DR. HOCK: Hi Mr. Johnson, I’m Dr. Hock. I understand you’re here to talk about your heroin use today, and I understand that you’re injecting a couple of times a day?

MR. JOHNSON: Yeah. It’s getting worse. I lost my job and I can’t take it any longer.

DR. HOCK: Have you ever been in treatment before?

MR. JOHNSON: A state methadone program last year for about six months, but dropped out.

DR. HOCK: Okay. So, it’s great that you were in treatment. What made you stop?

MR. JOHNSON: I don't know. I guess I got to hanging around all the guys and got to using a little, then a little more. You know how that goes.

DR. HOCK: Sure. Well, I’m glad that you came in today. What are some of the reasons that made you come here today?

MR. JOHNSON: A friend of mine on Suboxone suggested I come here for help. I feel like shit almost every day.

DR. HOCK: So, one of the things that we know is that treatment for opioid use disorder doesn’t always work every time. It’s a relapse remitting disease, and it’s great that you had six months before, and I feel like this time, you know, it’ll be even longer. But from looking at you, you do appear to be pretty uncomfortable. I read your vital signs earlier and you’re heartrate’s elevated at 120 beats of minute, your pupils are dilated and I can see that you’re kind of restless. Are you having abdominal pain?

MR. JOHNSON: Yes, all over my body.

DR. HOCK: Oh, what about nausea and vomiting?

MR. JOHNSON: I puked just outside, and I feel like I’m going to puke again. The nurse, she gave me this.

DR. HOCK: Great. All right. So, from reviewing our clinical opioid withdrawal scale, you meet criteria for severe withdrawal. It means your score is more than 30. What it does mean is that we can give you a dose of buprenorphine here in the emergency department. So, I’m going to have the nurse pull up a dose for you, and she’s going to give it to you. It’s going to be important that you place it underneath your tongue and let it dissolve completely, and I’ll come back in about a half an hour or so and see how you’re feeling, okay?

MR. JOHNSON: Okay. Thank you.

DR. HOCK: All right. So, Mr. Johnson, it looks like you’re feeling much, much better.

MR. JOHNSON: Yes, thank you.

DR. HOCK: Okay, that’s great. So, we’ll work on getting you a prescription for buprenorphine for three days. The nurse will be in with some information for you, including where to follow up with our buprenorphine clinic. Are you able to come in on Friday at nine AM?

MR. JOHNSON: Sure.

DR. HOCK: Okay, great. All right, and you have a place to stay?

MR. JOHNSON: Well, I think as long as I’m in treatment I can stay at my mom’s house.

DR. HOCK: Okay fabulous, that’s great. And so, we’ll work on getting that paperwork together, and when the nurse comes in she’ll also—is going to bring you a naloxone kit and some information for you and for your friends and family.

MR. JOHNSON: Thank you.

DR. HOCK: Okay, all right. And when you go to the clinic on Friday, they’ll be able to hook you in with a social worker, okay?

MR. JOHNSON: Okay.

DR. HOCK: Have you ever been tested for Hepatitis C or HIV?

MR. JOHNSON: A while back when I was in the program. Thankfully I was safe on both of those. I’m pretty good at using the needle exchange program, and I don't share needles.

DR. HOCK: All right, that’s great. All right. And from your exam today, I don’t see any evidence of skin infection or abscess, and so we’ll work on getting your stuff together and get you out of here, okay?

MR. JOHNSON: Thank you.

Dr. HOCK: All right. You made a great choice by coming in today.

MR. JOHNSON: Oh, I can’t thank you enough.

DR. HOCK: It’s nice to meet you.

MR. JOHNSON: Yeah.