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Drug Abuse and Addiction

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In performing urine drug testing (UDT), a physician must know all of the following, EXCEPT

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(A) the characteristics of the testing procedures, since many drugs are not routinely detected by all UDTs

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(B) that although no aberrant behavior is pathognomonic of abuse or addiction, such behavior should never be ignored

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(C) reliance on aberrant behavior to trigger a UDT will miss more than 50% of those individuals using unprescribed or illicit drugs

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(D) always prescribe "on-demand" for the patient until you are comfortable with the situation

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(E) a history of drug abuse does not preclude treatment with a controlled substance, when indicated, but does require a treatment plan with firmly defined boundaries

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(D) In performing UDT, know the characteristics of testing procedures, since many drugs are not routinely detected by all UDTs. Although no aberrant behavior is pathognomonic of abuse or addiction, such behavior should never be ignored.

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Reliance on aberrant behavior to trigger a UDT will miss more than 50% of those individuals using unprescribed or illicit drugs. Never prescribe on-demand for the patient until you are comfortable with the situation. A history of drug abuse does not preclude treatment with a controlled substance, when indicated, but does require a treatment plan with firmly defined boundaries.

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A 65-year-old man with cancer and multiple bony metastases complains of increasing requirement of intrathecal morphine. However, he also complains of increased nausea associated with the increased dose. All the workup with regards to carcinomatous spread failed to show any progression of the disease. Which of the following explanations is accurate?

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(A) The catheter is no longer in the intrathecal space and he is not receiving appropriate dosages

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(B) He is addicted to the drugs and requesting higher doses

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(C) He is physically dependent on the drug and is nauseated because of withdrawal symptoms

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(D) He has developed tolerance to the analgesics effects of intrathecal morphine

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(E) There is significant progression of the disease, which was unidentified by the evaluation

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(D) The patient is most likely developing tolerance to the analgesic effects of the intrathecal morphine while continuing to complain of the adverse side effect of nausea as the intrathecal dose is increased. The mechanism by which tolerance develops is not known. The development of tolerance can be minimized by selecting the lowest effective narcotic dose; placing the catheter as close as possible to the cord level of ...

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