START

Your patient Cathy is 22 and she has been your patient for five years. She comes in sporadically with minor illnesses, but rarely keeps follow-up appointments. She has been on fluvoxamine for depression for almost one year. 

Over the past few months, Cathy has come in several times requesting oxycodone with acetaminophen for migraine headaches. You have previously given her a prescription for 20 tablets of this medication.

Today, she requests oxycodone-acetaminophen again.

"I know you're busy today, doc, so if you can just give me a few more Percocet pills for my headaches, I'll be on my way."

You decide to briefly examine her first, since she appears thin and anxious. While taking her blood pressure, you notice these marks on her arm. 

When you ask her about these marks, she becomes tearful and admits to injecting heroin for the past year and a half. 

"But I really want to get off that junk, doc," she sobs. "Can you help me?"

How do you respond to this?

In the following question, please drag the choices into order from most (top) to least appropriate (bottom). It is not sufficient to simply indicate your first choice.

When you are satisfied with the order of priorities, move on to the Next Step.