GP CCE Cases · pain-management
Escalating opioid dose with red flags - CCE clinical encounter
CCE-style clinical encounter: a patient on escalating opioids with benzodiazepine co-prescription and early refills. The candidate must assess OUD risk, avoid dose escalation, introduce naloxone, and plan a supported taper.
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Target exams
RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 47-year-old man on oxycodone CR 40 mg twice daily after a workplace injury eighteen months ago attends requesting an increase. He has had two early refills in three months. He takes clonazepam at night for sleep. His work duties remain restricted and his mood is low.
Objectives
- Assess function and yellow flags rather than simply responding to the dose request. [1]
- Recognise the benzodiazepine-opioid combination as an overdose risk and address it. [2]
- Decline the dose increase respectfully, using SPACE evidence. [1]
- Introduce naloxone co-prescribing and a written treatment agreement. [2]
- Plan a slow supported taper and screen for opioid use disorder. [1]
References2ShowHide
- [1]Krebs EE, Gravely A, Nugent S, et al. Effect of Opioid vs Nonopioid Medications on Pain-Related Function (SPACE) JAMA, 2018.PMID 29509867
- [2]Sun EC, Dixit A, Humphreys K, et al. Association between concurrent use of prescription opioids and benzodiazepines and overdose BMJ, 2017.PMID 28292769