Posted: February 22nd, 2022
original discussion post
1. 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 sweating upon examination. He scores 15 on the Clinical Opioid Withdrawal Scale (COWS), indicating moderate withdrawal.
Initiate office-based buprenorphine/naloxone (Suboxone) with a plan for observation.
Multiple interventions can be used to treat opioid physical dependence. A common effective approach is office-based buprenorphine/Naloxone (Suboxone) treatment for opiate dependence (Sokol et al., 2018). The motivation for prescribing these drugs is their analgesic potency and a lack of accommodation for people desiring therapy for opiate addiction. It is recommended that the patient abstains from opioids for 12–24 hours or 24-36 hours (Beetham et al., 2019). The length of abstinence varies depending on the substance the patient is dependent on. The office-based treatment plan for the 24-year-old patient begins with a discussion and agreement of the terms of treatment with the patient. This process precedes the initial prescription. Other vital activities include laboratory tests to assess the patient’s liver function, urine toxicology, and complete blood count (CBC). The patient’s score on the Clinical Opioid Withdrawal Scale (COWS) is 15, which indicates moderate withdrawal.
2. Include your rationale for each treatment decision
The drug choices are based on evidence-based efficacy and positive outcomes. For instance, buprenorphine is needed to lessen withdrawal symptoms linked to opiate addiction (Sokol et al., 2018). Both buprenorphine and suboxone are also used generally for maintenance therapy. Since this patient has a high potential for abuse, it is reserved for detoxification purposes. According to Sokol et al. (2018), liver function assessments are required to minimize adverse drug-related risks to the liver since buprenorphine has moderate risks of liver toxicity, especially when ingested sublingually. Since induction appointment is only recommended after the patient has achieved moderate withdrawal, the 12-24 hours and 24-36 hours’ opioid abstinence is vital.
Treatment Plan Involving Ongoing MAT and Psychosocial Treatment Mediations
The patient should be enrolled in a Methadone-buprenorphine/naloxone-based treatment to reduce opioid dependence and restore balance. According to Food and Drug Administration (FDA) (2019), it is best to prescribe both methadone and buprenorphine for opioid agonist maintenance treatment. When one medication results in adverse effects on the patient or the patient fails to respond, the alternative will work. Therefore, to increase the effectiveness of the treatment, I will administer both methadone and buprenorphine to the patient. He should also commence psychotherapy to acquire mechanisms for developing better behavioral and thinking patterns that will help him resist opioid use. Cognitive-behavioral therapy is the best approach for behavioral changes because it will prompt the patient to identify and modify troubling patterns that adversely influence behaviors and emotions that trigger opioid use and dependence. The therapy will also form a basis for discussing factors influencing the patient’s substance dependence.
instructor question: discussion please include medication and dosage in MG
Case #2: You mentioned tapering over a period of time and percentages. How will the patient know how much and how frequent to take the drug? What drug will you use for the taper? How often will the patient need to see you during this time?
please use USA scholarly peer reviewed research within the last 5 years thank you!
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