Shawn is a 35yr Caucasian male who presents to clinic for issues related to using substances. Shawn identifies his drug of choice as heroin and has been using 1g intravenously per day. His last use was 12 hours ago. He has maintained current use for 2 years and reports of withdrawal symptoms when not having opioids. He began using following being prescribed Oxycodone 10mg when he broke his arm at 22yrs. He states, “I had never felt like that in my life.” When the medication stopped being prescribed, he began buying opioid pain pills in the community. His drug use increased over time with no more than 2 weeks of sobriety, which occurred while in a sober living facility. He states, “I couldn’t take it, I hate the way I feel without it.” He identifies opioids making him feel “normal.” He has experimented with methamphetamine but states “I don’t like the paranoia.” He uses THC daily averaging 1 joint per day. He has used THC since he was 13 yrs of age. He identifies being sad and hopeless about his drug use. He states, “I want to stop I just can’t stay away from it.” He identifies primary driver for use being the feeling he receives when using and avoiding withdrawal episodes. He is unsure of overall mental health status due to his persistent drug use. He reports of being anxious as a teenager which led to his mother having him attend counseling. He denies benefit with therapy. He primarily avoids social settings due to racing thoughts, worry, and jumping to conclusions about how others perceive him. He denies a history of mania, hypomania or psychosis. He denies thoughts of harm to self or others.
PHYSICAL: Reports of aches and pains related to not using opioid today. He has a mild tremor in arms bilaterally. He reports of vomiting while in the waiting room. He has no HX of surgeries or chronic illness. He has never been tested for HIV or hepatitis C.
SOCIAL: Shawn is a single male who has been couch surfing for the past year. He has struggled to maintain consistency in life due to substance use. He is currently unemployed and recently lost his job landscaping. He desires to return to work but struggles due to drug use. He has never been married and struggles to maintain relationships due to drug use. He has no support. He has not spoken to family in over 6 months.
Name the possible medication choices with rationales