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JAMA Psychiatry Clinical Challenge
June 2018

Opioid Use Disorder After Self-medicating Pain From Traumatic Brain Injury

Author Affiliations
  • 1Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
  • 2Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
JAMA Psychiatry. 2018;75(6):649-650. doi:10.1001/jamapsychiatry.2018.0098

A 29-year old man who is married and an employed Army veteran presented with headache from a mild traumatic brain injury (TBI) diagnosed before his Army discharge. He came to a Veterans Affairs hospital requesting buprenorphine/naloxone and complained of marital problems and job absenteeism. His TBI occurred when a roadside bomb overturned his supply truck in Afghanistan. He lost consciousness during the bombing and awoke with severe head and neck pain but no radiological brain, spine, or skull damage or focal neurological signs. He was given 20 oral morphine (5 mg) tablets and consumed them in 4 days rather than the intended 2 weeks. After finishing the morphine, he mitigated his pain with alcohol and ibuprofen (400-800 mg daily).