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Read your peers’ posts and respond to at least two of your peers. In your post, critique your peers responses by answering the following questions:

1-Do you agree/disagree with the plan?

2-Is anything missing from the plan?

3-Compare your peers’ 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 APA format. Reply separately to two of your classmates’ post (see attached classmates, post#1 and post#2)

***Important: Need at least one reply for Saturday before 10 pm Easter time

Your response should include evidence-based research to support your statements using proper citations and APA format.

Please, send me the two documents separately, for example one is the reply to my peers Post#1, and the second one is the reply to my other peer Post#2.

-Minimum of 300 words per peer reply.

-Turnitin Assignment.

Background: I live in South Florida; I am currently enrolled in the Psych Mental Health Practitioner Program. I am a Family Nurse Practitioner working in psychiatric area.

Post#1 Opioid Use by Ivan

What symptoms of Substance Abuse Disorder does the individual in the video present with?

Various symptoms of the substance use disorder noted in the case study are as follows. One of them is taking a more significant number of drugs over a longer time than intended. The patient in the case study asserts that he has been taking the hallucinogenic drug to stay awake over the night in almost all the Indian ceremonies he has attended. He also reports taking Percocet or Oxycontin over an extended time to relieve pain. Another symptom that the patient in the video presentation is an intense desire or unsuccessful effort to cut down opioid use. Individuals with substance disorders find it hard to cut down the substance use once they start taking the drug (Conrod & Nikolaou, 2016). The individual in the case study finds it hard to cut down Percocet or Oxycontin. He is even coming to the provider to look for these drugs. This shows that the patient has a substance use disorder. The other symptom that the patient presents with is problems fulfilling their daily obligations both at home and the workplace. The patient in the case study asserts that he can no longer bounce like he used to. And the last symptom evident in the case study is chronic pain. Continued use of opioids can likely lead to physical problems such as chronic pain that can likely worsen the patient’s conditions. The patient in the video complains of chronic pain and sweating, meaning that the continued use of opioids has declined his health condition.

What are other possible causes of his symptoms?

Some other causes of his symptoms are as follows. The first one is genetic variability. Some substance use disorders flow in the family lineage; if the parent had the condition, there is a high probability that the child too could have the disease (Patel et al., 2017). In our case study, if the patient comes from a family with opioid/substance use disorder, there is a high probability of having the condition. Another cause of the symptoms is the poor stress system response. Whenever some individuals are distressed, they are likely to turn to some drugs to relieve this stress. Some others may turn to substances such as opioids so that they can have some sleep. In the video, the patient reports having some chronic pain. The stress from such pain could expose him to opioids, eventually resulting in substance use disorder. And the last reason for the condition is prior opioid experimentation or increased exposure. This patient could have been exposed to some opioids that may have brought all these issues when growing up. In the video, the patient notes how they could take hallucinogenic drugs to stay awake all night. Such drugs could be the eventual cause of the symptoms that he exhibits.

What additional information would you like to have about this case?

Some additional information that I could have wanted to know about the case study are as follows. First, I would like to know whether any other family members have mental disorders. Some mental conditions, such as substance use disorders, run in the family (Patel et al., 2016). It is, therefore, vital to understand such data to examine how to best address the patient’s condition. I would also like to know whether the patient has ever taken any therapeutic intervention in the past. The provider in the case study has done a superb job by interviewing the patient about his past medication. However, the provider fails to enquire whether the patient has ever visited a therapist. Understanding such information would help the provider know the best intervention to provide. And the last thing that I would like to know is the patient’s functioning at the workplace. Understanding his functioning would help the provider examine the severity of the symptoms and the best way to address them.

Would you prescribe for this individual? Why or why not?

I would prescribe medication for this individual. But I would not prescribe the medicines (Percocet or Oxycontin) that he talks about it. Instead, I would give him a medication that helps would help him manage the pain and treat the drug addiction. One of the medications that would greatly help do this is methadone. Prescribing this medication would help relieve pain as well as manage other symptoms of opioid mental disorder.

What would your next steps be for this individual? What would your treatment plan be?

The treatment plan for this individual would incorporate both psychotherapy and pharmacotherapy. Psychotherapy that would best address the symptoms of the patient is motivational interviewing (MI). MI is a patient-centered approach that helps individuals find the motivation to make a positive behavior change (Madson et al., 2016). The method is mainly used on patients who have mixed feelings about changing their behaviors. When offering the intervention, I would apply various MI concepts, including evocation rather than education, rapport, and empathy, to help the patient develop his problem. Besides, I would incorporate methadone in the treatment plan to alter the patient’s behaviors, i.e., addiction, and relieve his pain. To manage the disorder, the patient should take 2.5 mg PO q8-12hr, titrated slowly with dose increases no more frequent than every 3-5 days. This synthetic opioid agonist medication eliminates pain and relieves drug cravings by acting on opioid receptors in the brain (Murphy, 2018). However, before administering the medication (Methadone), the provider should monitor Urine, saliva, hair, and blood tests to detect the presence of drugs in the patient’s system.

References

Conrod, P., & Nikolaou, K. (2016). Annual Research Review: On the developmental neuropsychology of substance use disorders. Journal of Child Psychology and Psychiatry, 57(3), 371-394.

Madson, M. B., Schumacher, J. A., Baer, J. S., & Martino, S. (2016). Motivational interviewing for substance use: Mapping out the next generation of research. Journal of Substance Abuse Treatment, 65, 1-5.

Murphy, M. (2018). Blueprints psychiatry. Lippincott Williams & Wilkins.

Patel, V., Chisholm, D., Parikh, R., Charlson, F. J., Degenhardt, L., Dua, T., … & Whiteford, H. (2016). Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities. The Lancet, 387(10028), 1672-1685.

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Opioid abuse

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Opioid Use

What symptoms of Substance Abuse Disorder do the individual in the video present with?

The patient feels excess confidence and exhilaration evident in how he answers the doctor confidently explaining that his health problems are so numerous that he can be used to teach a whole health encyclopedia. The opioid drugs are mainly used to relieve intense pain or chronic pain as mentioned by the patient. As a result of continued use, he became addicted to the substance, and he cannot do without it. The patient also explains the shortness of breath as tightness of the chest and also starts sweating. This is also a sign and symptom of opioid substance abuse. He developed panic attacks two weeks ago and has fragging attacks. The patient is struggling with addiction with medication since when he happened to forget the medication at home while on a road trip, he developed a complication that necessitated calling the ambulance but later he recovered when he took Oxycontin drugs which change how the body responds to pain and falls in the class of opioid analgesics (Koehl et al., 2019). He explains that the trip became stressful than normal before he got himself some alternative drugs. He does not have a specific dosage of the drugs and he pops the pills as he desires until he achieves satisfaction and to him, the dosage is not known. He explains that he pops the pills he is given. Whenever the patient takes the drugs his pain attacks are relieved and he returns to normal, a sign that he is dependent on opioid-related drugs.

What are other possible causes of his symptoms?

The patient must be having chronic disease especially cancer that requires him to use opioid-based drugs as painkillers which have resulted in his addiction due to continuous usage. The patient also has high blood pressure and diabetes. He uses multiple drugs and is in the habit of sharing drugs with his friends he explains, “Mark cut my dosage about three weeks ago.” As a result, his symptoms may keep varying due to different side effects of drugs. He changes to Ambien and Klonopin and takes without a doctor’s prescription since he takes some from his wife so that he can fight his insomnia and find some sleep. He has a problem mixing medications in addition to alcohol consumption. The patient confesses to using a hallucinogenic drug which they share with his friends, ‘you stay up all night, the drums are beating all night long and you’re in a sweat lodge hallucinating with other people.’

What additional information would you like to have about this case?

  As the patient describes, his wife too has chronic pains, and she uses some drugs. This indicates they have some serious chronic illness that requires serious medical attention, but the main concern is whether the client has reliable doctors who follow up his patient treatment plan. Does that doctor he claims to have as a friend advise him on dosage whenever he plans to change his type of medication? The client and his wife lack a serious treatment plan and the focus is majorly on relieving symptoms. The case does not present treatment for the high blood pressure and diabetes as mentioned by the client. The case also lacks information on appropriate dosages that the client should take in case of alternative drugs. The case does not present any clinical visits or consultations with the mentioned doctors whom the part with until the pain becomes severe and he comes to the doctor presented in the case. It would also be important to inquire from the patient whether he has considered at any time using the wife’s medications to relieve his own needs. This would further help in identifying possible misuse of other drugs beyond those described for the patient. The information would inform the extent to which possible addiction would be managed and for which medications (SAMHSA, 2020).

Would you prescribe for this individual? Why or why not?

  The patient needs a treatment plan for the opioid addiction and therefore prescription should be made for other drugs rather than those of opioid nature. The major health challenge for the client is opioid addiction and before treating any other symptoms, the patient’s addiction should be treated to give room for ease of treatment of other ailments. The advantage of addiction treatment is that it concurrently works with chronic pain treatment. Prescribing for the patient would exacerbate the current health problems presented by the client. Further, with the patient demonstrating non-adherence behaviors characterized by the sharing of his prescriptions with friends, this may be a signal of abuse of the medications not just by hum but by people around him (SAMHSA, 2020).

What would your next steps be for this individual? What would your treatment plan be?

The treatment plan can be done in three approaches, either as opioid detoxification, agonist, or antagonist maintenance as deemed best by the healthcare provider. The only antagonist Naltrexone agent available is unsuccessful in retention of treatment and removal of the illicit substance therefore the alternative agonist agents such as methadone hydrochloride, levomethadyl acetate, and buprenorphine hydrochloride can be prescribed (Garland et al., 2019). Oral methadone hydrochloride starts the action in 30 minutes and its effective action can last for 24-36 hours and this would be the medication of choice in this patient case. This unique pharmacological property makes the drug easy to maintain for a once-per-day dosage. When used to treat chronic pain as well as treat opioid drugs addiction it has to be taken thrice per day. When the dosage is judiciously titrated the patient may not experience sedation or impairment that can affect their daily tasks. The drug advantageously reduces narcotic craving which is the main cause of relapse. This drug is available in 5-10mg tablets, but an intravenous solution is also available but linked to bradycardia when administered for sedation. The oral dosage has manageable mild side effects (Volkow et al., 2019). A starting dosage of 5mg will be prescribed for the next four weeks. Importantly, the patient will be enrolled into a counseling therapy program for the next 12 weeks. The program will focus on identifying the exposure and trigger factors in the patient’s environment and therefore work on avoidance, and coping strategies for the patient (Garland et al., 2019).

References

Garland, E. L., Hanley, A. W., Riquino, M. R., Reese, S. E., Baker, A. K., Salas, K., … & Howard, M. O. (2019). Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial. Journal of Consulting and Clinical Psychology87(10), 927.

Koehl, J. L., Zimmerman, D. E., & Bridgeman, P. J. (2019). Medications for management of opioid use disorder. American Journal of Health-System Pharmacy76(15), 1097-1103.

SAMHSA. (2020, August 19). MAT medications, counseling, and related conditions. SAMHSA – Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions

Volkow, N. D., Jones, E. B., Einstein, E. B., & Wargo, E. M. (2019). Prevention and treatment of opioid misuse and addiction: a review. JAMA psychiatry76(2), 208-216.

Post#2 Opioid Use by Edina Boros

What symptoms of Substance Abuse Disorder does the individual in the video present with?

Joe presents with the following symptoms, which point to a substance abuse disorder: Joe is taking a higher dose of medication than intended. At least, that is what his vague answer to the question of how many pills he takes indicates that. It might also signal that he developed physical tolarenece toward the drug as well. Joe takes medication categorized as a controlled substance that is not prescribed to him (usdoj.gov, 2021). He reports increased anxiety when he has no access to the drug. He reports symptoms that could be due to opioid withdrawal, such as muscle aches and pain, insomnia, and sweating (Shah, 2021). Joe also exhibits drug-seeking behavior. He asks for the medication by name and is reluctant to discuss his complaints with the provider. He becomes irritable when questioned about his symptoms and is more concerned about the drug than his medical complaints. He also asks for pain medication to address his panic attack (James, 2016).

What are other possible causes of his symptoms?

His underlying heart disease can cause shortness of breath, sweating, and chest tightness. A panic attack or anxiety might cause the same symptoms as well.

What additional information would you like to have about this case?

What is the reason he started to take pain medication, and how long ago? Is the original condition resolved? Details of his history of substance abuse. Is he a smoker? What medications does he take for his medical conditions? Allergies. When was the last time he took opioid medication or his wife’s Klonopin? Is he employed? Any history of depression and anxiety, any other mental illness. Has he ever participated in alcohol/drug detox/rehab treatment? How much alcohol does he consume? Any problems in close relationships. Does he think his prescription misuse is a problem? How does his family feel about his medication misuse?

Would you prescribe for this individual? Why or why not?

I would not prescribe a controlled substance for Joe due to his drug-seeking behavior. I would perform a more detailed assessment and develop the treatment plan based on additional information.

What would your next steps be for this individual? What would your treatment plan be?

I would perform assessments targeting substance abuse severity, such as the Clinical Opiate Withdrawal Scale (COWS). Depending on what Joe reports of his alcohol consumption habit, I would also include the Clinical Institute Withdrawal Assessment for Alcohol (CIWA). The treatment plan would be based on the additional information I obtain and the patient’s willingness to participate in treatment. Using motivational interview skills, the provider could explore what the patient sees as a problem and what steps he is willing to take to change them. Treatment for opioid withdrawal is an option that could be an inpatient program under tight supervision. Depending on the severity of the withdrawal symptoms, it could be outpatient treatment with long-acting injectable naltrexone (Stahl, 2013).. Psychotherapy should be involved in the treatment, such as cognitive behavior therapy, dialectical behavior therapy, or motivational interviewing.

References

Controlled Substance Schedules. Controlled substance schedules. (2021). Retrieved November 5, 2021, from https://www.deadiversion.usdoj.gov/schedules/.

James, J. (2016, June 1). Dealing with drug-seeking behavior. Australian prescriber. Retrieved November 5, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919169/.

Shah, M. (2021, October 11). Opioid withdrawal. Stat Pearls [Internet]. Retrieved November 5, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK526012/.

Stahl, S. (2013). Essentials of Psychopharmacology, (4th edition). United Kingdom, Cambridge University Press, ISBN-13: 978-1107025981

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