{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T14:11:54Z","timestamp":1761919914045,"version":"3.44.0"},"reference-count":18,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2014,11,28]]},"abstract":"<jats:p>The prescribing of opioid pain medication has increased markedly in recent years, with strong opioid dispensing increasing 18-fold in Tayside, Scotland since 1995. Despite this, little data is available to quantify the problem of opioid pain medication dependence (OPD) and until recently there was little guidance on best-practice treatment. We report the case of a young mother prescribed dihydrocodeine for postoperative pain relief who became opioid dependent. When her prescription was stopped without support, she briefly used heroin to overcome her withdrawal. After re-exposure to dihydrocodeine following surgery 9\u2005years later and treatment with methadone for dependency, she was transferred to buprenorphine\/naloxone. In our clinical experience and in agreement with Department of Health and Royal College of General Practitioner guidance, buprenorphine\/naloxone is the preferred opioid substitution treatment for OPD. Our patient remains within her treatment programme and has returned to work on buprenorphine 16\u2005mg\/naloxone 4\u2005mg in conjunction with social and psychological support.<\/jats:p>","DOI":"10.1136\/bcr-2014-207458","type":"journal-article","created":{"date-parts":[[2014,12,17]],"date-time":"2014-12-17T05:53:20Z","timestamp":1418795600000},"page":"bcr2014207458","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Failure to identify or effectively manage prescription opioid dependence acted as a gateway to heroin use\u2014buprenorphine\/naloxone treatment and recovery in a surgical patient"],"prefix":"10.1136","volume":"2014","author":[{"given":"Stephen","family":"Conroy","sequence":"first","affiliation":[{"name":"Lanarkshire Alcohol and Drug Service, Coatbridge, Scotland, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duncan","family":"Hill","sequence":"additional","affiliation":[{"name":"NHS Lanarkshire, Motherwell, Scotland, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,12,17]]},"reference":[{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.1","unstructured":"Addressing prescription drug abuse in the United States: current activities and future opportunities. Atlanta: Centers for Disease Control and Prevention, 2013. http:\/\/www.cdc.gov\/homeandrecreationalsafety\/overdose\/hhs_rx_abuse.html"},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.2","unstructured":"The Royal College of General Practitioners. Prescription and over-the-counter medicines misuse and dependence. Fact Sheet 4. Treatment. 2014."},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.3","unstructured":"Health & Social Care Information Centre. Prescription cost analysis 2004\u20132012. http:\/\/www.hscic.gov.uk"},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.4","doi-asserted-by":"crossref","unstructured":"Ruscitto A , Smith BH , Guthrie B . Changes in opioid and other analgesic use 1995\u20132010: repeated cross-sectional analysis of dispensed prescribing for a large geographical population in Scotland. Eur J Pain 2014. doi: 10.1002\/ejp.520 .","DOI":"10.1002\/ejp.520"},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1402780"},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.6","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12133"},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.7","unstructured":"Hecht G , Barnsdale L , McAuley A . The National Drug-Related Deaths Database (Scotland) report: analysis of deaths occurring in 2012. NHS National Services Scotland, 2014."},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.8","first-page":"19","article-title":"Transfer to buprenorphine from daily doses of methadone greater than 30\u2005mg\u2014initial review of transfers","volume":"15","author":"Conroy","year":"2013","journal-title":"Heroin Addict Relat Clin Probl"},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.9","unstructured":"Epidemic: Responding to America's Prescription Drug Abuse Crisis: Office of National Drug Control Policy. US Executive Office of the President United States of America. 2011."},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1404181"},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.11","unstructured":"Scottish Intercollegiate Guidelines Network (SIGN). Management of chronic pain. Edinburgh: SIGN, 2013. (SIGN publication no. 136). [December 2013]. http:\/\/www.sign.ac.uk"},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.12","first-page":"342","article-title":"Opioid addiction and abuse in primary care practice: a comparison of methadone and buprenorphine as treatment options","volume":"104","author":"Bonhomme","year":"2012","journal-title":"J Natl Med Assoc"},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.13","first-page":"CD002207","article-title":"Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence","volume":"2","author":"Mattick","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.14","unstructured":"Department of Health (England) and the developed administrations. Drug misuse and dependence: UK guidelines on clinical management. London: Department of Health (England), the Scottish Government, Welsh Assembly Government and Northern Ireland Executive, 2007."},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.15","unstructured":"The Royal College of General Practitioners. Prescription and over-the-counter medicines misuse and dependence. Fact Sheet 1. The Problem. 2014."},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.16","unstructured":"The Royal College of General Practitioners. Prescription and over-the-counter medicines misuse and dependence. Fact Sheet 2. Prevention. 2014."},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.17","unstructured":"The Royal College of General Practitioners. Prescription and over-the-counter medicines misuse and dependence. Fact Sheet 3. Identification. 2014."},{"key":"2025082623461219000_2014.dec17_1.bcr2014207458.18","unstructured":"Delivering Recovery. Independent expert review of opioid replacement therapies in Scotland. Scottish Drug Strategy Delivery Commission. The Scottish Government, 2013."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2014-207458","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:46:23Z","timestamp":1756277183000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2014-207458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,12,17]]},"references-count":18,"alternative-id":["10.1136\/bcr-2014-207458"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2014-207458","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2014,12,17]]}}}