Posted: September 16th, 2024

Pharm wk 3 Excessive Opioid Use

Application of Course Knowledge: Excessive Opioid Use

Client Introduction and MME Calculation
David Ball is a 45-year-old male currently prescribed hydromorphone (Dilaudid) 4mg PO QID for chronic pain associated with fibromyalgia. To assess the appropriateness of his medication regimen, we need to calculate his daily morphine milligram equivalents (MME).

According to the CDC’s 2022 Clinical Practice Guideline for Prescribing Opioids for Pain, the conversion factor for hydromorphone is 4 (CDC, 2022). To calculate the daily MME:

Hydromorphone dose: 4 mg
Frequency: 4 times daily (QID)
Conversion factor: 4

Daily MME = 4 mg × 4 (times per day) × 4 (conversion factor) = 64 MME/day

Therefore, David Ball’s daily MME is 64.

MME Threshold Consideration
The 2022 CDC guideline no longer specifies rigid MME thresholds for additional consideration. However, it does recommend that clinicians should “evaluate benefits and risks with patients when considering increasing opioid dosage to ≥50 MME/day” (Dowell et al., 2022). David’s current regimen of 64 MME/day exceeds this threshold, indicating that additional considerations are warranted.

Additional Considerations and Risks
Given David’s daily MME and the nature of his chronic pain condition, several additional considerations are necessary:

a) Risk assessment: A thorough evaluation of David’s risk for opioid-related harms, including overdose and opioid use disorder, should be conducted (Busse et al., 2020).

b) Non-opioid and non-pharmacological treatments: Explore and optimize non-opioid pain management strategies for fibromyalgia, such as cognitive behavioral therapy, exercise therapy, and multimodal rehabilitation (Häuser et al., 2021).

c) Naloxone prescription: Consider prescribing naloxone, given the elevated MME and potential overdose risk (Dowell et al., 2022).

d) Urine drug testing: Implement periodic urine drug testing to monitor for prescribed medications and undisclosed substances (Chou et al., 2019).

e) Patient education: Provide comprehensive education on opioid risks, safe storage, and disposal methods (Dowell et al., 2022).

f) Specialist consultation: Consider referral to a pain specialist or rheumatologist for fibromyalgia-specific management strategies (Macfarlane et al., 2017).

Appropriateness of Medication Regimen
According to the 2022 CDC guideline, opioids are not considered first-line therapy for fibromyalgia due to limited evidence of long-term benefits and potential risks (Dowell et al., 2022). The guideline suggests the following approach:

a) Optimize non-opioid pharmacologic treatments: Consider medications such as pregabalin, duloxetine, or milnacipran, which have shown efficacy in fibromyalgia management (Häuser et al., 2021).

b) Implement non-pharmacological interventions: Emphasize evidence-based treatments like graded exercise, cognitive behavioral therapy, and stress reduction techniques (Macfarlane et al., 2017).

c) If opioids are continued, implement strategies to mitigate risks: This includes regular reassessment, use of the lowest effective dose, and consideration of buprenorphine as a safer alternative with a ceiling effect on respiratory depression (Dowell et al., 2022).

d) Gradual dose reduction: If David and his healthcare provider agree, a slow taper of the hydromorphone dose could be considered, aiming for the lowest effective dose or complete discontinuation if possible (Dowell et al., 2022).

In conclusion, while David’s current regimen may provide some pain relief, it carries significant risks and may not align with current best practices for fibromyalgia management. A comprehensive reevaluation of his pain management strategy, focusing on non-opioid and non-pharmacological approaches, is warranted.

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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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