Read the following case studies and search for the guidelines that answers the specific questions?
Case 1
A 54-year-old woman with chronic pain due to inflammatory arthritis presents to your clinic stating that she is having a “flare” of her arthritis but is out of her Oxycontin® and immediate-release oxycodone. She is aware that it is too early to fill her prescriptions, but she insists that she will be traveling out of state and “really needs” her medications.
Question: How do you Approach This Patient in the community setting?
What is the implications of prescribing this medication? Please provide evidence.
Case 2
A 27-year-old woman on buprenorphine-naloxone (Suboxone®) for treatment of opioid dependence is admitted to the hospital with severe abdominal pain due to a perforated gastric ulcer. She received hydromorphone in the ED, and is urgently taken to the operating room. Postoperatively, she is on a patient-controlled analgesic (PCA) pump containing fentanyl. Her last dose of buprenorphine-naloxone was 20 h prior to the surgery; her daily dose is 16 mg.
Question: How can Pain be Managed in Patients who are Taking Buprenorphine-Naloxone? What Adjustments to her Medication Regimen can be Recommended?
Case 3
A 20-year-old man is brought to the emergency department (ED) by his family for evaluation. His family reports that he failed out of school in his second year at a local community college. He admits to escalating struggles with prescription pain pills (prescription opioids), and then heroin use. He appears to be in opioid withdrawal; he describes anorexia and diarrhea, and is yawning and sweating on exam. He has a Clinical Opioid Withdrawal Scale (COWS) score of 15, indicating moderate withdrawal. His provider orders clonidine, ondansetron, and 2/0.5 mg sublingual buprenorphine/naloxone, with a plan to observe him in the ED. The provider subsequently receives a concerned call from the hospital pharmacist. Question: The Pharmacist States That the Provider is Unable to Administer Buprenorphine in the ED Without an X-Waivered DEA Number. Is This Accurate?
Case 4
A 23-year-old woman attends an outpatient treatment program and office-based buprenorphine clinic. She has been doing well while maintained on 16 mg/day of buprenorphine. Recently though, she has missed group sessions and provided a urine for drug screening that tested positive for clonazepam and amphetamine. One of the other members in her group reported that they saw a “urine bottle fall out of her purse” as it spilled next to her chair in a group session; her counselor was unaware of this event.
Question: What are the Policies Regarding the use of Illicit Substances or Urine Adulteration or Substitution During Substance Abuse Treatment?
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