Posted: September 16th, 2024

Pharm wk 3 Excessive Opioid Use

Analysis of Opioid Use in Chronic Pain Management: A Case Study of David Ball

David Ball, a 45-year-old male, is currently prescribed hydromorphone (Dilaudid) 4 mg orally four times a day (QID) to manage chronic pain associated with fibromyalgia. This case study examines the appropriateness of his opioid regimen, calculates his daily morphine milligram equivalents (MME), and evaluates the need for additional considerations based on the Centers for Disease Control and Prevention’s (CDC) guidelines for opioid prescribing.

Daily Morphine Milligram Equivalents (MME) Calculation
To assess the risk associated with David’s opioid use, it is essential to calculate his daily MME. The MME is a standard measure used to compare the potency of different opioids. According to the CDC’s conversion factors, hydromorphone has a conversion factor of 4.

Calculation:

Hydromorphone dose: 4 mg per dose
Frequency: 4 times a day
Total daily dose: 4 mg x 4 = 16 mg
MME: 16 mg x 4 (conversion factor) = 64 MME
David’s daily MME is 64, which is above the CDC’s recommended threshold of 50 MME/day for additional consideration and monitoring (CDC, 2022).

Evaluation of MME Threshold
The CDC guidelines suggest that opioid dosages at or above 50 MME/day warrant careful reassessment due to increased risk of overdose and other adverse effects. David’s MME of 64 exceeds this threshold, indicating a need for additional evaluation and potential adjustment of his pain management strategy (Dowell et al., 2022).

Additional Considerations and Recommendations
Given the elevated MME and limited information about David’s overall health and pain management plan, several steps should be considered:

Consultation with a Pain Specialist: A referral to a pain management specialist could provide a comprehensive evaluation of David’s pain and explore alternative therapies, such as physical therapy or cognitive-behavioral therapy, which may reduce reliance on opioids (Busse et al., 2018).

Prescription Review: Consideration of non-opioid medications, such as gabapentinoids or antidepressants, which have shown efficacy in managing fibromyalgia pain, may be appropriate (Häuser et al., 2020).

Patient Education: Educating David about the risks associated with high-dose opioid therapy, including the potential for dependence and overdose, is crucial. This education should also cover safe storage and disposal of medications to prevent misuse (CDC, 2022).

Regular Monitoring: Implementing a schedule for regular follow-ups to monitor pain levels, functionality, and any side effects of the medication can help in making timely adjustments to the treatment plan (Dowell et al., 2022).

Appropriateness of Current Medication Regimen
According to the CDC’s Clinical Practice Guidelines (CPG), opioids should be prescribed at the lowest effective dose and only when benefits outweigh risks. Given the chronic nature of fibromyalgia and the associated risks of long-term opioid use, alternative treatments should be prioritized. Non-opioid medications and non-pharmacological therapies are often recommended as first-line treatments for fibromyalgia (Häuser et al., 2020). If opioids are deemed necessary, the dose should be minimized, and the patient should be closely monitored.

David Ball’s current opioid regimen exceeds the CDC’s recommended MME threshold, necessitating a thorough review of his pain management strategy. By considering alternative therapies, consulting with specialists, and educating the patient, healthcare providers can optimize treatment outcomes while minimizing risks. This approach aligns with the CDC’s guidelines, emphasizing the importance of individualized care in managing chronic pain.

References
Busse, J. W., et al. (2018). Guideline for opioid therapy and chronic noncancer pain. CMAJ, 190(18), E517-E530.
Centers for Disease Control and Prevention (CDC). (2022). CDC Guideline for Prescribing Opioids for Chronic Pain. Retrieved from CDC website.
Dowell, D., Haegerich, T. M., & Chou, R. (2022). CDC guideline for prescribing opioids for chronic pain—United States, 2022. MMWR Recommendations and Reports, 65(1), 1-49.
Häuser, W., et al. (2020). Management of fibromyalgia: Key messages of the updated evidence-based guideline. Pain Reports, 5(5), e850.

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Pharm wk 3 Excessive Opioid Use.

David Ball, a 45-year-old male, is currently taking hydromorphone (Dilaudid) 4mg PO QID for chronic pain from fibromyalgia.

Preparing the Collaboration Café
Follow these guidelines when completing each component of the Collaboration Café. Contact your course faculty if you have questions.
General Instructions
Step 1: Review your assigned client scenario below. Your assigned client is based on the first letter of your last name in the chart below. The scenarios below depict inappropriate or excessive opioid use.
Last Name Client from Week 3 Lesson
A – E David Ball, a 45-year-old male, is currently taking hydromorphone (Dilaudid) 4mg PO QID for chronic pain from fibromyalgia.

Step 2: Review the client’s case and CDC’s (2022) CPG related to opioid prescribing. You can use the Ctrl F function on your keyboard to assist in your review of the CPG to help find keywords.
Step 3: Analyze and critique your assigned case and answer the prompts below with explanation and detail, providing complete references for all citations.
Step 4: Reply to peers with different assigned clients.
Include the following sections:
I. Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
1. Introduce your client, their situation, and their medication regimen. Calculate and describe your client’s daily morphine milligram equivalents (MME). Provide your calculations and a rationale for your answer. Refer to this linkLinks to an external site. for reference.
2. Discuss how your client’s daily MME falls above or below the threshold for additional consideration. How do you know?
3. Consider the need for additional considerations given the total MME, the limited information available in the case, and the risks for overdose. What other consultations, prescriptions, and education may be required given their current individual circumstances and medications?
4. Consider the appropriateness of your client’s medication regimen. According to the CPG, what other prescriptions may be more appropriate for their individual circumstances? If no change is needed or warranted according to the CPG, state that with support from the CPG.

NR565_W3 Collaboration Café
NR565_W3 Collaboration Café
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeApplication of Knowledge
4 Required Criteria

Answer all questions/criteria with explanations and detail:

1. Introduce your client, their situation, and their medication regimen. Calculate and describe your client’s daily morphine milligram equivalents (MME). Provide your calculations and a rationale for your answer. Refer to this link for reference.

2. Discuss how your client’s daily MME falls above or below the threshold for additional consideration. How do you know?

3. Consider the need for additional considerations given the total MME, the limited information available in the case, and the risks for overdose. What other consultations, prescriptions, and education may be required given their current individual circumstances and medications?

4. Consider the appropriateness of your client’s medication regimen. According to the CPG, what other prescriptions may be more appropriate for their individual circumstances? If no change is needed or warranted according to the CPG, state that with support from the CPG. 25 pts
Excellent
All requirements met. 23 pts
Very Good
3 requirements met. 21 pts
Satisfactory
2 requirement met.

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