Hi Dr. Ainsworth and class,
The patient is a 58-year-old woman with chronic pain due to inflammatory arthritis. She
presents for her first appointment with you in a primary care office. She states that she is
aware that she is asking for an early refill of her Oxycontin however she is traveling out of
state and she is concerned that she may have a flare up on her trip.
SBIRT is a reliable screening tool that can be completed within a few minutes. Most patients
who are screen annually do not need a further workup nor referral. The earlier a provider can
intervene with identifying potential misuse or abuse of drugs and/or alcohol the better the
prognosis.
Inflammatory arthritis can be debilitating and there are several different types of inflammatory
arthritis. This patient presenting for her first appointment with us and then requesting an early
refill on oxycontin is a little concerning. Most patients who have chronic pain and are on these
types of medications are typically under the care of pain management specialists. We do not
have any information on this patient, have never performed a thorough history and physical or
even reviewed past medical consultations. We should not prematurely judge or jump to
conclusions; however, we must investigate and understand the situation more comprehensively.
Is it autoimmune arthritis, crystalline arthritis, osteoarthritic arthritis etc., the different unknown
variables will inevitably change the course of management and treatment (Poudel, Goyal,
Bansal,et.al.,2021).
We can perform the SBIRT but it most likely will be inconclusive until we have more
information to review. She would be assessed using the NIDA quick screen which would be
positive, and we would move to the NIDA lifetime use of one or more substance (Goroll and
Mulley, 2014). Building the trusting rapport with this patient is vital in influencing her decision
making or transition to a non-opiate medication. At this time, I would not fill her Oxycontin for
a few different reasons. First our narcotic prescribing laws here in the state of Florida will not
allow treatment of chronic non-cancer pain unless we are a pain management specialist. We
would not be treating her as acute pain which would be treating with a 3 day script because of
her assumed long-standing history (leg.state.fl.us). Additionally, the lack of information and
only our first visit we do not have enough information to adequately treat this patient or assist in
potentially changing her medication to a non-opiate drug.
Apply the steps in SBIRT to this scenario
S-Screening
In the past 3 months how often have you used the substance that you mentioned?
Daily/weekly/monthly?
How long have you been taking the oxycontin?
Does it interfere with your normal activities of daily living?
Have you had any trouble with health, social, legal or financial problems with taking oxycontin?
Have you had any trouble with fulfilling obligations at home, school or work?
This study source was downloaded by 100000847426977 from CourseHero.com on 05-19-2022 12:29:09 GMT -05:00
https://www.coursehero.com/file/135965409/Week-7-opiate-abusedocx/
, Has a family member or friend expressed any concern about your use of oxycontin?
Has she ever tried to reduce or stop taking the oxycontin?
Each of the questions are scored and would provide a way to quantify her severity and risk
NIDA-Modified ASSIST screening. Her overall score would direct further care.
BI-Brief Intervention
Review her screening total and why it is used with opiates.
Discussing the dangers of addiction and potential concerns.
Other options available for adequate pain management.
Assessing if she would like assistance or to transition to something else.
Referral and Treatment
Depending on her risk assessment score we would make a decision on referral
Evaluation of her motivation and understanding of the concerns with opiate use
Identify additional questions for this patient
Do you take other prescription opiates other than oxycontin?
What is your diagnosis and who diagnosed you?
Who does she currently see for chronic pain management?
What dosage did she start on and what is the dosage on now?
How many pain pills do you take per day?
What other medications has she taken for pain control?
Are you having to take more to achieve pain relief?
Have you consulted with the prescribing doctor to let them know you may need to fill early?
How is it prescribed-daily use or PRN?
Have you had a change in your medication or an increase in dosing recently?
How often is it filled?
Develop a treatment plan for this patient
A comprehensive history and physical would need to be performed with it only being our first
appointment.
Diagnostic labs
E-Forced or use of electronic controlled medication monitoring reviewed
Request for medical records from other treating providers
Medication Reconciliation
Discuss other options
Encourage her to call her prescribing physician to discuss her concerns
Explain the state statutes on prescribing opiates/controlled for acute pain vs. chronic pain
Schedule a follow up complete physical
2.The patient is a 24-year-old man brought to your clinic by his family for an evaluation.
The patient states that he is struggling with prescription pain pills and wants help. He
appears to be in opioid withdrawal; he describes anorexia and diarrhea, he is yawning and
This study source was downloaded by 100000847426977 from CourseHero.com on 05-19-2022 12:29:09 GMT -05:00
https://www.coursehero.com/file/135965409/Week-7-opiate-abusedocx/
The patient is a 58-year-old woman with chronic pain due to inflammatory arthritis. She
presents for her first appointment with you in a primary care office. She states that she is
aware that she is asking for an early refill of her Oxycontin however she is traveling out of
state and she is concerned that she may have a flare up on her trip.
SBIRT is a reliable screening tool that can be completed within a few minutes. Most patients
who are screen annually do not need a further workup nor referral. The earlier a provider can
intervene with identifying potential misuse or abuse of drugs and/or alcohol the better the
prognosis.
Inflammatory arthritis can be debilitating and there are several different types of inflammatory
arthritis. This patient presenting for her first appointment with us and then requesting an early
refill on oxycontin is a little concerning. Most patients who have chronic pain and are on these
types of medications are typically under the care of pain management specialists. We do not
have any information on this patient, have never performed a thorough history and physical or
even reviewed past medical consultations. We should not prematurely judge or jump to
conclusions; however, we must investigate and understand the situation more comprehensively.
Is it autoimmune arthritis, crystalline arthritis, osteoarthritic arthritis etc., the different unknown
variables will inevitably change the course of management and treatment (Poudel, Goyal,
Bansal,et.al.,2021).
We can perform the SBIRT but it most likely will be inconclusive until we have more
information to review. She would be assessed using the NIDA quick screen which would be
positive, and we would move to the NIDA lifetime use of one or more substance (Goroll and
Mulley, 2014). Building the trusting rapport with this patient is vital in influencing her decision
making or transition to a non-opiate medication. At this time, I would not fill her Oxycontin for
a few different reasons. First our narcotic prescribing laws here in the state of Florida will not
allow treatment of chronic non-cancer pain unless we are a pain management specialist. We
would not be treating her as acute pain which would be treating with a 3 day script because of
her assumed long-standing history (leg.state.fl.us). Additionally, the lack of information and
only our first visit we do not have enough information to adequately treat this patient or assist in
potentially changing her medication to a non-opiate drug.
Apply the steps in SBIRT to this scenario
S-Screening
In the past 3 months how often have you used the substance that you mentioned?
Daily/weekly/monthly?
How long have you been taking the oxycontin?
Does it interfere with your normal activities of daily living?
Have you had any trouble with health, social, legal or financial problems with taking oxycontin?
Have you had any trouble with fulfilling obligations at home, school or work?
This study source was downloaded by 100000847426977 from CourseHero.com on 05-19-2022 12:29:09 GMT -05:00
https://www.coursehero.com/file/135965409/Week-7-opiate-abusedocx/
, Has a family member or friend expressed any concern about your use of oxycontin?
Has she ever tried to reduce or stop taking the oxycontin?
Each of the questions are scored and would provide a way to quantify her severity and risk
NIDA-Modified ASSIST screening. Her overall score would direct further care.
BI-Brief Intervention
Review her screening total and why it is used with opiates.
Discussing the dangers of addiction and potential concerns.
Other options available for adequate pain management.
Assessing if she would like assistance or to transition to something else.
Referral and Treatment
Depending on her risk assessment score we would make a decision on referral
Evaluation of her motivation and understanding of the concerns with opiate use
Identify additional questions for this patient
Do you take other prescription opiates other than oxycontin?
What is your diagnosis and who diagnosed you?
Who does she currently see for chronic pain management?
What dosage did she start on and what is the dosage on now?
How many pain pills do you take per day?
What other medications has she taken for pain control?
Are you having to take more to achieve pain relief?
Have you consulted with the prescribing doctor to let them know you may need to fill early?
How is it prescribed-daily use or PRN?
Have you had a change in your medication or an increase in dosing recently?
How often is it filled?
Develop a treatment plan for this patient
A comprehensive history and physical would need to be performed with it only being our first
appointment.
Diagnostic labs
E-Forced or use of electronic controlled medication monitoring reviewed
Request for medical records from other treating providers
Medication Reconciliation
Discuss other options
Encourage her to call her prescribing physician to discuss her concerns
Explain the state statutes on prescribing opiates/controlled for acute pain vs. chronic pain
Schedule a follow up complete physical
2.The patient is a 24-year-old man brought to your clinic by his family for an evaluation.
The patient states that he is struggling with prescription pain pills and wants help. He
appears to be in opioid withdrawal; he describes anorexia and diarrhea, he is yawning and
This study source was downloaded by 100000847426977 from CourseHero.com on 05-19-2022 12:29:09 GMT -05:00
https://www.coursehero.com/file/135965409/Week-7-opiate-abusedocx/
