A new addiction for the New Year I have a patient who was on chronic opioid therapy for about six years for a musculoskeletal condition. I inherited her from a retiring physician who was known for being a bit loose with his prescription pad and not regularly requiring UAs. When I get patients like this, I usually wait a month or two before asking for urine because many people will abstain from illicit drug use for their first appointment with me. This is exactly what I did with this patient because something seemed "off" with her. She's a woman in her 20s, about 5'6", 135 lbs. Other than her chronic pain from this condition, she's an otherwise healthy woman, but the way she behaved had my Spidey senses tingling. Well, I gave her a surprise UA after two months and sure as hell, she tested positive for methamphetamine. Rather than fire her as a patient, I offered to keep her on and refer her to an inpatient rehab for detox and treatment. Most patients get mad and go on down the road, but to my surprise, she agreed to treatment. When she missed her next appointment, I figured she was using again and found another provider, so I thought nothing of it. Fast forward to a few days ago. I was covering a shift at our urgent care and a familiar name comes up. It's my patient! Only this time, something is different on the chart. 5'6", 235 lbs. No, this has to be a typo! Nope, she's absolutely HUGE! She's there for lower extremity pain and swelling. Her legs are weeping fluid and she was winded just walking a few yards to the lab for the blood draw. Diagnosis: congestive heart failure. What did this rehab do, give Rocky Road IVs for withdrawal symptoms?