Male Age: 16


Ricky is new to your practice. He was the star running back on his high school football team before a back injury. Upon examination, you note that he has low blood pressure, appears drowsy, and has difficulty following the conversation. His mother expresses concern that he misses a lot of school because of persistent fatigue. Out of the presence of his mother, Ricky attributes his problems to his injury. He tells you he sometimes uses marijuana to help himself feel better about things and assures you he will be okay as soon as you prescribe more painkillers.

You recognize the signs of opioid misuse: drowsiness, low blood pressure, difficulty concentrating in conversation, and eagerness to get more painkillers. Opioid misuse—even just one large dose—can cause severe respiratory depression and death, according to the National Institute on Drug Abuse. Combined with his marijuana use, this places Ricky at high risk of increased substance abuse and serious health consequences.

As a busy primary care provider, you regularly see patients like Ricky who need treatment for substance use and a range of emotional and behavioral issues.