PS511 Unit 5 Opioid Use Disorder Case Study Example

Methadone an Hour Away or Buprenorphine in Town: A PS511 Unit 5 Case Study on Opioid Use Disorder and Medication Options

[Student Name]

Purdue University Global

PS511: Chemical and Psychological Dependency Counseling

Unit 5 Opioid Use Disorder Case Study

[Instructor Name]

[Date]

The client, his family, the clinic, the mine and every detail of the case are composite and illustrative; the sources cited are real.

Presenting Problem

Mitch is a 46-year-old taconite mine haul-truck driver, married with two teenage children, referred after nodding off at the wheel of a loaded truck in the pit. No one was hurt. The mine placed Mitch on leave pending a fitness-for-duty evaluation. Units 1 and 2 described how a month of prescribed oxycodone after back surgery in 2023 became daily use of pills bought from a coworker. This case study completes the diagnosis and proposes treatment.

Current Use

Mitch now takes five to seven oxycodone tablets of unknown strength each day, bought for cash. Twice in the past three months, when the coworker ran out, Mitch bought pressed "blues" from a stranger in Duluth, not knowing they could contain fentanyl. Mitch has never injected. Withdrawal begins about eight hours after the last dose, with aching, sweating, diarrhea, yawning and anger. Mitch has tried to taper three times, most recently in December, and lasted four days.

Diagnostic Evidence

For opioids the manual uses its usual list of eleven problems, with one exception worth noting here: tolerance and withdrawal are set aside when someone develops them only while taking a medicine exactly as a doctor directs (American Psychiatric Association, 2022). Mitch's early use followed a prescription, but his current use is not medically supervised, so both count.

The evidence supports at least eight criteria: taking more than intended (1), failed attempts to cut down (2), a great deal of time spent obtaining pills and recovering (3), craving, especially before night shifts (4), continued use despite arguments with his wife about money and his moods (6), giving up ice fishing and his son's hockey games (7), use in a physically hazardous situation, driving a haul truck (8), tolerance (10) and withdrawal (11). His leave from work means role failure (5) now applies too.

Nine criteria, a counterfeit pill bought from a stranger and a truck that weighs as much as a house: the diagnosis is severe and the risk is immediate.

Diagnosis

Opioid use disorder, severe. Because Mitch has bought counterfeit pills, overdose risk is high. The plan below begins with medication and overdose prevention, and adds counseling as the foundation for everything else.

Medication Options

Mitch's prescriber can choose among methadone, buprenorphine and a long-acting injected form of naltrexone, the three drugs federal regulators have cleared for this purpose. The choice depends on the evidence, the client's preferences and practical facts about where Mitch lives and works.

Mattick et al. (2014) reviewed randomized trials comparing buprenorphine maintenance with placebo and with methadone. Buprenorphine kept people in treatment better than placebo at every dose studied, and at medium and high doses it reduced illicit opioid use. When doses were flexible, as in most real clinics, buprenorphine retained fewer people than methadone, but at adequate fixed doses the two performed similarly for reducing use.

Sordo et al. (2017) pooled cohort studies and found that death rates, both overall and from overdose, ran far lower during the months people stayed on methadone or buprenorphine than during the months they spent off it. Risk rose sharply in the weeks right after leaving treatment, and for methadone the first weeks after starting were also a period of higher risk. For Mitch, the lesson is that staying in treatment matters more than which medication starts it.

Weighing the Options for Mitch

Methadone is dispensed daily at an opioid treatment program, and the nearest one is about an hour's drive, a hard trip in winter for someone who works rotating shifts. Buprenorphine can be prescribed by a doctor at the clinic in town and taken at home. The monthly naltrexone shot only works once every opioid has cleared the body, typically after a week or more with none, and Mitch's three collapsed tapers make that week look unlikely.

Mitch's job adds a question. Returning to a haul truck while taking any medication that can cause drowsiness requires an evaluation by the mine's doctor. Many people on stable doses of buprenorphine work in demanding jobs, but the decision belongs to the physician who conducts the fitness-for-duty exam, not to the counselor.

After discussing these options, Mitch chose buprenorphine through the clinic's prescriber, mainly because of the drive. The prescriber will start treatment this week.

Counseling and Supports

Counseling will run alongside medication. In the first month, the focus is on staying in treatment, since Sordo and colleagues show that leaving is when risk peaks. Sessions will be weekly and timed around Mitch's shifts. Mitch and his wife each received naloxone and training at intake, and the counterfeit pills were discussed openly. Later sessions will address the job fear and pain management described in the earlier units, with a referral to physical therapy for his back. His wife will be invited to two joint sessions to address the money arguments.

Confidentiality and the Mine

The mine's fitness-for-duty process creates pressure to share more than Mitch may want. Our records fall under the federal confidentiality rule for substance use treatment, so nothing goes to the mine without Mitch's written consent naming the mine, the information and the purpose. Mitch agreed to release confirmation of attendance and the prescriber's statement that Mitch is on a stable medication dose, and declined to release session notes. The mine's own physician will make the safety decision with that information. Explaining this split early helped Mitch trust that counseling would not become a report card for the employer.

Barriers on the Range

Two practical barriers could undo the plan. The first is winter travel: a missed session in a February storm is not a sign of poor motivation, so the clinic will offer telehealth sessions on storm days. The second is stigma. Mitch worried that crewmates would see the truck at the clinic, and the coworker who sold pills still works at the mine. We agreed that Mitch would park at the grocery store next door for now and that the plan for returning to work would include a way to refuse offers from that coworker.

Goals

Within one week, Mitch begins buprenorphine and carries naloxone. Within one month, Mitch attends all weekly sessions and has urine tests negative for oxycodone and fentanyl at least three of four weeks. Within three months, Mitch completes the fitness-for-duty process and starts physical therapy. These goals will be reviewed monthly.

Conclusion

Nine items fit Mitch's pattern, so the opioid problem is severe, and the counterfeit pills make an overdose a danger this month rather than someday. Mattick and colleagues' review supports buprenorphine as an effective option, and Sordo and colleagues' findings make retention in treatment the central goal. Buprenorphine from a local prescriber, naloxone, weekly counseling timed around shifts and a physician-led return-to-work evaluation fit both the evidence and the realities of life on the Range.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2014). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews, 2014(2), Article CD002207. https://doi.org/10.1002/14651858.CD002207.pub4

Sordo, L., Barrio, G., Bravo, M. J., Indave, B. I., Degenhardt, L., Wiessing, L., Ferri, M., & Pastor-Barriuso, R. (2017). Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. BMJ, 357, Article j1550. https://doi.org/10.1136/bmj.j1550