Read the following case studies and search for the guidelines that answers the specific questions?

Case 1

A 54-year-old woman with chronic pain due to inflammatory arthritis presents to your clinic stating that she is having a “flare” of her arthritis but is out of her Oxycontin® and immediate-release oxycodone. She is aware that it is too early to fill her prescriptions, but she insists that she will be traveling out of state and “really needs” her medications. 

Question: How do you Approach This Patient in the community setting?

What is the implications of prescribing this medication? Please provide evidence.

Case 2

A 27-year-old woman on buprenorphine-naloxone (Suboxone®) for treatment of opioid dependence is admitted to the hospital with severe abdominal pain due to a perforated gastric ulcer. She received hydromorphone in the ED, and is urgently taken to the operating room. Postoperatively, she is on a patient-controlled analgesic (PCA) pump containing fentanyl. Her last dose of buprenorphine-naloxone was 20 h prior to the surgery; her daily dose is 16 mg.

Question: How can Pain be Managed in Patients who are Taking Buprenorphine-Naloxone? What Adjustments to her Medication Regimen can be Recommended?