Case I-B: High Dose Opioids, New Patient, Part 2
At the end of the first visit
A patient-provider agreement and informed consent were reviewed and signed which explained monitoring strategy including urine drug tests, pills counts and review of the state prescription monitoring program data. Also patient signed a release to talk to his previous provider.
Patient was prescribed a 2 week supply of ER oxycodone 40 mg two times per day, oxycodone 5mg/acetaminophen 325 mg 1 tab up to three times per day for breakthrough pain. He was also started on gabapentin 300 mg three times per day. Patient was scheduled to follow up in 1 week.
In between the first and second visit
Physician reviewed old chart (had poor documentation of pain and function but confirmed dosing). No mention of aberrant behavior. Spoke to previous provider who has been following patient for over 20 years – before accident…and stated "patient is very “sad case”, used to be a strong guy who worked hard but now just sits around the house all day. He is always asking from more meds. I have never had any problems with him…he doesn’t seem like an addict but he is a very sad case. Nothing seems to touch his pain.”
UDT from previous visit was opiates only.