I am replying to a classmate’s post on opioid use disorder video

Week 11 Discussion 1: Opioid Use

Done: Make forum posts: 1

Value: 100 points

Due: Create your initial post by Day 4, and reply to at least two of your classmates’ posts by Day 7.

Grading Category: Discussion Forums

Initial Post

1. View the Opioid Use Disorders Video | Opioid Use Disorder Moderate Transcript
2. Answer the following questions:
3. Your initial post should be in APA format with evidence-based references to support your statements.

Reply Posts

Read your peers’ posts and respond to at least two of your peers. In your posts, critique the plan by answering the following questions:

• Does the clinical decision and treatment plan follow guidelines? Why or Why not?
• Is anything missing from the plan?
• Compare your peer’s plan to yours. What are the advantages and disadvantages of each?
• Your response should include evidence of review of the course material through proper citations using the APA format.

Please refer to the Grading Rubric for details on how this activity will be graded. 

I am repling to my peer’s post. 

This is her post

Re: Week 11: Discussion 1: Opioid Use

by Bhagyshree Brahmbhatt – Wednesday, 15 March 2023, 2:41 PM

      Patient mainly wants to talk more about Percocet’s and does not want to talk about his symptoms or problems. Based on the conversation, it seems like the patient takes many pills (Dugosh & Cacciola, 2022) since he said he takes Ambien, Oxycontin, and his wife’s medication, Klonopin. When he goes on his trip to Sturgis, he gets carried away with drugs. Patient also seems like he has become tolerant (Dugosh & Cacciola, 2022) to his previous oxycontin dose because since his doctor reduced the dose a few weeks ago, he started taking his wife’s medication to help. He also mentioned he had symptoms of chest tightness, sweating and he was out of breath, which were consist of a panic attack two weeks ago. This may have been precipitated due to withdrawal from opiates (Roy-Byrne, 2022). Patient also states he has many other health issues, so I would need more information about that to assist with treatment and any drug interactions to be concerned about. It would be best to look get medical records and look into the prescription drug monitoring program (PDMP). All signs and symptoms point to substance use disorder.

      For treatment, I would prescribe him both pharmacotherapy and psychotherapy. MOUDs work by reducing withdrawal symptoms and opioid cravings while decreasing the biological response to future drug use (Hoffman et al., 2019). I would prescribe him transmucosal buprenorphine (Strain, 2022). He will need to be abstinent from other opioids for a period of time so he can be in a state of mild withdrawal (Strain, 2022). Medication will be inducted when he is manifesting symptoms of withdrawal and will happen in office, so we are able to observe the patient for a full two hours for relief of symptoms and any symptoms of withdrawal (Strain, 2022). If patient continues to show signs of withdrawal, we can increase the dose up to 4 mg (Strain, 2022). The next day, we will give the same dose given the first day and monitor again for one to two hours. If symptoms continue, we can give another 4 mg and monitor and continue to increase and monitor up to a maximum of 16 mg if symptoms persist (Strain, 2022). When the symptoms have gone down, we will provide the patient with maintenance doses for one week and follow up with them to assess. The dose of the medication will be dependent on his symptoms. Transmucosal buprenorphine improves treatment retention, reduces opioid use, and is associated with decreased mortality in individuals with OUD (Strain, 2022). It seems as though patient is not aware of his substance use disorder, so I would explain it to him in detail and also have him do cognitive behavioral therapy since it will help him develop an awareness of his cognitive distortions that negatively impact his mood and likelihood of relapse and help him better understand the function of their substance use, including factors precipitating use (Peavy, 2021).

References

Dugosh, K. L., & Cacciola, J. S. (2022). Clinical Assessment of Substance Use Disorders. UpToDate. https://www.uptodate.com/contents/clinical-assessment-of-substance-use-disorders?search=substance%20abuse%20disorder&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H4135196361

Hoffman, K. A., Ponce Terashima, J., & McCarty, D. (2019). Opioid Use Disorder and Treatment: Challenges and Opportunities. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4751-4

Peavy, K. M. (2021). Psychosocial Interventions for Opioid Use Disorder. UpToDate. https://www.uptodate.com/contents/psychosocial-interventions-for-opioid-use-disorder?sectionName=SELECTING%20PSYCHOTHERAPY&topicRef=108803&anchor=H2606067275&source=see_link#H2606067275

Roy-Byrne, P. R. (2022). Panic disorder in Adults: Epidemiology, Clinical Manifestations, and Diagnosis. UpToDate. https://www.uptodate.com/contents/panic-disorder-in-adults-epidemiology-clinical-manifestations-and-diagnosis?search=panic%20attack%20treatment&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H2742048403

Strain, E. (2022). Medication for Opioid Use Disorder. UpToDate. https://www.uptodate.com/contents/medication-for-opioid-use-disorder#H3807189453

Week 11 Discussion 1: Opioid Use

Done: Make forum posts: 1

Value: 100 points

Due: Create your initial post by Day 4, and reply to at least two of your classmates’ posts by Day 7.

Grading Category: Discussion Forums

Initial Post

1. View the Opioid Use Disorders Video | Opioid Use Disorder Moderate Transcript
2. Answer the following questions:
3. Your initial post should be in APA format with evidence-based references to support your statements.

Reply Posts

Read your peers’ posts and respond to at least two of your peers. In your posts, critique the plan by answering the following questions:

• Does the clinical decision and treatment plan follow guidelines? Why or Why not?
• Is anything missing from the plan?
• Compare your peer’s plan to yours. What are the advantages and disadvantages of each?
• Your response should include evidence of review of the course material through proper citations using the APA format.

Please refer to the Grading Rubric for details on how this activity will be graded.

The described expectations meet the passing level of 80 percent. Students are directed to review the Discussion Grading Rubric for criteria that exceed expectations.Re: 

Week 11: Discussion 1: Opioid Use

by Cindy Faraguna – Tuesday, 14 March 2023, 4:32 PM

What symptoms of Substance Abuse Disorder does the individual in the video present with?Joe came into the office and shared he has several medical problems including chronic pain. Joe appeared mildly uncomfortable during the interview and wanted to skip the “talking” and go right to what he needed, and this was a prescription for Percocet or Oxycontin. In the interview, Joe shared some personal history and current information which gave the insight to conclude he has an Opioid Use Disorder. According to the Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) diagnosis criteria, a patient will need to present a problematic pattern of opioid use within 12 months; furthermore, the severity is based on the number of criteria the patient presents (Black & Grant, 2014). The criteria Joe shows are the following: a long-term use of opioids that was longer than intended, unsuccessful effort to cut down or control his opioid use, a strong desire to use opioids, he had a panic attack one week after his doctor cut down on his opioid dose, dysphoric mood, sweating, muscle aches, mixed Ambien with Klonopin, and the Klonopin was not prescribed to Joe. Additional information Joe shared was his history of leisure drug use over the years.What are other possible symptom causes?Joe can be suffering from depression and/or anxiety. He expressed how things area when they used to be, he was worried and anxious about finances, and he appeared frustrated with all his health conditions, including chronic pain. When individuals have depression and/or anxiety, they may self-medicate to forget bad feelings, cope with problems, and relieve symptoms of other mental health disorders (Esmaeelzadeh et al., 2018). Joe experiences shortness of breath and tightness in his chest can be symptoms of anxiety, heart attack, irregular heartbeat (atrial fibrillation), or pulmonary embolism (Merschel, 2022). Joe has a history of heart disease and has three cardiac stents. Joe also has diabetes and it may be uncontrolled causing symptoms he is experiencing. Diabetes can lead to complications such as heart and blood vessel disease, slow healing, sleep apnea, eye damage, and nerve damage, and can lead to stroke (Mayo Clinic, 2023).What additional information would you like to have about this case?In Joe’s case, I would like to learn more about when and why he started taking opioids. I would want to learn more about his physician friend’s medical specialty. I would want to know if his physician friend was the same physician who prescribed Joe’s Ambien. I will want a list of all the medications Joe is currently taking. I will want to know the dose and frequency of the opioid Joe is taking.What would you prescribe for this individual? Why or why not?According to the National Institute for Health and Care Excellence (2010), pharmacological treatment will be buprenorphine or methadone. For Joe, I would select buprenorphine. Joe is at the beginning stages of experiencing withdrawal and his first dose would be a 4 mg sublingual (Epocrates, 2023; Puzantian & Carlat, 2020). The dose can be increased by 2-4mg until symptoms stabilize (Epocrates, 2023; Stahl et al., 2021; Puzantian & Carlat, 2020). I will want to start slow with Joe due to his age and medical history. Buprenorphine works as a maintenance treatment with a long duration of action protecting against overdose (Shulman et al., 2019). Buprenorphine is a mu-opioid receptor partial agonist; therefore, produces less tolerance and less intoxicating effects (Shulman et al., 2019).What would your next steps be for this individual? What would your treatment plan be?Initiating Joe’s treatment plan will need to begin with identifying the problem, then we would set goals, discuss objectives to reach those goals, and plan interventions together. In addition to buprenorphine, Joe will continue with psychotherapy sessions. In a session, Joe will be provided with an Abuse Screen Test (DAST). I will review the Controlled Substance Utilization Review and Evaluation System (CURES) to see if Joe has multiple physicians prescribing him opioids. I will order a urine drug screen and liver function test when initiating treatment and during treatment (ASAM, 2016; Stahl et al., 2021). A part significant part of this treatment plan is the patient’s commitment to agree and cooperate with the treatment plan provided (ASAM, 2016). Joe will need to agree to keep all appointments, take medications only prescribed to him, agree to routine drug testing, allow family and friends involvement, and avoid people, places, and situations that encourage drug use (ASAM, 2016).

ReferencesAmerican Society of Addiction Medication. (2016). Opioid addiction treatment. ASAM. Retrieved March 14, 2023, from https://www.asam.org/docs/default-source/publications/asam-opioid-patient-piece_-5bopt2-5d_3d.pdf