Case II: Illicit Drug Use, Established Patient
Mr. Paul Russo is a 48 year old male, established patient, who presents for follow-up who has had chronic right knee and ankle pain for the past 5 years after a motorcycle accident. He is on hydrocodone 5 mg with acetaminophen 500 mg 2 tablets 3 times per day for the past 3 years.
On routine urine drug testing his most recent urine is positive for hydrocodone and cocaine.
Posttraumatic knee pain status post infected distal femoral and ankle fracture 5 years ago. He has been on opioids and NSAIDs ever since.
His pain is always 4-5 out 10.
Other medical history:
Substance use history:
History of marijuana use 10+ years ago. He denies current use. No family history of substance abuse.
He lives with his long-term girlfriend. He is employed at a friend’s store as a cashier where he is able to sit most of the day.
Uncomfortable with ambulation. He uses a cane. His knee is deformed with very limited range of movement.
Will you continue to prescribe hydrocodone in the setting of cocaine use?