A 38-year-old male has presented to the clinic complaining of too much worrying concerning various issues. He states feeling easily fatigued, uncomfortable, trouble concentrating, muscle tension, sleep disturbance, irritability, and feeling of panic attack. He is currently on Ritalin 5mg PO after being diagnosed with ADHD as an adolescent, but he still feels that his mental condition is getting worse day by day. History of depression Hep C, anxiety, PTSD. The patient chief complaint is vague pain in his whole body and requesting prescription for Percocet and oxycontin. He was referred by a concerned friend to clinic. On the general appearance, he maintains good eye contact. Involved in interview. Linear thought process. He states that he is taking recreational medication, smoke heavily, and denied drinking at this time. he was previously taking 2 pints of vodka each day. VS with blood pressure is slightly increased and HR on 50’s. Toxicology screening is performed to figure out if the patient is taking other medications and stop any drug to drug interactions. Urine results were positive for fentanyl and benzodiazepine presumption.

Although pain is defined as a subjective experience upon observations patient did not display any major sign of pain. Question if he has medical seeking behavior. The patient become irritated when asked the reason for looking for opioid pain drug prescription. This behavior indicates that the patient has developed substance dependence that is “physiological adaptation” over time to the medication (Stahl, 2017). Furthermore, we must consider that SUDs and other psychiatric and medical condition happen comorbidly. We can cite anxiety, depression, attention-deficit hyperactivity disorder (ADHD), antisocial disorder amongst other, and post-traumatic stress disorder (National institutes of health, 2020).  Therefore, his feeling i]=of panic attack may be a antecedent to him seeking more drugs to self-meditate. His attitude towards substance use was discussed, readiness or willingness to change was assessed. He was recommended physical therapy for the management of his generalized muscle pain, considering his state of drug abuse, it would be safer to use non-opioids to treat his pain (Trasolini, McKnight & Dorr, 2018). 

He was therefore recommended to take over the counter Tylenol 975 mg every six hours. The patient was also given sertraline 25 mg PO and increased it to 50 mg maximum as required. Sertraline is a selective serotonin reuptake inhibitor (SSRIs) and has fewer major side effects and low chances of an overdose, including a lack of abuse potential (Stahl, 2017). Additionally, we provided addiction counseling, and in the occasion that he needed to give it a try, the benefit of having assistance in place to fight addiction. He states that he has friends in recovery and just required “to pick the 1000lb” phone and call them. Moreover, we explained about available resources such as rapid recovery coach in case things become intolerable for him. He unconditionally accepted the phone number. Accepted the plan as documented. He will continue with Ritalin 5 mg daily, Gabapentin 800 mg tab Wellbutrin 150 mg every 12 hours. He was given referral for physical therapy in order to manage muscle pain, and referral to addiction clinic.

References

National Institutes of health. (2020, April). National institute on Drug Abuse. The  Connection Between Substance Use Disorders and Mental Illness.  https://www.drugabuse.gov/publications/research-reports/common-  comorbidities-substance-use-disorders/part-1-connection-between-  substance-use-disorders-mental-illness

 Stahl, S. M. (2017). Stahl\’s essential psychopharmacology: Neuroscientific basis  and practical applications (4th ed.). Cambridge University Press.   

Trasolini, N. A., McKnight, B. M., & Dorr, L. D. (2018). The opioid crisis and the  orthopedic surgeon. The Journal of arthroplasty, 33(11), 3379-3382.