Opioids withdrawal, addiction in 45-year-old man with no previous substance abuse history

Craig, age 45 years, owns and manages a successful, respected construction company. He works long hours and employs a staff of 20. While on the job, a piece of heavy equipment falls on Craig’s back and causes multiple breaks in his lumbar vertebrae. As a consequence, Craig requires a back brace and three months of physical rehabilitation.

After Craig rated his pain as a nine or 10 on an analogue scale, his physician put him on a one-month trial of oral oxycodone 10 mg every 12 hours. Craig’s pain almost immediately was reduced to a two on the pain scale. He also reported a feeling of mild euphoria when taking the medication.

After the month’s trial was over, Craig requested another prescription, but higher dose. His physician increased the dose to 20 mg orally, twice per day. While this was initially helpful in keeping his pain at level 2, Craig began taking more pills daily than prescribed. Ultimately, he sought care from multiple practitioners, each of whom would write him a prescription for oxycodone.

At a follow-up appointment, Craig’s primary physician is suspicious and obtains a more detailed substance use history. Within the past three months, Craig has been taking between 120 mg and 200 mg of oxycodone per day. He has been absent from work or, when there, not focused, spending most of his time recovering from the sedating effects of the medication or planning for this next dose.

Further history taking reveals that Craig had become isolated from his family, his wife has threatened to leave him because of his erratic behavior. Craig also has used high doses of oxycodone while driving and been involve in two minor traffic accidents.

When not taking oxycodone, Craig reports he drinks several beers throughout the day to “take the edge off.” Craig does not report the use of any illicit drug. He admits he is addicted to opioids, but says he has been too ashamed and embarrassed to seek help. He is very worried that his providers will stop prescribing him narcotics, and recently contemplated buying heroin from a drug dealer. “I want help, but I don’t know where to get started; my life is a mess,” he says, during burying his face in his hands, weeping.