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self index.cfm
site_filepath /www/sites/mfapp/templates/main/
 
Alan Trachtenberg, Md  
     
     
APA Problem cases
I disagree with the following:
Incorrect. The answer is No. Not unless he becomes committed to abstinence from heroin including on weekends. The buprenorphine should then be focused on short-term detoxification.

3.
What medications should be included in the initial treatment plan?

a.
clonidine and naltrexone

b.
methadone and naltrexone

c.
buprenorphine and naltrexone

d.
buprenorphine and clonidine


--------------------------------------------------------------------------------


Incorrect. Answer a is correct: clonidine and naltrexone. Abstinence from heroin and probably initial detoxification with transition to naltrexone treatment are the goals. Clonidine might also be used for detoxification and transition to naltrexone.




I disagree with the following:
4.
What is the diagnosis?

a.
Opioid abuse

b.
Opioid dependence

c.
Opioid dependence in remission

d.
Opioid withdrawal

e.
Opioid intoxication


--------------------------------------------------------------------------------


Incorrect. Answer a is correct: Opioid abuse. The patient does not meet DSM-IV criteria for dependence either in terms of tolerance and a withdrawal syndrome, or sufficient level of psychosocial impairment to meet the required number of criteria. He has not had any use in about two months, but clearly began abuse again, as soon as he left the jail. He is not in remission.



5.
Is this patient a candidate for treatment with buprenorphine?

a.
Yes

b.
No


--------------------------------------------------------------------------------


Incorrect. The answer is No. He does not need detoxification and should be tried with naltrexone first rather than buprenorphine.