After receiving a diagnosis of chronic low back pain, a 48-year-old male patient with a history of major depressive disorder and substance use disorder in partial remission asks about medication options. Which of the following is not an appropriate option given his clinical scenario?

Choice A reason: Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) approved for chronic musculoskeletal pain and also treats depression. It is appropriate for this patient due to its dual benefit and non-addictive profile. Choice B reason: Opioids pose a high risk of relapse in individuals with a history of substance use disorder. They are generally contraindicated unless all other options have failed and strict monitoring is in place. In this case, they are not appropriate. Choice C reason: Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) effective for chronic pain. It is non-addictive and suitable for patients with substance use history, assuming no contraindications like GI or renal issues. Choice D reason: Acetaminophen is a safe, non-opioid analgesic for mild to moderate pain. It is appropriate for patients with substance use disorder and can be used alone or in combination with other non-opioid agents.