Response 1

Nice post. I agree that Joe is demonstrating symptoms of substance use related disorder but also withdrawal symptoms. Some of his symptoms could be related to his medical conditions, poly-pharmacy and most likely a combination of all of those things. Joe stated he was released from the ER the next day but did not elaborate I am assuming his ekg labs were normal and cardiac causes were ruled out? Otherwise this could be a classic case of panic attacks, poorly controlled diabetes, uncontrolled pain, withdrawal symptoms or opioid induced analgesia (Stahl, 2013). For medications I think buprenorphine could be a good option if Joe is ready and able to be compliant. However, I was under the impression that he is still receiving Percocet at a reduced dose from his pain management physician and he would have to wean off of this to a pretty low dose and start on the buprenorphine and find a tolerated dose (Stein , 2019). Patient education and discussing all their option with them is so important. Exercise and a healthy diet will not only help improve his co- morbidities, help with self-esteem and overall adherence with a plan when he is ready. I also recommended for long term goals he be offered a comprehensive pain management plan or enrolled in a program that offers a combination of therapies which is more likely to have long lasting effects (Renda & Slater, 2021). References: Renda, S., & Slater, T. (2021). Nonopioid management of chronic pain. Journal of Radiology Nursing, 40(1), 23–29. https://doi.org/10.1016/j.jradnu.2020.07.006 Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.

 

 

 

Response 2

Nice Post. I agree Joe should not be prescribed full opioid agonist medications, as he is displaying drug seeking behaviors due to his current symptoms of opioid withdrawal. I also agree with your choice of buprenorphine as the medication treatment as I choose the same treatment. Currently, I also think Joe will not consent to inpatient treatment and being treated on an out-patient bases would be efficient enough if he has a clear understanding of the treatment plan and is an able to commit to the regiment that goes with this type of treatment. Thorough education is needed in avoiding illicit substances and implement written patient opioid agreement and urine drug testing is needed. However, his decision to decline this aspect of the treatment plan should not prevent buprenorphine treatment. Motivational interviewing can be useful in encouraging Joe to engage in psychosocial treatment services (American society of addiction medication, 2020). Another major issue is Joe consent to be treated and the continuation of this relationship with his “Doctor” who is prescribing him medications outside of clinical settings. Substance abuse disorder often requires continuing care to be effective and family support. I forgot to address the wife’s involvement in the treatment plan (American Psychiatric Association, 2018). 

References

American Psychiatric Association (2018). Opioid use disorder. https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder/opioid-use-disorder American society of addiction medication (2020). The ASAM national practice guidelines for the treatment of opioid use disorder 2020 focus update. https://www.asam.org/docs/default-source/quality-science/npg-

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