Part two: This week's case is about a patient, Tania, a 37- year-old female with chronic pain from lupus vasculitis and peripheral neuropathy. She has episodes of severe abdominal pain and describes intermittent electrical sensations in her legs and feet. Medications include hydroxychloroquine and azathioprine for lupus, duloxetine and bupropion for depression, and meloxicam, gabapentin, and lidocaine patches for pain. For severe pain she uses hydrocodone/acetaminophen 10 mg/325 mg, 1-2 tablets every 4-6 hours, and is prescribed 84 tablets every 28 days. She fills this medication on time every 4 weeks and has never requested early refills.

This week's case is about a patient, Tania, a 37- year-old female with chronic pain from lupus vasculitis and peripheral neuropathy. She has episodes of severe abdominal pain and describes intermittent electrical sensations in her legs and feet. Medications include hydroxychloroquine and azathioprine for lupus, duloxetine and bupropion for depression, and meloxicam, gabapentin, and lidocaine patches for pain. For severe pain she uses hydrocodone/acetaminophen 10 mg/325 mg, 1-2 tablets every 4-6 hours, and is prescribed 84 tablets every 28 days. She fills this medication on time every 4 weeks and has never requested early refills.

his week’s case is about Bob is a 50-year-old man with chronic low back pain who has been taking oxycodone ER 20 mg three times daily for three years. He recently asked for early refills, reports lost prescriptions twice, and his urine drug screen shows fentanyl and benzodiazepines. The state prescription drug monitoring program indicates prescriptions from multiple providers. This constellation of behaviors—unapproved dose increases, obtaining opioids from multiple prescribers, and concurrent non-medical drug use may signal increased risk for OUD. Bob insists he is taking opioids for pain but admits buying additional pills to “avoid getting sick.”