A Complex Case of Opiates and Related Pathologies

  • Jennifer L. Pikard
  • Sarah Penfold
  • M. Nadeem Mazhar


The use and overuse of pain relief medications have become a contemporary topic of interest with increased public visibility. Opioid use disorder and its implications are discussed here with reference to a complex case of PTSD. Here, we provide a context for the case as well as outline the various risk factors, characteristics of withdrawal, and treatment options.


Opioid Use Disorder PTSD Methadone Naltrexone 


Disclosure Statement

“The authors have nothing to disclose.”


  1. 1.
    Sharma B, Bruner A, Barnett G, Fishman M. Opioid use disorders. Child Adolesc Psychiatr Clin N Am. 2016;25:473–87.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Bateman N. Opioids Med. 2012;40(3):141–3.CrossRefGoogle Scholar
  3. 3.
    Comerford D. Techniques of opioid administration. Anesth Intensive Care Med. 2011;12(1):16–20.CrossRefGoogle Scholar
  4. 4.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: Am Psychiatr Assoc; 2013.CrossRefGoogle Scholar
  5. 5.
    Al-Hasani R, Michael R. Bruchas. Molecular mechanisms of opioid receptor-dependent signaling and behavior. Anesthesiology. 2011;115(6):1363–81.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Stahl SM. Essential psychopharmacology online. 2008. Retrieved September 3, 2016 from “
  7. 7.
    Terault JM, Butner JL. Non-medical prescription opioid use and prescription opioid use disorder: a review. Yale J Biol Med. 2015;88:227–33.Google Scholar
  8. 8.
    Tetrault JM, Fiellin DA. Current and potential pharmacological treatment options for maintenance therapy in opioid dependent individuals. Drugs. 2012;72(2):217–28.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    College of Physicians and Surgeons of Ontario (CPSO) methadone maintenance treatment program standards and clinical guidelines 4th edition February 2011 accessed on August 26, 2016 at: “
  10. 10.
    Kampman K, Jarvis M. American Society of Addiction Medicine (ASAM) national practice guidelines for the use of medications in the treatment of addiction involving opioid use. J Addict Med. 2015;9(5):1–10.CrossRefGoogle Scholar
  11. 11.
    Handelsman L, Cochrane K, Aronson M, et al. Two new rating scales for opiate withdrawal. Am J Alcohol Abuse. 1987;13:293–308.CrossRefGoogle Scholar
  12. 12.
    Katzman M, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(1):S1.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Goodman D, Milliken C, Theiler R, Nordstrom B, Akerman S. A multidisciplinary approach to the treatment of co-occurring opioid use disorder and posttraumatic stress disorder in pregnancy: a case report. J Dual Diagn. 2015;11(3–4):248–57.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    ACOG Committee on Health Care for Underserved Women and American Society of Addiction Medicine. ACOG committee opinion no. 524: opioid abuse, dependence, and addiction in pregnancy. Obstet Gynecol. 2012;119(5):1070–6.CrossRefGoogle Scholar
  15. 15.
    Finnegan L, Connaughton J, Kron R, Emich J. Neonatal abstinence syndrome: assessment and management. J Addict Dis. 1975;2(1–2):141–58.Google Scholar
  16. 16.
    D’Apolito K. Neonatal opiate withdrawal: pharmacologic management. Newborn Infant Nurs Rev. 2009;9(1):62–9.CrossRefGoogle Scholar
  17. 17.
    Sutter M, Leeman L, His A. Neonatal opioid withdrawal syndrome. Subst Abuse During Pregnancy. 2014;41(2):317–34.Google Scholar
  18. 18.
    Roberts N, Roberts P, Jones N, Bisson J. Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2015;38:25–38.CrossRefPubMedGoogle Scholar
  19. 19.
    Najavits L, Roger D, Weiss S, Shaw S, Muenz L. “seeking safety”: outcome of a new cognitive-behavioral psychotherapy for women with posttraumatic stress disorder and substance dependence. J Trauma Stress. 1998;11(3):437–56.CrossRefPubMedGoogle Scholar
  20. 20.
    Schmitz M. The case: treating Jared through seeking safety. J Clin Psychol In Session. 2013;69(5):490–3.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jennifer L. Pikard
    • 1
  • Sarah Penfold
    • 1
  • M. Nadeem Mazhar
    • 1
  1. 1.Department of PsychiatryQueen’s UniversityKingstonCanada

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