Howard is a 24-year-old male who presents to the clinic his wife for what he states is severe
lower back pain. He states the pain is so bad that he rates it as a “50 out of 10.” He also
tells you that due to a past medical history of an ulcer, he cannot take any medications
“like Motrin.” He states that the pain is from a car accident in 2012, and that it flairs up
and he needs pain medications. He also tells you that he has a high pain tolerance, and that
when he gets pain meds he requires the higher doses.
What would you do first prior to prescribing any medication?
Because opioid use carries a high risk for dependency, tolerance and abuse, Howard would need
to be screened for dependency. Because Howard has a history of chronic pain with what sounds
like a history of the use of high dose opioids, prior to prescribing any medication I would
perform urine drug screen and give him the DAST-20 screening and CAGE-AID. If substance
abuse is suspected, the patient may require a pain contract. Clear expectations and
responsibilities should be outlined and mutually set for treatment goals (Woo & Robinson,
2015).
What are the various schedules of medications for controlled substances? The various
schedules of medications for controlled substances include:
Schedule I- have no accepted medical use and high potential for abuse (i.e. Ecstasy, heroin,
LSD) (Drug Enforcement Administration [DEA], 2018).
Schedule II-have a high potential for abuse and may lead to severe psychological or physical
dependence (i.e. hydromorphone (Dilaudid), methadone (Dolophine), meperidine (Demerol),
oxycodone (OxyContin, Percocet), and fentanyl (Sublimaze, Duragesic). Other Schedule II
narcotics include: morphine, opium, codeine, and hydrocodone) (DEA, 2018). Scheduled
stimulants include: amphetamine (Dexedrine, Adderall), methamphetamine (Desoxyn), and
methylphenidate (Ritalin) (DEA, 2018). Other Schedule II substances include: amobarbital,
glutethimide, and pentobarbital (DEA, 2018).
Schedule III-potential for abuse less than substances in Schedules I or II and abuse may lead to
moderate or low physical dependence or high psychological dependence( i.e products containing
not more than 90 milligrams of codeine per dosage unit (Tylenol with Codeine), and
buprenorphine (Suboxone), schedule III non-narcotics include: benzphetamine (Didrex),
phendimetrazine, ketamine, and anabolic steroids such as Depo-Testosterone (DEA, 2018).
Schedule IV- low potential for abuse relative to substances in Schedule III (i.e. alprazolam
(Xanax), carisoprodol (Soma), clonazepam (Klonopin), clorazepate (Tranxene), diazepam
(Valium), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril), and triazolam
(Halcion) (DEA, 2018).
Schedule V- low potential for abuse relative to substances listed in Schedule IV and consist
primarily of preparations containing limited quantities of certain narcotics (i.e. cough
lower back pain. He states the pain is so bad that he rates it as a “50 out of 10.” He also
tells you that due to a past medical history of an ulcer, he cannot take any medications
“like Motrin.” He states that the pain is from a car accident in 2012, and that it flairs up
and he needs pain medications. He also tells you that he has a high pain tolerance, and that
when he gets pain meds he requires the higher doses.
What would you do first prior to prescribing any medication?
Because opioid use carries a high risk for dependency, tolerance and abuse, Howard would need
to be screened for dependency. Because Howard has a history of chronic pain with what sounds
like a history of the use of high dose opioids, prior to prescribing any medication I would
perform urine drug screen and give him the DAST-20 screening and CAGE-AID. If substance
abuse is suspected, the patient may require a pain contract. Clear expectations and
responsibilities should be outlined and mutually set for treatment goals (Woo & Robinson,
2015).
What are the various schedules of medications for controlled substances? The various
schedules of medications for controlled substances include:
Schedule I- have no accepted medical use and high potential for abuse (i.e. Ecstasy, heroin,
LSD) (Drug Enforcement Administration [DEA], 2018).
Schedule II-have a high potential for abuse and may lead to severe psychological or physical
dependence (i.e. hydromorphone (Dilaudid), methadone (Dolophine), meperidine (Demerol),
oxycodone (OxyContin, Percocet), and fentanyl (Sublimaze, Duragesic). Other Schedule II
narcotics include: morphine, opium, codeine, and hydrocodone) (DEA, 2018). Scheduled
stimulants include: amphetamine (Dexedrine, Adderall), methamphetamine (Desoxyn), and
methylphenidate (Ritalin) (DEA, 2018). Other Schedule II substances include: amobarbital,
glutethimide, and pentobarbital (DEA, 2018).
Schedule III-potential for abuse less than substances in Schedules I or II and abuse may lead to
moderate or low physical dependence or high psychological dependence( i.e products containing
not more than 90 milligrams of codeine per dosage unit (Tylenol with Codeine), and
buprenorphine (Suboxone), schedule III non-narcotics include: benzphetamine (Didrex),
phendimetrazine, ketamine, and anabolic steroids such as Depo-Testosterone (DEA, 2018).
Schedule IV- low potential for abuse relative to substances in Schedule III (i.e. alprazolam
(Xanax), carisoprodol (Soma), clonazepam (Klonopin), clorazepate (Tranxene), diazepam
(Valium), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril), and triazolam
(Halcion) (DEA, 2018).
Schedule V- low potential for abuse relative to substances listed in Schedule IV and consist
primarily of preparations containing limited quantities of certain narcotics (i.e. cough
