Essay (any type) (Essay Sample)

Week 11 Discussion 1: Opioid Use Discussion Prompt Value: 100 points Due: Create your initial post by Day 4, and reply to at least two of your classmates’ posts by Day 7. Grading Category: D Reply Posts Read your peers’ posts and respond to at least two of your peers. In your posts, critique the plan by answering the following questions: Does the clinical decision and treatment plan follow guidelines? Why or why not? Is anything missing from the plan? Compare your peer’s plan to yours. What are the advantages and disadvantages of each? Your response should include evidence of review of the course material through proper citations using the APA format. 2 references per reply = 4 total by Loretta-Marie Lane - Tuesday, 12 March 2024, 12:52 PM Week 11 Discussion 1: Opioid Use What symptoms of substance abuse disorder does the individual in the video present with? The patient Joe in this video exhibits symptoms of a polypharmacy-related substance use disorder due to his current medication regimen; he shares non-prescription medications with his spouse; he experiences withdrawal symptoms when certain drugs for the complaint of chronic pain (unspecified) are stopped, such as shaking, sweating, and chest pain; emergency room visit in an ambulance, he experiments with recreational drugs and alcohol at festivals and is surrounded by friends who also lead this dangerous and risky lifestyles. The suggestion of treating anxiety was met with immediate no, with no possibility despite the symptoms also resemble anxiety. He is also vocal on which medications work best for him. He also recently had a doctor stop prescribing for him recently. Joe meets the DSM-5, for OUD which is defined as recurrent opioid use within a 12-month period that results in issues or distress when two or more of the following occur: Continuous opioid use in the face of declining physical or mental health; Persistent opioid use in the face of social and interpersonal repercussions; Reduction in social or recreational activities; Difficulty performing professional duties at work or school; Prolonged time spent obtaining or recovering from opioid use; Overindulgence in opioids; Cravings for opioids; Inability to cut back on opioid use; Development of tolerance to opioids; and Persistent opioid use in the face of danger (Dydyk et al., 2024). What are other possible symptom causes? Other possible causes for Joe’s symptoms include a Mood disorder for example, mood disorders drive people to turn to drugs and alcohol to cope with their negative affective states. The substances may initially reduce or moderate the symptoms of mood disorders, but withdrawal and chronic abuse usually exacerbate mood degradation, leading to increasing abuse and ultimately dependence (Quello et al., 2005). Some symptoms variations that mimic Substance Abuse Disorder(SUD) includes manic episodes marked by grandiosity, impulsivity, irritability, increased psychomotor activity, delusions, or hallucinations. Or when patients display depressive symptoms like depression, sadness, guilt, loss of interest in enjoyable activities, thoughts of self-harm, or suicide (Sekhon & Gupta, 2023). What additional information would you like to have about this case? Things that are needed for diagnosing an OUD include laboratory tests like blood tests for liver panel including Hep B and C, total blood count (particularly in the presence of any endocarditis-related or bacterial infection symptoms) (Module 5: Assessing and Addressing Opioid Use Disorder (OUD), n.d.), Complete metabolic panel for disturbances, urine drug test, Patient monitoring record for controlled substances, and ask about Narcan prescriptions or overdose, previous providers, past records from doctor’s record release signature required including ER record for the ambulance ride he talked about, and current medication reconciliation including the shared medications. Method of administration (examples like oral, intravenous, intranasal) can help gauge likelihood of severe withdrawal or possible infections, which will influence further testing and the need for counseling, or past attempts of recovery (Module 5: Assessing and Addressing Opioid Use Disorder (OUD), n.d.). Also the ability for the patient to sign a medication patient agreement. What would you prescribe for this individual? Why or why not? Unless the extra information above is acquired and submitted for review. I would not prescribe for this individual. There is a high risk with OUD not only for his health but diversion to others which would make any provider uncomfortable. Research warns when dealing with new patients who have strange stories or unusually high or low medication comprehension. They may also exhibit resistance to treatment, strange symptoms, specific drug requests, a lack of willingness to cooperate, thorough care, the use of patient medication agreements, or protection of your prescriptions by not allowing access (Cole, 2001). What would your next steps be for this individual? What would your treatment plan be? The next step for this individual is getting all his information together, starting laboratory work-up, screenings like the The Clinical Opiate Withdrawal Scale (COWS) is specific to opiate withdrawal and measures things like pulse rate and pupil size. The Clinical Institute Withdrawal Assessment (CIWA) is designed for alcohol withdrawal and focuses on symptoms like tremors and agitation (What Is the Clinical Opiate Withdrawal Scale (COWS)? - Still Detox, 2023). Start a patient agreement to counseling before prescribing, and gauge what the patient’s readiness to treatment is. References Cole, B. E. (2001, October 15). Recognizing and preventing medication diversion. AAFP. https://www.aafp.org/pubs/fpm/issues/2001/1000/p37.html Dydyk, A. M., Jain, N. K., & Gupta, M. (2024, January 17). Opioid use disorder. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK553166/ Module 5: Assessing and Addressing Opioid Use Disorder (OUD). (n.d.). https://www.cdc.gov/drugoverdose/training/oud/accessible/index.html Sekhon, S., & Gupta, V. (2023, May 8). Mood disorder. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK558911/ Quello, S., Brady, K. T., & Sonne, S. C. (2005). Mood Disorders and Substance use disorder: a complex comorbidity. Science & Practice Perspectives, 3(1), 13–21. https://doi.org/10.1151/spp053113 What is the Clinical Opiate withdrawal Scale (COWS)? - Still detox. (2023, December 15). Still Detox. https://stilldetox.com/opioids/clinical-opiate-withdrawal-scale-cows/#:~:text=and%20comprehensive%20therapy.-,CIWA%20vs%20COWS,pulse%20rate%20and%20pupil%20size. Student 2 Re: Week 11 Discussion 1: Opioid Use by Lisa Mack - Tuesday, 12 March 2024, 3:04 PM Joe is seeking medication for chronic pain. It is uncertain how long he has been taking oxycodone as prescribed by his doctor, but he endorses that for the past two weeks he has experienced symptoms of elevated blood pressure, diaphoresis, chest tightness and sleep issues. He reports the use of substance use, both alcohol and hallucinogenic drugs, in combination with the prescribed oxycodone. He reports combining oxycodone, an opioid, with clonazepam, a benzodiazepine. He has combined medications that were not prescribed since he took the benzodiazepine from his wife. He is using medication at higher levels as he states “popping pills” without knowledge of his prescribed dose. According to DSM-V criteria for opioid use disorder (OUD), the patient is exhibiting a strong urge for opioid use since he is going to extreme measures to obtain medication and he is combining higher doses of medications despite experiencing physical symptoms that are as a result of the opioid use. It appears he is seeking opioids for non-medical use (APA, 2017). Joe is exhibiting tolerance and withdrawal symptoms. What are other potential symptom causes? Joe has taken medications from his wife so he is seeking more medication likely due to tolerance, addiction, or withdrawal. He is exhibiting compulsive behaviors to obtain opioids which contributes to addiction. He is showing physical symptoms of alcohol addiction and increased tolerance with elevated pulse, sweating, and insomnia. Additional signs of addiction includes hallucinations, tremors, nausea, vomiting, seizures and potential death (Stahl, 2021). Joe is presenting with potential opioid withdrawal since he has reduced access to opioid There needs to be a comprehensive medical and psychiatric history obtained for this patient which will include past medical diagnosis, medications, allergies, family and social history. A urine drug test, and hepatic function panel are indicated for this patient. Vital signs and screenings for anxiety, depression, tobacco, alcohol, prescription medicine and other substances (TAPS) would be performed in an office visit. Obtaining prior medical records are appropriate measures. Calculations of the opiate withdrawal score would be a recommended tool (Wesson, 2021). What would you prescribe for this patient? The patient is abusing opioids and combining medications of abuse. He has admitted to concomitant use of alcohol, psychedelics, opioids, and benzodiazepine. He is a risk to self so safety measures and education on medications needs to be discussed. Treatment for the patient includes pharmacological and psychosocial treatment. Therapy should be devised that is patient centered with a shared decision making process. After proper assessment and confirmed diagnosis of OUD, initiation of Suboxone (buprenorphine/naloxone) 2mg/0.5 mg sublingual tablet would be prescribed (VA/DoD, 2021). Suboxone medication has improved remission rates and reduced mortality rates in management of opioid use disorder (Paul et al, 2023). Lab would need to be initiated to rule out hepatic disease. Avoid abrupt withdrawal. Monitor respiratory rate, blood pressure, dental care (Epocrates, 2024). Medication adherence, adverse reactions and goals of treatment are reviewed. Another alternative for delivering medications is through weekly or monthly injections. Studies in Australia noted improved adherence,reduced expense, and ease of access of extended release buprenorphine injections were preferred for treatment for opioid use disorder (Larance et al, 2020). What are your next steps? What is the treatment plan? The treatment plan entails assessment of all substances of abuse, education on substance use disorders, motivation for change, protective factors and risk factors for relapse, and the patients social, cultural and home environment. Psychotherapy will assist with changing behavioral patterns through cognitive behavior therapy, family therapy, and self-help groups (NICE, n.d). May need to increase dose to relieve withdrawal and cravings. Due to chronic pain as reported by patient, dosing can be divided into twice a day dosing. Close monitoring of central nervous system depression. Ensure no other medications are added to avoid drug interactions or adverse effects. Patient education on long-term treatment. Review risks of overdose and death with combined use of alcohol, benzodiazepines, and antidepressants. Contingency management is recommended to enforce adherence, reward systems, and reinforcement to gain active and consistent care (VA/DoD, 2021). There is a growing focus on harm reduction models to increase access to interventions and reduce substance and opioid use. The methods provide alternative ways to reduce overdose, improve access with mobile clinics, acceptance to reduce stigma, and education on safer injection techniques for IV drug use. While abstinence is the source..