Special Populations and the Use of Buprenorphine: Case Study Number 1
A 27-year-old woman presents to your medical office on a Monday morning for a
scheduled new patient appointment. She is 4 months pregnant and is seeking your
help with care for this, her first pregnancy. She is generally healthy, smokes
one pack of cigarettes a day, drinks occasional alcohol about once per month,
and has a distant history of a motor vehicle accident that required a
several-day stay in the hospital. She is on no medications and has no drug
allergies.
You have a general medical practice in a small, rural town. A mid-sized
metropolitan area is about 75 miles away. Your practice has included the
delivery of noncomplicated pregnancies at the local hospital, which has about 50
beds, and you have successfully treated four patients with buprenorphine in the
office setting. However, two other patients you initially attempted to treat
with buprenorphine eventually required referral to a methadone program in the
city.
The patient does not initially admit to drug use, but during questioning, she
reports sniffing heroin, which she began using with her boyfriend about 6 months
ago. This has been primarily on weekends, and she denies any injecting of drugs.
(Physical examination shows no evidence of injecting.) She believes she can stop
using heroin without any problem. However, she is a bit worried as she feels ill
this day and thinks it is probably a cold or the pregnancy, but she also admits
to being bothered with the idea that she should go home and use some heroin
after she is finished meeting with you. During further questioning, she states
that on rare occasions, she has snorted "just a touch" of heroin
during the week to help her feel better.
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