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Webinar 2: Guide to Rational Opioid Prescribing fo ...
Webinar 2: Guide to Rational Opioid Prescribing for Chronic Pain
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Video Transcription
Welcome to the course, A Guide to Rational Opioid Prescribing for Chronic Pain. I'm Dr. James Finch, a family physician by training and prior practice, but now practicing primarily addiction medicine in Durham, North Carolina. I'm also the Director of Physician Education for the Governor's Institute. Everyone is aware of the ongoing epidemic of opioid misuse and abuse, including the dramatic increase in associated overdose deaths. Many factors contribute to this, social as well as clinical, but it has focused our attention on the need for clinicians, regardless of specialty or practice setting, to take additional care when prescribing medications like opioids with potential for misuse or abuse. That said, many clinicians often feel they're caught between a rock and a hard place. Chronic pain is a common but often complex clinical problem, and in the past, practitioners have been criticized for inadequate treatment of pain, particularly chronic, non-malignant pain. For this reason and a variety of others, the use of prescription opioids has increased dramatically in the past 15 years. But problems associated with their use have also increased dramatically. For most problems related to drug abuse, there is a direct relationship between the availability of a particular drug and problems associated with that drug. This holds true for illegal drugs like cocaine, as well as legal drugs like nicotine and alcohol, and this relationship has held true for opioid analgesics as well. As stated, the rate of prescribing opioid analgesics has escalated dramatically over the past 15 years, as shown here by the green line. But as the rate of prescribing opioids has escalated, so has the rate of problems associated with them, including the rates of emergency room visits and other admissions for treatment. And most dramatically, in the rates of accidental overdose deaths. This is not to say that this current public health dilemma is simply a matter of over-prescribing. It's far from that simple. However, current prescribing patterns have contributed and must be addressed to begin decreasing the magnitude of these morbidity and mortality figures. Although there is an obvious need to decrease the morbidity and mortality associated with opioids and other controlled medications in terms of impairment, accidents, and overdoses, there is also a need and expectation to provide adequate treatment for chronic pain, a common and often debilitating condition. Clinicians often face the difficult challenge of balancing these needs and expectations in the setting of an evolving knowledge base related to chronic pain management, including a woefully inadequate clinical research base as it relates to using opioids effectively, as well as increased regulatory oversight and legal attention for both undertreatment and overtreatment of chronic pain. All of which adds up to a need to evolve and apply a reasonable and acceptable standard of care as it relates to the use of opioids in chronic pain management. This is sometimes seen as a need to push back the pendulum of opioid prescribing, a pendulum that many see as having swung too far in response to concerns over undertreatment, toward an overemphasis on and overuse of opioid analgesics, prescribing without attention to risk and without appropriate monitoring, at times prescribing excessive doses without making use of alternatives or adjunctive treatments, and failing to intervene when problems develop. But as we respond to the current concerns, we can't afford to push the pendulum too far back so that clinicians, out of exaggerated perception of risk or fear of regulatory action, avoid using opioids at all when they might be safe and useful for some or possibly many patients suffering from chronic pain. In seeking balance, we need to apply a process of rational prescribing consistent with accepted principles of medicine that minimizes risk when possible and allows access to opioid pain management when needed and appropriate. Achieving a balanced approach to opioid prescribing is one of the main goals of this training. But other medications, such as benzodiazepines and stimulants, also have the potential for misuse or abuse. Although not addressed directly in this training, most of what will be presented in terms of strategies for lowering prescribing risk can be adapted to these other classes of medications as well. So how will this training help you deal with these clinically challenging situations? To help outline the information, this training is organized into three modules. The first module introduces certain core concepts related to chronic pain and the role of opioids in its management, presents core concepts related to identifying aberrant medication behaviors, and introduces the new standards of practice related to opioid prescribing, such as those of the North Carolina Medical Board and the U.S. Centers for Disease Control and Prevention. The second module presents specific recommendations related to initiating treatment with opioids, including recommendations related to adequate evaluation, treatment planning, and informed consent. The third deals with elements of monitoring and adapting treatment in response to inadequate functional improvement or aberrant medication-related behaviors, including when and how to stop prescribing opioids or other control medications when needed. All three training modules will use a combination of didactic presentations, clinical role plays, and references to other useful materials or resources. To make this material applicable across the broad range of medical practice, all of the training material has been developed by an interdisciplinary team of providers, drawing on expertise from primary care, addiction medicine, psychiatry, and pain management. Thank you for taking the time to learn more about how to effectively and safely prescribe opioids for chronic pain. We hope that this course will be beneficial to you as you pursue your medical training as well as your future patients and your community.
Video Summary
The video is a course introduction by Dr. James Finch on rational opioid prescribing for chronic pain. Dr. Finch highlights the ongoing epidemic of opioid misuse and abuse and the need for clinicians to be cautious when prescribing opioids. He discusses the increase in prescription opioid use and the corresponding increase in problems associated with their use, including emergency room visits and accidental overdose deaths. Dr. Finch emphasizes the importance of finding a balance between providing adequate treatment for chronic pain and minimizing the risks associated with opioid use. The training is organized into three modules, which cover core concepts of chronic pain, initiating treatment with opioids, and monitoring and adapting treatment. The material has been developed by an interdisciplinary team of providers.
Keywords
rational opioid prescribing
chronic pain
opioid misuse
clinicians
prescription opioid use
The content on this site is intended solely to inform and educate medical professionals. This site shall not be used for medical advice and is not a substitute for the advice or treatment of a qualified medical professional.
Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 and grant no. 1H79TI085588 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
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