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Adolescent Presenting with Opioid OD Video

Video transcript

PATIENT: What’s going on?

DR. HARRINGTON: You’re in the emergency department. I’m your doctor, Dr. Harrington. Your friend, Marissa, called 911 last night. She was really worried about you. It seemed like you overdosed. They had to give you naloxone to resuscitate you.

PATIENT: Can I have my phone? It’s—I got to call her to come get me.

DR. HARRINGTON: Yeah, we have your phone but we’ll get it in a minute, okay? I want to also let you know that we did call your parents and that they’re on their way in.

PATIENT: My parents?

DR. HARRINGTON: Yeah.

PATIENT: No, they, they, they can’t come here. They don’t—they have no clue.

DR. HARRINGTON: No clue about what?

PATIENT: That I was at the party. They’re going to be really mad. They think I just drink. They’re going to—they’re going to kill me when they find out I passed out. You don’t have to tell them everything, do you?

DR. HARRINGTON: Well, let’s talk about that in a little bit, okay? Your test that we did came back and it looks like your urine was positive for alcohol and opioids. Can you tell me a little bit more about what you took last night?

PATIENT: Just percs. I mean, I’ve had—I’ve been trying them since I got hurt in lacrosse a couple months ago, and I had a lot left over so my friends asked me to bring them to the party. I mean, I didn’t know that was going to be heroin. That’s over the top.

DR. HARRINGTON: Did you try any heroin?

PATIENT: A little bit yeah, but I just kind of stuck to my oxys and the drinks.

DR. HARRINGTON: Okay. How often do you take the Oxycodones?

PATIENT: Like on the weekends mostly. That’s about it.

DR. HARRINGTON: Okay, and what about last night? How many do you think you took last night?

PATIENT: Maybe three or four, I’m not—I’m not really sure. I kind of lost track.

DR. HARRINGTON: Yeah, it sounds like it, and especially when you mix opioids with alcohol, you have an increased risk of overdosing. Your friend was really, really worried about you. You stopped breathing and you didn’t come-to until you got the naloxone, which is that medicine that reverses opioid overdose.

PATIENT: Okay. Well, I’m not like an addict or anything. This is just like a one-time thing.

DR. HARRINGTON: You know, I hear you, it sounds like it’s really important to you that this problem doesn’t come to the level of an addiction, but I am really concerned. It’s really scary that you overdosed, and I’d like to help you so this doesn’t become a pattern in the future.

PATIENT: Well then, then we can tell my parents that it was just like a one-time thing, right?

DR. HARRINGTON: Okay, well you started to use the Oxycodone, it sounds like, after your lacrosse injury this past year, and it sounds like you use it pretty often on the weekends, so if it’s okay with you, I’d like to ask you some questions about how the Oxycodone might be affecting other areas of your life. Is that okay?

PATIENT: Okay, I guess. Yeah.

DR. HARRINGTON: Okay. These questions are pretty structured and sometimes seem repetitive, but it’s important we get through all of them, all right?

PATIENT: Sure.

DR. HARRINGTON: In the past 12 months, have you often found that when you started using, you ended up taking more than you intended?

PATIENT: Yeah, tonight. Geez.

DR. HARRINGTON: Okay. Have you wanted to stop or cut down using, or control your use?

PATIENT: Well, like right now, yeah.

DR. HARRINGTON: Okay. Have you spent a lot of time getting or using Oxycodone?

PATIENT: No, I’ve got a lot left over, you know.

DR. HARRINGTON: Have you had a strong desire or urge to use Oxycodone in between those times when you were using?

PATIENT: No, not—not really.

DR. HARRINGTON: Okay. Have you missed work or school or come in late because you were intoxicated, high, or recovering from the night before?

PATIENT: No. I—I’m fine. I’m not like a drug addict or anything. It was like a one-time thing.

DR. HARRINGTON: Okay. Has your use of Oxycodone caused problems with other people, like family members, friends, or people at work or school?

PATIENT: No, but it might now with my parents.

DR. HARRINGTON: We’ll help you talk to your parents, okay?

PATIENT: Okay.

DR. HARRINGTON: But let’s get through all these questions. Have you had to give up or spend less time working, enjoying hobbies, or being with others, because of your drug use?

PATIENT: No. I’m usually like a really responsible person. It…it’s, I don't know, it’s just it’s been kind of hard keeping up with stuff.

DR. HARRINGTON: Okay. Have you ever gotten high before doing something that requires coordination or concentration, like driving or sports?

PATIENT: No. I—after parties we usually just call an Uber. We don’t drive after, you know.

DR. HARRINGTON: Okay, good. Has the Oxycodone caused you problems like making you depressed or anxious or agitated or irritable?

PATIENT: No. In the mornings it’s like hard to get up, but I usually just take it when I can sleep in the next day, you know.

DR. HARRINGTON: Okay. Have you found you needed to use much more Oxycodone to get the same effect that you did when you first started using?

PATIENT: No, not really.

DR. HARRINGTON: Okay. Do you feel sick when you cut down or stop using, like shaking, body aches, fevers, throwing up?

PATIENT: No, no. It’s—I’m not a drug addict. It’s like just for fun. That’s all it is.

DR. HARRINGTON: Okay. Well, thank you for being honest. Based on your answers to these questions, it seems like we have a mild opioid use disorder, and that’s based on the fact that sometimes your use gets out of control like it did tonight and that you’ve been trying to cut down for a while. The good news is that this doesn’t seem like you’re dependent on the Oxycodone yet, which is wonderful, but I’m worried that if you continue this pattern of use 00:06:26 you could get to that level. And the other positive thing is that it really doesn’t seem like it’s affecting you in your day to day life yet, but again, I worry that that would happen if you continued to use.

PATIENT: You make it sound like I just dodged a bullet or something.

DR. HARRINGTON: You know, I think you really have, but the good thing is that you can stop this, and it’s much easier to do it now than waiting until later.

PATIENT: Okay, well like how?

DR. HARRINGTON: I’d really like to refer you to a counselor that specializes in addiction. I think they can really help you, but I want to talk to you a little bit more about that. On a scale of 1 to 10, 1 being not interesting at all in seeing a counselor and 10 being very interested, where do you think you’d fall?

PATIENT: Like a 6?

DR. HARRINGTON: That’s great, that means you’re 60% of the way there. Why did you pick a lower number, meaning what are some good reasons you have for wanting to see a counselor?

PATIENT: I’m not sure, like I guess just because I don't want to get into any more trouble. I…it’s kind of like scary, you know. I mean, my parents are going to be really angry about all this, and I don't know what’s going to happen.

DR. HARRINGTON: Yeah. What else?

PATIENT: I guess I’ll have more energy if I do, and I’ll be able to just kind of keep myself together more, I don't know.

DR. HARRINGTON: So, it sounds like you have some really important reasons as to why you want to see a counselor.

PATIENT: Yeah.

DR. HARRINGTON: The other thing with drinking is that, like we’ve said before, we really worry when you combine it with opiates, because it increases your risk for overdosing, and then also sometimes when you drink to excess, you do things that you wouldn’t normally do, like taking any heroin. I’ll get the number for that counselor that we talked about, okay? And then we’ll also loop your pediatrician in so they know what happened and so they can help you once you leave here, too.

PATIENT: Thanks.

DR. HARRINGTON: You’re welcome.

PATIENT: But—but what about my parents? They’re going to be really, really mad when they find out all about all of this.

DR. HARRINGTON: You know, I think that once they see that you’re okay, I think they’re going to be really relieved, and I bet that if you’re honest with them and you talk to them about your goals—seeing a counselor—I bet they’ll cut you some slack. But it’ll be really important to remember that you got to follow through with those goals, you know, see your counselor, stop using the pills and, you know, decreasing your drinking.

PATIENT: Yeah. Yeah, you’re right.

DR. HARRINGTON: All right.

PATIENT: And I’m—I guess I’m just like…I’m mad at myself for disappointing them, you know.

DR. HARRINGTON: You know, it’s okay, and I know it’s tough, but I’d be happy to stay in here and help you talk with them when they get here.

PATIENT: Thank you.

DR. HARRINGTON: You’re welcome.

 

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