Case I-A: High Dose Opioids, Part 1
John Robertson is a 62 year old male, new patient, who presents for the first visit after moving from out of state in order to live with his sick mother. He has a 15 year history of chronic lower back, bilateral hip and knee pain.
His pain started after a major motor vehicle crash 15 years ago in Florida. He required many surgeries with complicated postoperative infections requiring 2 months in the intensive care unit followed by 3 months in a physical rehabilitation program. He has been unemployed and on high dose opioids ever since his accident.
(by history and confirmed in old medical records supplied by patient)
• Fentanyl 100 mcg patch every 2 days
• ER morphine 100 mg 3 times a day
• IR oxycodone 30 mg every 3 hours
Other medical history:
He also has a history of COPD, well controlled hypertension and hyperlipidemia.
Substance use history:
He smokes 1-2 pack per day (50 pack year history), he drinks beers 2-3 times per year during the holidays. He denies drug use. No family history of substance abuse.
He is a former electrician but has been unemployed on disability since his accident. He is single and now lives with his 87 year old mother.
He ambulates using 2 canes. He grimaces when he gets in and out of the chair and has difficulty getting on and off the exam table. He has multiple well healed scars from his prior trauma/surgeries. His exam is otherwise unremarkable.
Will you prescribe the patients current regimen of fentanyl, morphine and oxycodone on this first visit?