Section: Case Study Practice | Buprenorphine Training: Treating Opioid Use Disorder | NextGenU.org
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Case: John, a 35-year-old male, presents to the ED with signs of opioid withdrawal. He is restless, anxious, exhibiting profuse sweating, and complaining of body aches. John confirms that he has been using heroin for the past seven years and had his most recent dose about 14 hours ago. He expresses a desire to quit using but has failed to manage withdrawal symptoms on his own.
Activity: Analyze this case according to these prompts:
- Using your knowledge of the Clinical Opiate Withdrawal Scale (COWS), identify and rate the withdrawal symptoms John is demonstrating.
- Discuss the suitability of ED-Initiated Buprenorphine for John, considering his opioid use history, the timing of his last use, and his current state of withdrawal.
- Describe the process of initiating Buprenorphine in an ED setting, focusing on the steps necessary to manage John's current situation and level of withdrawal.
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Students mustViewStart discussions: 1
Case: Emily, a 30-year-old female, presents to the ED with complaints of severe abdominal pain. Upon further probing, she admits to misusing prescription opioids for the past 18 months, specifically OxyContin. The last time she took the pills was 36 hours ago. She expresses wanting to quit but is fearful of withdrawal symptoms.
Activity: Analyze Emily's case and answer the following prompts:
- Identify and rate the withdrawal symptoms Emily might be experiencing, using the COWS as a guide.
- Discuss the risks and benefits of initiating Buprenorphine for Emily, considering her opioid use history, the time since her final use, and her current symptoms.
- Explore potential complications due to Emily's complaint of severe abdominal pain. Discuss how to manage this situation while considering her withdrawal.
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Students mustViewStart discussions: 1
Case: Alex, a 22-year-old college student, is brought to the ED by his roommate who found him in a state of distress, complaining of restlessness, irritability, and abdominal cramping. Alex admits to misusing prescription opioids, particularly Percocet, for about two years and his latest intake was 20 hours ago.
Activity: Analyze the provided case, considering the following:
- Using the Clinical Opiate Withdrawal Scale (COWS), rate the symptoms that Alex is showing.
- Discuss the applicability of ED-Initiated Buprenorphine for Alex. Consider factors like his opioid use history, the timing of his last use, and current withdrawal symptoms.
- Discuss the protocol for Buprenorphine administration in the ED, focusing on the steps required for Alex's current case.
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Students mustViewStart discussions: 1
Case: Sarah, a 40-year-old woman, presents to the ED with feelings of nausea, sweating, and shaky hands. She reveals she has been misusing her husband's prescribed Oxycodone for six months. The last time she took the prescription opioid was about 30 hours ago.
Activity: Analyze Sarah's case, considering the following:
- Using the COWS scale, identify and rate the withdrawal symptoms Sarah is demonstrating.
- Discuss the indications of initiating Buprenorphine in an ED setting for Sarah, focusing on her opioid use history, the time since her last use, and her current symptoms.
- Deliberate on the possible complications due to Sarah's misuse of someone else's prescription and discuss how to manage this situation.
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Students mustViewStart discussions: 1
Case: Michael, a 28-year-old male, enters the ED demonstrating clear signs of opioid withdrawal. He reports feelings of intense discomfort, restlessness, excessive yawning, and runny nose. Upon questioning, he admits to using fentanyl and reports that his last dose was 12 hours ago.
Activity: Develop a comprehensive treatment plan for Michael by following these prompts:
- Reflecting on Michael's use of fentanyl, the timing of his last dose, and his withdrawal symptoms, discuss the potential induction dosage of Buprenorphine.
- Identify potential complications that might arise during the treatment process, focusing on Michael's use of fentanyl.
- Outline the necessary steps for his ongoing treatment following the ED visit, considering the accessing treatment resources in the community for patient transitioning.
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Students mustViewStart discussions: 1
Case: Lisa, a 33-year-old female, appears at the ED exhibiting signs of opioid withdrawal. Upon questioning, she confesses to using a combination of heroin and prescription opioids, specifically morphine. Her last dose was roughly 24 hours ago, and she wishes to quit.
Activity: Develop a detailed treatment plan for Lisa, focusing on:
- A discussion around the likelihood of precipitated withdrawal due to Lisa's use of both heroin and prescription opioids, including when and how to initiate Buprenorphine.
- Identification of potential complications that may arise during Lisa's treatment, specifically considering her use of a combination of opioids.
- A detailed plan for her ongoing treatment and follow-up care post-ED visit, including the consideration for community-based referrals for seamless continuity of care.
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Students mustViewStart discussions: 1
Case: Robert, a 45-year-old construction worker, arrives at the ED showing signs of opioid withdrawal. He admits to using heroin and his last dose was 16 hours ago. He expresses his readiness to quit.
Activity: Develop a comprehensive treatment plan for Robert by answering the following prompts:
- Contemplating Robert's use of heroin, the time of his last dose, and his withdrawal symptoms, discuss the potential initiation dosage of Buprenorphine.
- Identify possible complications that might arise during Robert's treatment process.
- Outline the necessary steps for ongoing treatment post-ED visit, including the process of transitioning Robert to community-based resource care.
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Students mustViewStart discussions: 1
Case: Michelle, a 37-year-old single mother, comes to the ED exhibiting signs of opioid withdrawal. She admits to using a combination of prescription opioids, specifically, she’s been misusing hydrocodone. Her last dose was approximately 18 hours ago, and she is eager to receive help.
Activity: Develop a detailed treatment plan for Michelle, considering:
- Discuss the likelihood of precipitated withdrawal due to Michelle's use of hydrocodone, and the suitable time and method to initiate Buprenorphine.
- Identify potential complications that may emerge during Michelle's treatment, considering her use of hydrocodone.
- Detail the steps for Michelle's ongoing treatment and follow-up care following the ED visit, considering the importance of family support in her case.
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