This case involves a 56-year-old man with a history of heroin use who presented with abdominal pain. He was initially treated for opioid withdrawal with methadone and morphine. However, his abdominal pain worsened and he was later found to have a perforated colon requiring surgery. The failure to properly evaluate the source of his pain and worsening condition despite treatment for withdrawal led to delays in diagnosis and appropriate care. Opioid dependence is a chronic medical condition and providers should be aware of atypical withdrawal presentations and avoid biases that could impact diagnosis and treatment.

1. Spotlight Case July 2008 Dependence vs. Pain