomy, beneficence, nonmaleficence, and justice must guide care while balancing effective analgesia and addiction stability. Regional anesthesia and multimodal approaches are evaluated as ethically compelling alternatives to opioid-centered regimens, offering effective pain relief while reducing potential harms. System-level barriers, including stigma, inconsistent protocols, and limited access to addiction expertise, hinder equitable care. Addressing these requires institutional and policy reforms that prioritize education, interdisciplinary collaboration, and expanded access to MOUD and regional anesthesia. This review concludes that ethically sound acute pain management in OUD demands individualized, multimodal approaches that respect patient autonomy, prevent harm, and advance justice. Clinicians must integrate ethics and evidence to deliver compassionate, equitable care in the midst of the opioid crisis.