Psychiatrymiddle twist
A 41-year-old woman stabilised on methadone 80 mg daily for opioid dependence has had open reduction and internal fixation of an ankle fracture. Four hours later she is distressed by severe pain despite regular paracetamol and parecoxib. The surgical registrar has withheld this morning's methadone dose and is reluctant to prescribe any opioid because of her 'addiction'. She is alert and not sedated, with a respiratory rate of 18/min. Which one of the following is the most appropriate plan for her pain?