The program saved $2.43 million over 6 years for the health care system by reducing hospital length of stay with safe and appropriate discharge planning for IDUs with infections requiring long-term IV antibiotics.

Fibromyalgia is a chronic condition that is diagnosed primarily by the presence of generalized pain along with tenderness on palpation of certain body regions. Unfortunately, the pharmacological treatment of fibromyalgia remains problematic. Two patients are described who highlight the use of the atypical neuroleptic olanzapine for the control of symptoms related to fibromyalgia. Prior to the use of olanzapine, both patients had received a multitude of treatments, none of which greatly improved their ability to function in daily activities. With olanzapine, both patients reported a significant decrease in pain and marked improvement in daily functioning. In one case, the pain returned during a period of time when olanzapine was discontinued, an effect that was reversed when olanzapine was reintroduced. The paucity of serious side effects (i.e., extrapyramidal signs) with the atypical neuroleptic olanzapine strongly favors further exploration and use of this drug for the treatment of fibromyalgia symptoms.

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Prescribing of opioids for acute and chronic pain has increased; so has the incidence of abuse of these medications. Patients in the hospital may have hyperalgesia, tolerance, and dependence on opioids which can complicate their overall treatment. Some patients have opioid addiction from prescription opioids as well as heroin with aberrant medicine taking behaviors. Managing these patients takes special knowledge and skills from the whole team. It is important to identify patient concerns and barriers to treatment and work as a team to treat the pain with pharmacological, nonpharmacological, and behavioral techniques to help keep the patient safe and comfortable during their hospitalization. A nonjudgmental attitude and problem-solving approach are necessary for medical (pain) and psychosocial issues. Recommendations for safe prescribing of opioids to the addicted patient at discharge are included.

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