Submitted by Pam Shultz, MD, FASM
A 20 yo male was admitted to his first residential CD treatment for opioid use disorder. He has a 3yr. hx of opioid use and has been injecting heroin IV daily for the last 6 mos. He was detoxed with Suboxone and then given gabapentin. However, after 3 wks. of treatment he has a conflict with a peer. He decides to leave treatment ASA, and cannot be dissuaded. He admits that he is having significant cravings for opioids. He is warned of the risks of opioid overdose due to loss of tolerance, but patient insists that he is not going to go back to using opioids. He refuses any referrals for outpatient treatment.
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