This week’s case is about David, who is a 65- year-old male with chronic pain from severe degenerative osteoarthritis of the cervical and lumbar spine. He takes extended-release oxycodone 20 mg twice a day, supplemented with immediate-release oxycodone 10 mg up to 4 times daily. The regimen has been unchanged for 8 years. Over that time, he has occasionally run out of his immediate release prescription early, which he has attributed to acute exacerbations of severe pain. He rates his pain as moderate on most days, and has variable function, is able to go on longer walks and go shopping on good days while relegated to staying at home during severe episodes. He returns for his scheduled 3-month follow-up appointment.

This week’s case is about Andrea, a 67-year-old woman with anxiety and insomnia who has been taking high-dose clonazepam for years, also takes citalopram and occasionally drinks alcohol, and is seeking support to safely reduce her medication, highlighting the importance of careful assessment, shared decision-making, and a structured taper.

This week's case is about a patient, John, currently prescribed OxyContin 40 mg every 12 hours and hydrocodone/acetaminophen 10-325 mg, two tablets three times daily, totaling approximately 180 MMEs per day. The patient is being considered for a transition to buprenorphine for chronic pain management using a standard rotation approach. We'll walk through the clinical reasoning, dosing strategy, and the transition protocol.