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Opioid Use Disorder

Opioid Use Disorder

Video # or Discussion Board Prompt #

Brief description of the patient

A brief explanation of the presenting symptoms

Opioid use problems can cause physical, psychological, or behavioral symptoms. It might be difficult to determine whether someone is addicted in many circumstances. Potential opioid addiction warning signals include Coordination problems, Speech slurring (No I was seizure. I don’t have any like seizures, but when it gets really busy at work, like I said, I need to go take a pot break my), drowsiness, shaking, and sweating.

Depression, anxiety attacks (‘It’s the anxiety is what really gets me so I’ll be working behind the cooktop get a rush. It’s late at night. There’s nobody else for me there. And you know the anxiety just comes up and my hands started shaking and I don’t feel safe holding a knife chopping up ingredients for people so I’ll just step aside smoke a little and then call myself that’), irritability, drastic mood changes, and decreased motivation are some of the psychological and behavioral symptoms (Townsend & Morgan, 2018). Poor decision-making, neglect of obligations Financial difficulty, and Sleeping pattern changes are other symptoms of opioid use disorder.

Any Known Medical History, Allergies,

The video has not shown any past medical and surgical history, as well as a history of drug and food allergies, therefore, it is important for the nurse to ask these questions before commencing any treatment.

Psychiatric Diagnosis

My psychiatric diagnosis, according to the DSM V, is Opioid Use Disorder (American Psychiatric Association, 2013). The diagnostic criteria according to DSM 5 are:

  1. A chronic habit of opioid use that results in clinically substantial deterioration or distress, as demonstrated by at least two of the following over 12 months:
  2. Opioids are frequently used in greater quantities or for longer periods than indicated.
  3. There is a continuous desire or failed attempt to reduce or limit opioid consumption.
  4. A significant amount of time is spent on tasks that are required to get the opiate, use the opiates, or recuperate from its effects.
  5. A great desire consumes opioids.
  6. Repeated opioid use leads to an inability to fulfill important job responsibilities,
  7. Persistent or recurring social or interpersonal issues caused or aggravated by opioid usage.
  8. Persistent opiate usage despite the awareness of a chronic or recurring bodily or psychological condition caused or aggravated by the opioid.
  9. Tolerance, as characterized by one or both of the following:
  10. The requirement for much higher doses of opioids to produce the intoxication or the intended effect.
  11. A significantly reduced impact with repeated usage of the same dosage of opioid.
  12. Withdrawal evidenced by one or more of the following:
  13. The typical opioid withdrawal syndrome in criterion A
  14. Opioids (or a similar chemical) are used to alleviate or prevent withdrawal symptoms.

Differential Diagnosis

Opioid-induced mental illnesses -Opiate problems are common in people with opioid use disorder. Opioid-induced disorders can have symptoms similar to underlying psychiatric illnesses, for example, dysthymia.  Opiates are far less prone than other drugs to misuse to cause signs of mental instability(American Psychiatric Association, 2013). Opiate intoxication and withdrawal are differentiated from other opioid-induced disorders by the fact that the manifestations in the latter disorders dominate the symptomatology and are severe to justify independent clinical attention.

Alcohol, sedative, hypnotic, or anxiolytic intoxication can provide clinical manifestations similar to opioid intoxication. The lack of pupillary constriction or a reaction is typically enough to rule out alcohol, sedative, hypnotic, or anxiolytic intoxication(American Psychiatric Association, 2013). Intoxication caused by opioids plus alcohol or other sedatives may occur in some circumstances.

Other withdrawal symptoms. Anxiety is a symptom of opioid withdrawal that are similar to those experienced in sedative-hypnotic withdrawal. Opioid withdrawal, on the other hand, is followed by rhinorrhea, lacrimation, and pupillary dilatation, which are not found in sedative withdrawal(American Psychiatric Association, 2013). Dilated pupils are also observed in psychedelic and stimulant intoxication. However, there are no additional indications or symptoms of opiate withdrawal, such as vomiting, nausea, diarrhea, stomach cramps, rhinorrhea, or lacrimation.

Homicidal Risk Assessment

Suicide attempts and completed suicides are more likely among those who take opioids. Some suicide risk factors coincide with opioid use disorder risk factors. Repeated opiate intoxication or withdrawal may be linked to severe depression, which, while transient, can be acute enough to lead to suicide attempts and completions. Suicide risk assessment yields a clinician’s judgment of the likelihood that the person would attempt suicide in the near future.

In the immediate to short-term, a patient’s suicide risk can be ascribed to one of four broad risk categories: high risk, medium risk, low risk, or no (foreseeable) risk. The patient’s level of unpredictability and the clinician’s trust in the evaluation rating are both considered.

In the high risk and low confidence in assessment, the nurse ensures that the patient is in a safe and secure setting. The nurse arranges for a re-evaluation within 24 hours, and continuous care and attentive monitoring are recommended. There are measures in place for a quick re-evaluation if discomfort or symptoms worsen. Suicide is a substantial yet moderate danger in medium-risk patients.

The nurse is out to ensure that patients at this level of risk are re-assessed in a week and that contingency measures for quick re-assessment are in place if distress or symptoms worsen. The low-risk patient has a definite yet low risk of suicide. The nurse believes that a patient at this level of risk should be reviewed at least monthly.

Clinical discretion should be used to decide the timing for evaluation. The review must be completed within one week of release from an in-patient unit. The patient at risk should be given written information about 24-hour access to appropriate clinical treatment.

Psychiatric Tools Diagnosis

SOAPP®-R (Screener and Opioid Assessment for Patients with Pain) is a 24-question screening instrument. It is intended to anticipate abnormal drug-related behaviors prior to the start of long-term opioid medication (Ducharme & Moore, 2019). Each of the 24 things is graded 0 (never), 1, 2, 3, 4 (often), for a total of 96.

A score of 18 suggests that a patient is more likely to misuse prescription opioids. Validation tests indicate a sensitivity of 81% and a specificity of 68%. According to Ducharme and Moore (2019), research reported sensitivity ranging from 41% to 79% and specificity ranging from 50% to 71%.

Medications Being Ordered

Opioid use disorders can be effectively treated with medications such as buprenorphine, methadone, and extended-release naltrexone.  According to NIDA research, once treatment begins, a buprenorphine/naloxone combination and an extended-release naltrexone formulation are both equally effective in treating opioid use disorder (National Institute on Drug Abuse, 2018).

However, because naltrexone needs complete detoxification, commencing therapy among active users was more challenging. Both drugs were equally effective after detoxification was complete. Due to the potential for sedative overdose, methadone and buprenorphine should not be administered to patients who exhibit indications of drunkenness or sedation (Connolly & Bhatt, 2019).

Non-pharmacological Treatments

One of the basic facets of Cognitive Behavioral Therapy for opioid usage is that drugs of abuse are effective motivators of behavior. Positive (e.g., lowering unpleasant effects) and negative (e.g., increasing social encounters) reinforcing effects become connected with a wide range of both internal and exterior stimuli over time.

The core elements of CBT, according to McHugh et al. (2020), is to mitigate the powerfully positive symptoms of drugs of abuse through either enhancing the contingency related to non-use or by constructing skills to accommodate decrease of use and preservation of abstinence, as well as facilitating potentials for rewarding non-drug activities. Even within the context of CBT for opioid addiction, the length of therapy might vary substantially.

According to McHugh et al. (2020), there is a mixed association between treatment duration and intensity, with certain correlational studies showing a favorable relationship involving longer duration and positive results.

Labs And Medical Tests

As an initial evaluation for infection, liver dysfunction, and other disorders, a complete blood count and liver function testing should be performed; abnormal findings may indicate the need for further examination(Townsend & Morgan, 2018). Another test is the Opioid detection test, which frequently detects metabolites of opioid analgesics such as oxycodone.

Questions to Strengthen Diagnosis

Other questions include whether the patient is on maintenance treatment(Townsend & Morgan, 2018). Inquire if and when the patient had substance abuse therapy, as well as the type like a medical withdrawal, opioid maintenance with medications like buprenorphine, inpatient, residential, outpatient counseling, or self-help groups(Townsend & Morgan, 2018).

Inquiring about the patient’s longest time of abstinence can assist in forecasting the patient’s capacity to sustain abstinence in the future. Inquiring about difficulties resulting from drug usage allows the patient to start thinking about reasons to cease taking drugs (Townsend & Morgan, 2018). Patients should be asked about their current and former health and psychological illnesses, as well as their legal and social problems, especially if they have lost employment, relationships, or freedom due to their heroin use.

Resources For The Patient

Townsend and Morgan (2018) show that in opioid use disorder, the function of the client instructor is critical. This demonstrates to the patient the significance of follow-up care.

References

American Psychiatric Association (2010). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American PsychiatriAssociation, 2013.

Connolly, M., & Bhatt, A. (2019). 421 implementation of national dyspepsia guidelines to reduce prescribing and return patients to self-care: Results from an educational intervention and prospective clinical audit in England. Gastroenterology, 136(5), A-72. https://doi.org/10.1016/s0016-5085(09)60323-1

Ducharme, J., & Moore, S. (2019). Opioid use disorder assessment tools and drug screening. Missouri Medicine, 116(4), 318–324. https://www.ncbi.nlm.nih.gov/pubmed/31527982

McHugh, R. K., Hearon, B. A., & Otto, M. W. (2020). Cognitive behavioral therapy for substance use disorders. The Psychiatric Clinics of North America, 33(3), 511–525. https://doi.org/10.1016/j.psc.2010.04.012

National Institute on Drug Abuse. (2018). Effective treatments for opioid addiction. National Institute on Drug Abuse. Retrieved from https://nida.nih.gov/publications/effective-treatments-opioid-addiction

Townsend, M., & Morgan, K. (2018). Pocket guide to psychiatric nursing, 10e. F.A. Davis.

Opioid Use Disorder Instructions

 -	DSM-5
-	Drug guide of your choice (text or online)
-	1 scholarly peer reviewed journal article, dated within the last 5 year
The APA 7 style of writing is required
Your Treatment plan should include the following categories:
1.	Title page
2.	Content of treatment plan (The title of your treatment plan should be on line 1 of page 2).
a.	Video # or Discussion Board Prompt #
b.	Brief description of the patient 
c.	Brief explanation of the presenting symptoms
d.	Any known medical history, allergies, etc. 
e.	Your psychiatric diagnosis (supported by the DSM-5).
f.	List 3 of the differential diagnosis from the DSM-5, and briefly state why that was chosen as a differential diagnosis, and not as the main diagnosis. (See course materials on Differential Diagnosis) (supported by the DSM-5).
g.	Suicide and/or homicidal risk assessment (this includes ideation, intent, plan, means, etc.). 
h.	What psychiatric tools or scales you used (or that you would use) to help support your diagnosis (include citations).
i.	Medications being ordered 
i.	Include name of medication(s) and what the med is used for (include citation)
ii.	Include the route, dosage, frequency (include citation)
iii.	Include black box warnings or what the pt needs to know/foods to avoid, etc. (include citation)
j.	Non-pharmacological treatments that are being ordered (include citation that supports these).
k.	Any labs or medical tests that need to be completed to rule out organic causes, for medication monitoring, and so forth (include citation). (include a short line stating why each lab/test is being ordered)
l.	Questions that you would ask to further solidify your diagnosis (brief list)
m.	Any further directives/resources for the patient (this would include, follow up with primary doctor to monitor HTN or diabetes; directives to follow-up with other members of the comprehensive treatment team; safety plan if you are sending the pt home and they have suicidal or homicidal thoughts; return for medication assessment in x number of weeks, etc. This also includes support group and hotline phone numbers for things like SI and SUD).
3.	References Page – include all citations used in the paper, formatted per APA 7, double spaced and in alphabetical order. References are to include the DSM-5, the course textbook, a drug book of your choice (text or online), and 1 scholarly journal article reference within the last 5 years, for each of the videos or discussion board prompts being assessed.