Dr. Marie-H茅l猫ne Marchand is a family doctor at Maisonneuve-Rosemont Hospital specializing in palliative care and working in addiction medicine at CLSC Hochelaga. She is the co-founder of , which focuses on providing palliative care to the homeless population of Montr茅al.听
On Palliative Care 91直播鈥檚 Continuing Professional Development Day (November 21st, 2025), Dr. Marchand will be giving a (hybrid) talk on Palliative Care and Substance Use Disorder, which discusses听the treatment approaches for palliation in patients with a history of substance use disorder.听
Vanessa Ruan (VR): Why is it important to discuss substance use disorder in palliative care?
Dr. Marie-H茅l猫ne Marchand (MHM): One reason is that people undergoing severe substance abuse and homeless people have almost no access to palliative care, although both populations have a high mortality rate and are probably the sickest of our patients. Studies show that they die outside hospitals. They die on the street or in their cars, and these places are not made for that. People around them鈥�for example, community workers鈥�don't know what to do. Another reason is that we are not dealing with substance use properly. Studies show that even when people with drug addiction are hospitalized, they are at a higher risk of dying compared to when they are not hospitalized.
VR: These are shocking results. Why is this the case?
MHM: One of the main reasons is that drug addiction is a taboo in our society. Even in the healthcare system, we believe that 颈迟鈥檚 a choice and the person is empowered to stop. So, we tend to judge drug addiction as a behavioral problem. We now know that it's more of a chronic disease. It's difficult for them to stop using drugs even if it's harmful.
Despite this knowledge, we have not changed how we treat people with substance abuse disorders. We still tend to judge them and shame their behaviour. Because of this, we don't address their addiction directly. It's like the elephant in the room鈥攏obody talks about it. Everybody's judging the person but not addressing their symptoms and their needs. But the need is still there, so usually, the patient will hide when they are using drugs. However, as a patient loses their tolerance due to their treatment, they become at higher risk of overdose, which could be fatal.
The other reason is that if we don't address their needs and physical symptoms, they will just leave the hospital. Most of the time, they leave before treatment is finished. This puts them at a higher risk of death. For example, if they develop an infection, they are no longer in an environment where it can be treated.
VR: How can palliative care health professionals adjust their treatment plan for patients with substance use disorders?听
MHM: There are two things we can do. The first is more medical. Many of them have a huge tolerance for opiates. I have many patients who are using听grams of fentanyl. If you're not aware of that and give a small dose of hydromorphone or another opiate, it's going to do nothing and they will suffer.听We need to learn what medication we can use; how to use the medication; and how to find a balanced dosage, depending on what drug the patient is using. You must adjust quickly, because in the meantime, they're suffering, and at a certain point, they will leave. Furthermore, different drugs鈥攚丑ether 颈迟鈥檚 alcohol, cannabis, or cocaine鈥�lead to different withdrawal symptoms. You need to know what those symptoms are so that you can address them and make your patients more comfortable.听
We're also not fully aware of the medications that we can give. Studies show that methadone may be helpful for patients with addiction. In the field of palliative care, we know that this molecule exists, but most of us don't know how useful methadone is or how to use it. It is actually one of the most efficient drugs for medical prescription. It 诲辞别蝉苍鈥檛 keep people completely off drugs, but it stabilizes them. And when patients are more stable, then we can address their social problems, such as lodging.听
The second part, more importantly, is to recognize the elephant in the room. You need to try to talk with patients about their addiction and find a balance between your goal鈥�usually to give treatment鈥�and theirs. You can describe your goal and the schedule that you would like. Then, you need to listen to what their needs are. When they name their goals, 颈迟鈥檚 often way easier to figure out an agenda that fits.听
VR: In the learning objectives for your talk, you mention that the concept of harm reduction can be applied in palliative care. Can you explain this to us?听
MHM: The core philosophy of harm reduction is to see what the patient鈥檚 goal is and to try to align with this goal.听I鈥檝别 seen a lot of fighting with patients, with the health care professionals saying, 鈥淚'm going to give you less鈥�, and the patient saying, 鈥淚 want more.鈥� Then, nobody is satisfied. 滨鈥檓 trying to share a different perspective. I don't think our goal is to reduce anything. Their drug use has been going on for many years, and we're not going to change that at the end of their lives.听
For palliative care, we need to be aware of what we can do for patients to reduce the negative impact of using drugs. The person may continue to use drugs through the end of his life. However, instead of spending so much time on finding the drugs on the street, they may wish to connect with friends or family during this hard time. For example, you could say, 鈥淥kay, I'm going to replace, not all, but some of what you're using with my medications. So maybe you will spend less time trying to find drugs on the street, which are contaminated with so many other things.鈥�听
VR: Besides physical needs, how can healthcare professionals in palliative care address the psychosocial and spiritual needs of patients with substance use disorder?听
MHM: Most people with substance use disorder have been through huge traumas. If you have a team composed of different professionals, you need to use all your tools to uncover and alleviate some layers of their suffering, slowly. I rarely change behavior, but we can build trust and see the human being behind their substance abuse. I see the connection; I see the love. We are not going to cure them, but we can try to connect more and alleviate suffering.听
To attend Dr. Marchand's talk, "Palliative Care and Substance Use Disorder", as well as the rest of our CPD Day events, please .听