Buprenorphine for prescription opioid addiction in a patient with depression and alcohol dependence.

摘要

"Ms. B" is a 28-year-old woman with a 4-year history of illicit prescription opioid use by the oral and nasal routes. She began by occasionally sharing pills with friends at parties, then progressed to 1-2 pills a day and steadily increased to an average of 250-350 mg of oxy-codone or its equivalent per day but sometimes taking up to 450 mg a day. She sporadically inhaled heroin but denied injecting it, and she was consuming 5-9 drinks (mixed or straight vodka) 6-7 nights per week. She had attended community college for a year but did not graduate, and she was working in a medical office. She obtained opioids by buying them "on the street," by "doctor shopping" using a vague complaint of back injury with severe pain, or by forging prescriptions, carefully rotating the pharmacies where she filled them to avoid raising pharmacists' suspicions. She debated with herself about quitting because she felt that her life was "ruined and going nowhere," and she sought treatment because she became frightened after nearly getting caught stealing prescription pads at work. She also reported feeling sad, with crying spells and feelings of hopelessness and self-deprecation, but without suicidal ideation.