W-10 Opiod use

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Opioid abuse

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Opioid Use

What symptoms of Substance Abuse Disorder do the individual in the video present with?

The patient feels excess confidence and exhilaration evident in how he answers the doctor confidently explaining that his health problems are so numerous that he can be used to teach a whole health encyclopedia. The opioid drugs are mainly used to relieve intense pain or chronic pain as mentioned by the patient. As a result of continued use, he became addicted to the substance, and he cannot do without it. The patient also explains the shortness of breath as tightness of the chest and also starts sweating. This is also a sign and symptom of opioid substance abuse. He developed panic attacks two weeks ago and has fragging attacks. The patient is struggling with addiction with medication since when he happened to forget the medication at home while on a road trip, he developed a complication that necessitated calling the ambulance but later he recovered when he took Oxycontin drugs which change how the body responds to pain and falls in the class of opioid analgesics (Koehl et al., 2019). He explains that the trip became stressful than normal before he got himself some alternative drugs. He does not have a specific dosage of the drugs and he pops the pills as he desires until he achieves satisfaction and to him, the dosage is not known. He explains that he pops the pills he is given. Whenever the patient takes the drugs his pain attacks are relieved and he returns to normal, a sign that he is dependent on opioid-related drugs.

What are other possible causes of his symptoms?

The patient must be having chronic disease especially cancer that requires him to use opioid-based drugs as painkillers which have resulted in his addiction due to continuous usage. The patient also has high blood pressure and diabetes. He uses multiple drugs and is in the habit of sharing drugs with his friends he explains, "Mark cut my dosage about three weeks ago." As a result, his symptoms may keep varying due to different side effects of drugs. He changes to Ambien and Klonopin and takes without a doctor’s prescription since he takes some from his wife so that he can fight his insomnia and find some sleep. He has a problem mixing medications in addition to alcohol consumption. The patient confesses to using a hallucinogenic drug which they share with his friends, ‘you stay up all night, the drums are beating all night long and you’re in a sweat lodge hallucinating with other people.’

What additional information would you like to have about this case?

  As the patient describes, his wife too has chronic pains, and she uses some drugs. This indicates they have some serious chronic illness that requires serious medical attention, but the main concern is whether the client has reliable doctors who follow up his patient treatment plan. Does that doctor he claims to have as a friend advise him on dosage whenever he plans to change his type of medication? The client and his wife lack a serious treatment plan and the focus is majorly on relieving symptoms. The case does not present treatment for the high blood pressure and diabetes as mentioned by the client. The case also lacks information on appropriate dosages that the client should take in case of alternative drugs. The case does not present any clinical visits or consultations with the mentioned doctors whom the part with until the pain becomes severe and he comes to the doctor presented in the case. It would also be important to inquire from the patient whether he has considered at any time using the wife’s medications to relieve his own needs. This would further help in identifying possible misuse of other drugs beyond those described for the patient. The information would inform the extent to which possible addiction would be managed and for which medications (SAMHSA, 2020).

Would you prescribe for this individual? Why or why not?

  The patient needs a treatment plan for the opioid addiction and therefore prescription should be made for other drugs rather than those of opioid nature. The major health challenge for the client is opioid addiction and before treating any other symptoms, the patient’s addiction should be treated to give room for ease of treatment of other ailments. The advantage of addiction treatment is that it concurrently works with chronic pain treatment. Prescribing for the patient would exacerbate the current health problems presented by the client. Further, with the patient demonstrating non-adherence behaviors characterized by the sharing of his prescriptions with friends, this may be a signal of abuse of the medications not just by hum but by people around him (SAMHSA, 2020).

What would your next steps be for this individual? What would your treatment plan be?

The treatment plan can be done in three approaches, either as opioid detoxification, agonist, or antagonist maintenance as deemed best by the healthcare provider. The only antagonist Naltrexone agent available is unsuccessful in retention of treatment and removal of the illicit substance therefore the alternative agonist agents such as methadone hydrochloride, levomethadyl acetate, and buprenorphine hydrochloride can be prescribed (Garland et al., 2019). Oral methadone hydrochloride starts the action in 30 minutes and its effective action can last for 24-36 hours and this would be the medication of choice in this patient case. This unique pharmacological property makes the drug easy to maintain for a once-per-day dosage. When used to treat chronic pain as well as treat opioid drugs addiction it has to be taken thrice per day. When the dosage is judiciously titrated the patient may not experience sedation or impairment that can affect their daily tasks. The drug advantageously reduces narcotic craving which is the main cause of relapse. This drug is available in 5-10mg tablets, but an intravenous solution is also available but linked to bradycardia when administered for sedation. The oral dosage has manageable mild side effects (Volkow et al., 2019). A starting dosage of 5mg will be prescribed for the next four weeks. Importantly, the patient will be enrolled into a counseling therapy program for the next 12 weeks. The program will focus on identifying the exposure and trigger factors in the patient’s environment and therefore work on avoidance, and coping strategies for the patient (Garland et al., 2019).

References

Garland, E. L., Hanley, A. W., Riquino, M. R., Reese, S. E., Baker, A. K., Salas, K., ... & Howard, M. O. (2019). Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 87(10), 927.

Koehl, J. L., Zimmerman, D. E., & Bridgeman, P. J. (2019). Medications for management of opioid use disorder. American Journal of Health-System Pharmacy, 76(15), 1097-1103.

SAMHSA. (2020, August 19). MAT medications, counseling, and related conditions. SAMHSA - Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions

Volkow, N. D., Jones, E. B., Einstein, E. B., & Wargo, E. M. (2019). Prevention and treatment of opioid misuse and addiction: a review. JAMA psychiatry, 76(2), 208-216.