A 53-year-old woman with chronic low back pain presented for a prescription refill of hydrocodone/acetaminophen. She had partial paralysis from a thoracic spinal cord infarction secondary to aortic dissection from prior cocaine use and reported taking hydrocodone on that day but no recent illicit drug use. Urine immunoassay drug screen results were negative overall but positive for cocaine. How would you proceed?
This guideline from the Centers for Disease Control and Prevention makes 12 recommendations to improve communication about opioids for chronic pain, to improve the safety and effectiveness of pain treatment, and to reduce risks associated with long-term opioid therapy.
Saitz and coauthors tested the efficacy of 2 brief interventions among 528 adults with unhealthy drug use identified by screening in primary care. They compared a brief negotiated interview and an intervention based on motivational interviewing with no brief intervention. In an Editorial, Hingson and Compton discuss the importance of exploring drug use with patients in primary care.
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