Drug Addiction or False Conviction?

[摘要] A 25-year-old woman with a history of multiple medical problems including a distal pancreatectomy and splenectomy 6 months earlier for pancreatic mass (solid pseudopapillary tumor with negative margins), systemic lupus erythematous (SLE),3 Crohn disease, and a history of alcohol abuse presented to her pain management physician with weakness, decreased appetite, worsening joint pain, abdominal pain, and diarrhea (five episodes per day, some visibly bloody). At presentation, her vital signs included temperature 97.1 °F, blood pressure 127/89 mmHg, and heart rate 97 beats/min. Physical exam was remarkable for hyperactive bowel sounds, diffuse joint pain, and periumbilical pain at the surgical incision site described as constant and gnawing and graded 8 out of 10. She was prescribed morphine and oxycodone (as needed) for pain; hydroxychloroquine and prednisone for SLE; and mesalamine, docusate, and infliximab for Crohn disease.She was referred to her gastroenterologist for management of her gastrointestinal complaints. Her dosages of prednisone and hydroxychloroquine were maintained to control her SLE. Pulse doses of steroids and a higher dose of prednisone were considered, but the risk of infection was determined to be too great. Before refilling her morphine and oxycodone prescriptions, her physician confirmed that her previous urine drug testing results showed the presence of her prescribed medications (and related metabolites), suggesting medication compliance, as well as no unexpected drugs. The physician also performed a pill count and documented her last dose of morphine (that morning) and oxycodone (3 days before). In addition, she was asked to complete a Screener and Opioid Assessment for Patients with Pain questionnaire (1), designed to assess her risk of medication noncompliance and abuse. On the basis of her responses to the questionnaire, the pill count, and her previous consistent urine drug testing results, the physician felt she was at low risk for noncompliance and renewed …

[学科分类] 过敏症与临床免疫学