Case discussion March 2016

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. 
 
Questions:

1. Would you write this patient a prescription for Naloxone?
2. Do you prescribe Naloxone for parenteral injection , or intranasal Naloxone?
3. Do you keep a supply of Naloxone at your clinic  or facility to give to patients such as this?
4. If so, is this provided  free of charge?
5. Do you have a “Collaborative Practice Agreement” with a pharmacy to provide Naloxone to your patients?
6. Have you/do you prescribed Naloxone to families or acquaintances of opioid dependent patients?

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