F11.20 Opioid Dependence: Case Study

The patient is in the process of being reassigned with a mental health therapist through CHR and it is currently pending. The patient is planning to follow up today about the outcome because she then reports, " I have to do the intake again."

The issue of pain management has been an ongoing crisis for ages. The need for solutions and methods of avoiding pain is natural, however, as time has passed, misuse of these solutions has gotten out of hand. The abuse of prescription opioids, in particular, must be acknowledged. By prescribing opioids to patients, doctors are inadvertently creating drug addicts and fueling the heroin epidemic. As patients grow tolerant to opioids, they are forced to search for stronger drugs, commit crimes, and ultimately die. Alternate solutions for pain management and regulation of opiates must be implemented in order to prevent the meaningless loss of lives.

The Opioid Risk Tool (ORT) specifically identifies whether or not an individual has a family history of substance use, personal history of substance use or a psychological disorder. A second assessment is The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), this tool is typically self administered and consists of 24 questions. The SOAPP-R was designed to identify aberrant medication-related behaviors (Lakha, Louffat, Nicholson, Deshpande & Mailis-Gagnon, 2014). Finally, The Current Opioid Misuse Measure (COMM), a 17 question inventory, was also designed to measure the likelihood that the patient will misuse their prescribed medication. The SOAPP-R and the COMM were both designed to take an individual's pain scale into consideration during the assessment (Jamison, Serrailler & Michna,

The physiologic effects of the opioids withdrawal syndrome include, arthralgias, diarrhea, myalgias, abdominal cramping, rhinorrhea, piloerection, lacrimation, insomnia, and yawning as well as temperature dysregulation. It is greatly suspected that Mr. HR was experiencing an opioid withdrawal syndrome due to his medical presentations, such as, rhinorrhea, muscle aches, mild sweating and increased lacrimation.

By conducting 2-3 day trainings on PDMP before physicians and pharmacist utilization, it can reduce opioid abuse and addiction. Wtth detailed guidance, physicians can interpret findings, integrate the PDMP into the workflow and talk with patients about their results. Checking PDMP will help in improving clinical decision-making, and reducing doctor shopping and diversion of opioid. Moreover, using PDMP will enable the providers to identify the patients at risk of opioid abuse, thereby allowing them to refer the high-risk patients to a treatment center, the crucial first step toward recovery. Findings revealed that there are no current laws addressing the proper use of PDMP, patients were more likely to engage in diversion

The treatment option chosen is accurate because it was discussed in class a treatment option. The fact that Day is classified as an addict is accurate. He describes at length how the drug negatively impacted is work and personal life and how the use of the drug felt out of his control which are signs of addiction because the drug is the priority and it affects many areas of the users’ life. The video was very accurate and the only inaccuracy I noticed was when Day said he couldn’t complete withdrawal on his own because the drug was psychologically preventing him but in contrast cites physical withdrawal symptoms as the reason he was uncomfortable and chose to keep taking the drug. His assessment of the type of dependence was inaccurate. Without further questioning, there is not enough information to declare a psychological dependence for Day. The video closes by mentioning other drugs that can assist in opioid addiction treatment, which were also mentioned in class so they are

Opioid Use Disorder (OUD) is a chronic and potentially life-threatening disease, and the main feature of which is addictive and compulsive opioid use (Drugs & Crime, 2010). Opioid drugs include some of the prescribed pain relievers as well as illicit drugs, such as heroin, codeine, oxycodone, etc. In the United States, about 9.5 million adults use pain relievers for nonmedical purpose, 1.6 million adults meet diagnostic criteria of pain reliever use disorders, and 0.56 million have heroin use disorder (Hedden, 2015), at a huge social and financial cost (Alan G. White et al., 2011). Furthermore, the relapse rate of OUD patients in treatment is high (Davstad et al., 2007).

D-This writer agreed to meet with the patient as he was placed hold to attend group. Reported stability on his current dose and denies the need for a dose increase when offered by this writer. This writer reviewed the patient's record and learned that he obtained his 3rd take home bottle on 01/04/2017. The patient is aware that he in order for him to obtained the 4th take home bottle, he must attend the take home bottle group. Addressing his medication, this writer noticed that the patient has not refilled the following medications:

John is at risk for opioid withdrawal because his current medication schedule will not be maintained because he will be NPO due to his procedure. To avoid withdrawal he will need a pain management consult. The doctors need to come up with a pain management plan to control John’s chronic and now acute pain to avoid withdrawal. It is extremely important for the nurse to monitor John for signs and symptoms of opioid withdraw such as irritability, agitation, goose bumps, headaches, restlessness, insomnia, nausea, vomiting, abdominal cramping, anxiety, and increase in pain.

OPIOID TREATMENT: For patients attempting to detoxify from opioid addiction, methadone, buprenorphine, and naltrexone are frequently used. They act on the same receptors in the brain as heroin to suppress withdrawal symptoms and reduce cravings.

D- The patient arrived on time for her counseling session. Reported unstable on her dose and accepted a dose increase of 5mgs as she is still experiencing withdrawals and cravings. The patient admits to using illicit drugs recently- heroin-5 bags by inhalation, cocaine-a couple of lines by inhalation, and smoke a couple of days of THC. Alternatives were discussed, which led to a discussion about the patient's treatment plan goals. The patient reported that she has a hearing with SSA, referring to her Disability hearing on September 7, 2016.

D-The patient arrived to the clinic emotional and was advised to see this writer. According to the patient, she's upset about her DCF case, her supervised visit with her son that hasn't occurred yet, loss of employment, and owing $80. 00 for her rent. This writer provided support, validated the patient feelings, and encourages the patient to maintain contact with her attorney and to also, contact 211 for financial assistance. In addition, reach out to the court system to address the violation to her supervised visit as it is not being honored. During the remainder of the session, the patient provided an updated on her mental health provider whereas she is no longer going to Wheeler Clinic due to the travel distance. The patient signed an ROI

Addiction is a multifactorial psychiatric disorder in which twin studies have established a compelling case for a genetic heritability of increased susceptibility in some human hosts more than others . Outside of genetics, addiction is partial to several environmental, behavioral, and developmental risk factors as “neither genetic nor environmental factors act in isolation to increase susceptibility to addiction.” Thus, there does not appear to be any necessary nor sufficient factors that are responsible for the increased likelihood of substance use/abuse and subsequent addiction.

Everyday more and more treatment options and medications are being used to help to combat the world of drug abuse and addiction. According to the CDC about 980,000 people in the United States are abusing some form of opiates, weather it is pills or heroin. One of the newer trends of treatment that is now being used and growing rapidly is Medical Assisted Treatment (MEDICAL ASSISTED TREATMENT). As with any treatment or medication therapy there are the medical benefits and also the medical downsides. Medical Assisted Treatment was intended to help prevent people from continuing their drug abuse, but is now not only helping people but is also turning into an abused drug itself. ‘

As the Pt’s severe and persistent opiate addiction have stabilized, Pt has been able to to fully commit to doing it well at work but his recovery is at risk due to working all the time and long hours. Pt. is currently is paying all his all treatment fees in advance and avoiding any administrative taper. During upcoming quarter, Counselor will encourage Pt. if applicable to make payments in advance towards his treatment fees to avoid any interruptions. Counselor will encourage Pt. to report any negative changes in his financial status and financial difficulty making TX payments to this writer and AMS director as soon as