Requirements

Complete the following case studies:

1. 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.

  • Apply the steps in SBIRT to this scenario
  • Identify additional questions for this patient
  • Develop a treatment plan for this patient

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 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.
  • Include your rationale for each treatment decision
  • Develop a treatment plan for this patient that includes ongoing MAT and psychosocial treatment interventions.
  • Construct a safe taper schedule for a patient taking alprazolam (Xanax) 2mg TID. Include a brief narrative explaining the evidence for tapering a patient who has been on a benzodiazepine for an extended amount of time.

Solution

  1. 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.
  2. Apply the steps in SBIRT to this scenario
    1. SBIRT stands for screening, brief intervention, and referral to treatment. It is a public health framework to identify and deliver services to those at risk for substance use disorders, depression, and other mental health conditions. Primary care is the first entry to the healthcare system for many patients, and this tool allows these patients to be identified early on (Hargraves et al., 2017).
    1. Screening includes assessing for the presence of risky substance use, following positive screens with further assessment of problem use, and identifying the appropriate level of treatment. Questions posed during assessment may  include: asking how many times in the past year the patient may have used an illegal or prescription medication for non-medical reasons, asking if they  use more than one drug at a time, asking whether they  can stop using the drug,  asking if  they ever blackout, and if they  ever feel guilty or bad about drug use, asking if the spouse or family complain about their drug  usage, asking if they have  neglected family because of  use of drugs, whether they have  engaged in illegal activities to obtain drugs,  whether they have ever felt sick if they  didn’t take it, and if they  ever had memory loss, hepatitis, convulsions, or bleeding from using the drug (Hargraves et al., 2017)….Kindly click the purchase icon to purchase the full solution at $10