Life Stage 2: Early Adulthood
During the last year Kayla has not had a consistent primary care physician. She started feeling nauseous on a consistent basis and followed up at the local community medicine clinic. Upon testing her, the clinic determined a positive urine drug screen for oxycodone, hydrocodone, alprazolam and marijuana. Kayla then admitted she had been taking her sister's pain medication for back pain. Kayla states that with all of the stress she has been going through, she needs the alprazolam to keep her from going "off the edge." She states she has just been trying to treat her pain the best that she can and that nobody has been willing to help her. The alprazolam was prescribed by an urgent care doctor, but she's about to run out of that medication. She states she is "desperate" for a new prescription. During this visit it is found that Kayla is also pregnant. Kayla states the pregnancy was definitely not expected but she wants to keep the child./n /n Upon examination by an OB/GYN, Kayla is found to be 11 weeks pregnant. Patient is still complaining of back pain and is worried that as the pregnancy goes on, her back pain will worsen. Patient is also complaining of significant anxiety despite taking daily alprazolam. Patient also states that she will need the opioids to have any chance of dealing with the pain.
At this point Kayla has all the signs and symptoms of a life that is generally out of control. Many times these patients will arrive to a primary care physician having not had a urine drug screen and will definitely not confess to the medications they are taking. This is also a time in which many physicians will not check the prescription drug monitoring program to identify that there were many prescribers of medications. /n /n Despite the fact that this patient was referred to an OB/GYN, many patients will not follow-up because they are worried that child protective services will take their child from them. This, coupled with the generally negative interaction they may have with the staff of an uninformed OB/GYN clinic, can deter these patients from obtaining prenatal care. It should also be noted that benzodiazepines and marijuana as well as tobacco all have significant risk to the unborn child, much more than the opioid.