W-10 Opiod use

Post#2 Opioid Use by Edina Boros

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

Joe presents with the following symptoms, which point to a substance abuse disorder: Joe is taking a higher dose of medication than intended. At least, that is what his vague answer to the question of how many pills he takes indicates that. It might also signal that he developed physical tolarenece toward the drug as well. Joe takes medication categorized as a controlled substance that is not prescribed to him (usdoj.gov, 2021). He reports increased anxiety when he has no access to the drug. He reports symptoms that could be due to opioid withdrawal, such as muscle aches and pain, insomnia, and sweating (Shah, 2021). Joe also exhibits drug-seeking behavior. He asks for the medication by name and is reluctant to discuss his complaints with the provider. He becomes irritable when questioned about his symptoms and is more concerned about the drug than his medical complaints. He also asks for pain medication to address his panic attack (James, 2016).

What are other possible causes of his symptoms?

His underlying heart disease can cause shortness of breath, sweating, and chest tightness. A panic attack or anxiety might cause the same symptoms as well.

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

What is the reason he started to take pain medication, and how long ago? Is the original condition resolved? Details of his history of substance abuse. Is he a smoker? What medications does he take for his medical conditions? Allergies. When was the last time he took opioid medication or his wife’s Klonopin? Is he employed? Any history of depression and anxiety, any other mental illness. Has he ever participated in alcohol/drug detox/rehab treatment? How much alcohol does he consume? Any problems in close relationships. Does he think his prescription misuse is a problem? How does his family feel about his medication misuse?

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

I would not prescribe a controlled substance for Joe due to his drug-seeking behavior. I would perform a more detailed assessment and develop the treatment plan based on additional information.

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

I would perform assessments targeting substance abuse severity, such as the Clinical Opiate Withdrawal Scale (COWS). Depending on what Joe reports of his alcohol consumption habit, I would also include the Clinical Institute Withdrawal Assessment for Alcohol (CIWA). The treatment plan would be based on the additional information I obtain and the patient's willingness to participate in treatment. Using motivational interview skills, the provider could explore what the patient sees as a problem and what steps he is willing to take to change them. Treatment for opioid withdrawal is an option that could be an inpatient program under tight supervision. Depending on the severity of the withdrawal symptoms, it could be outpatient treatment with long-acting injectable naltrexone (Stahl, 2013).. Psychotherapy should be involved in the treatment, such as cognitive behavior therapy, dialectical behavior therapy, or motivational interviewing.

References

Controlled Substance Schedules. Controlled substance schedules. (2021). Retrieved November 5, 2021, from https://www.deadiversion.usdoj.gov/schedules/.

James, J. (2016, June 1). Dealing with drug-seeking behavior. Australian prescriber. Retrieved November 5, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919169/.

Shah, M. (2021, October 11). Opioid withdrawal. Stat Pearls [Internet]. Retrieved November 5, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK526012/.

Stahl, S. (2013). Essentials of Psychopharmacology, (4th edition). United Kingdom, Cambridge University Press, ISBN-13: 978-1107025981