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- Mar 16, 2006
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Hi all,
Just wanted to get some thoughts on this.
Lets say there is a patient who has been prescribed clonazepam 16mg total daily for the past 8 or so years from a PCP. Her medication prescription database has been checked, and she is not filling inappropriately. she has severe panic attacks and has been taking it as prescribed. no hx of doctor shopping, DUI/DWI, family problems from use. Even though she is on a whopping dose of klonopin, would she qualify for an abuse/dependence diagnosis? Or is she moreso a product of inappropriate prescribing? While she is very apprehensive about lowering the doses, she has agreed to it and over months is now down to 4mg total daily.
Another part to my question is : how do you assess for the 'tolerance' and 'withdrawal' criteria in substance dependence? For sure, if a cancer pt was given 100mg morphine PO total daily over 4 months and then the patient ran out (because the could no longer afford the medication, not because they overused and ran out early), most likely the pt would go through withdrawal. But I'm not so sure that means that the patient was addicted per se. any person prescribed that amount could go through tolerance/withdrawal.
So, in checking the criteria of dependence, do you account for tolerance and withdrawal at full face value if it occurs under any context? Or does do they really only count towards the diagnosis only if its occurred in a maladaptive sense- say they are withdrawing because they ran out early due to taking more than prescribed?
Just wanted to get some thoughts on this.
Lets say there is a patient who has been prescribed clonazepam 16mg total daily for the past 8 or so years from a PCP. Her medication prescription database has been checked, and she is not filling inappropriately. she has severe panic attacks and has been taking it as prescribed. no hx of doctor shopping, DUI/DWI, family problems from use. Even though she is on a whopping dose of klonopin, would she qualify for an abuse/dependence diagnosis? Or is she moreso a product of inappropriate prescribing? While she is very apprehensive about lowering the doses, she has agreed to it and over months is now down to 4mg total daily.
Another part to my question is : how do you assess for the 'tolerance' and 'withdrawal' criteria in substance dependence? For sure, if a cancer pt was given 100mg morphine PO total daily over 4 months and then the patient ran out (because the could no longer afford the medication, not because they overused and ran out early), most likely the pt would go through withdrawal. But I'm not so sure that means that the patient was addicted per se. any person prescribed that amount could go through tolerance/withdrawal.
So, in checking the criteria of dependence, do you account for tolerance and withdrawal at full face value if it occurs under any context? Or does do they really only count towards the diagnosis only if its occurred in a maladaptive sense- say they are withdrawing because they ran out early due to taking more than prescribed?