Woman Released From Prison Requesting Tramadol and Gabapentin — Free SCA Practice Case

Character Overview: You are Kelly, 34, released from prison two weeks ago after a sentence of several months. You are living in a hostel, working shifts as a hospital porter, and trying to find somewhere of your own to rent. You have no family contact and no friends nearby; you feel very isolated. You have long-standing lower back pain for which you were prescribed tramadol in prison, and you have almost run out. You also want gabapentin: you took it inside and found it helped you sleep and "took the edge off". If asked directly, you will admit you were not prescribed the gabapentin — another inmate gave it to you, and you have been taking it on and off, not regularly. You are not using illicit drugs or drinking. You are polite but persistent about the gabapentin, and you will become frustrated if you feel judged or simply refused without explanation. You would engage well with practical help.

Opening Sentence: "Hello Doctor. I got out a couple of weeks back and I've registered here. I need my prescriptions sorted — I'm on tramadol for my back, and I need gabapentin as well. I've nearly run out of both."

History if Asked (Data Gathering Phase)

• ●The tramadol: "I've been on tramadol for my back for a good while. They gave me a week's worth on release and it's nearly gone."
• ●The gabapentin: "I take that too. It helps me sleep and it takes the edge off things."
• ●If asked directly who prescribed the gabapentin: "Honestly? It wasn't prescribed to me. Another woman inside used to give me hers. I've been taking it on and off since."
• ●Her back: "It's been bad for years. It aches constantly, worse when I'm on my feet — and I'm portering, so I'm on my feet all shift."
• ●Her situation: "I'm in a hostel. Working as a porter. Trying to get somewhere of my own to rent. I've got no family and nobody round here really."
• ●Sleep: "I can't sleep in that hostel. That's half of why I want the gabapentin."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores her perspective.

• ●Ideas: Kelly believes gabapentin is simply a medication that helps her sleep and her back, and does not see the informal way she obtained it as a problem. "It helped me inside, so I don't see why I can't have it prescribed properly now."
• ●Concerns: Her dominant concerns are coping with her back pain at work, not sleeping, and holding her life together after release — including keeping her job and getting housed. "If my back goes and I can't work, I lose everything I'm trying to build. And I'm shattered from not sleeping."
• ●Expectations: She expects both prescriptions, particularly the gabapentin. "I want both sorting, especially the gabapentin."

If Asked — Pain, Medication, Substance, and Resettlement Screen

The patient answers these only when directly asked.

• ●If asked about the back pain (site, radiation, character, duration): "Lower back, aching, for years. It doesn't shoot down my legs."
• ●If asked about cauda equina red flags (saddle numbness, bladder/bowel control, leg weakness): "No numbness down below, no problems with my bladder or bowels, no weakness in my legs."
• ●If asked about malignancy/infection red flags (weight loss, fever, night sweats, night pain): "No weight loss, no fevers or sweats."
• ●If asked about how much tramadol she is taking and whether it helps: "Usually two or three a day. It takes the edge off but doesn't get rid of it."
• ●If asked about how much gabapentin and how often: "On and off — not every day. Whenever I can't sleep or the back's bad."
• ●If asked, non-judgementally, about illicit drug use, alcohol, or injecting: "No. I don't drink and I'm not using anything. I've worked hard to stay clean."
• ●If asked about previous substance misuse or treatment services: "I've had problems in the past, years ago. I'm not under any service now."
• ●If asked about mood, anxiety, and self-harm (sensitively): "My mood's low with the isolation, but I'm not depressed as such, and no, nothing like that."
• ●If asked about sleep in detail: "The hostel's noisy and I'm on shifts. I lie awake for hours."
• ●If asked about housing, work, probation, and support: "Hostel accommodation, working as a porter, I see my probation officer. No family, no friends here."
• ●If asked about physiotherapy or other treatments tried: "I saw a physio once inside. Nothing since. Nothing else has been tried, really."
• ●If asked about what she is hoping for long-term: "My own flat. A steady job. Just something normal."

Responses to Management (The Negotiation Phase)

• ●If the Doctor explains the letter does not list gabapentin: "Yeah, I know it won't be on there — like I said, it wasn't prescribed to me." (The tested point is verifying the prescription against the discharge letter rather than accepting the request at face value.)
• ●If the Doctor declines gabapentin and explains the safety reason — key: "So it's not just red tape — you're saying gabapentin and tramadol together can affect my breathing? Nobody ever told me that." (The tested point is declining an unverified controlled drug with a clear clinical safety rationale, not a bureaucratic refusal.)
• ●If the Doctor continues the tramadol on a short script with review: "So you'll do the tramadol, but a short amount and then review it? I can live with that." (The tested point is continuing verified medication safely with planned review.)
• ●If the Doctor offers proper management of the back pain: "Physio, and something else for the pain? I'd try it if it means not relying on tablets."
• ●If the Doctor addresses her sleep without a hypnotic: "So there are other ways to deal with the sleep? The hostel is the real problem, if I'm honest."
• ●If the Doctor offers resettlement support — key: "There's someone who can actually help with housing and getting settled? That'd mean a lot. It's the isolation that's hardest." (The tested point is engaging social prescribing/resettlement support.)