Approaches to Responsible Opioid Prescribing. The Opioid Naïve Patient
|
|
- Todd Thomas
- 5 years ago
- Views:
Transcription
1 Approaches to Responsible Opioid Prescribing The Opioid Naïve Patient
2 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any means graphic, electronic, or mechanical, including photocopying, recording, or information storage and retrieval systems without prior written permission of Sea Courses Inc. except where permitted by law. Sea Courses is not responsible for any speaker or participant s statements, materials, acts or omissions.
3 Learning Objectives After attending this program, participants will be able to: Apply the 2017 Canadian Opioid Guidelines with respect to starting opioids in patients who have chronic non-cancer pain (CNCP) Use Strategies to monitor appropriateness of opioid therapy in patients with with CNCP
4 Question Once you start a patient on opioids A) They must take them forever or as long as they have pain B) Doses seem to increase over time C) Stopping opioids can be difficult due to severe withdrawal symptoms or other unexpected problems D) It can be hard to tell if you have created a patient with an addiction to the opioid Do you feel trapped when you start opioids?
5 INTRODUCING: RENEE Copyright: fotosmurf / 123RF Stock Photo
6 Patient Profile: Renee Female aged 55 years Bilateral knee pain with moderate osteoarthritic changes Orthopedic review conservative therapy Not a Surgical Candidate Obesity; onset 6 years ago after her daughter s suicide Current BMI 31 kg/m 2 Chronic anxiety and mild to moderate depression On disability for 1 year following a difficult cholecystectomy complicated by several episodes of Clostridium difficile BMI, body mass index.
7 Seeing a bariatric surgeon Current Treatments: Renee With an appropriate weight loss strategy, has lost 30 pounds in the last 6 months Escitalopram 30 mg once daily Clonazepam 1mg twice daily for anxiety Zopiclone 7.5mg at bedtime for insomnia Lyrica 75 mg BID Acetaminophen 1000 mg TID prn Has tried physiotherapy, chiropractic therapy, topical compound medication, CBT and mindfulness meditation Has had both cortisone and orthovisc injections No help with topical Pennsaid or Voltaren Gel
8 Renee s Visit Today She makes an appointment to see you because her function and enjoyment of life are deteriorating because of her bilateral knee pain.
9 Renee Average pain score is 8/10, increasing to 10/10 with prolonged walking, generally proportional to activity Brief Pain Inventory score: 55/70 indicating severe interference with daily life activities Mood: PHQ-9 score is 9 (mild depression), GAD-7 score is 15 (moderate anxiety) Sleep apnea screening: initial insomnia (anxious thoughts) and severe sleep apnea GAD-7, Generalized Anxiety Disorder 7-item scale. PHQ-9, Patient Health Questionnaire 9-item scale. TSH, thyroid-stimulating hormone. UDT, urine drug test.
10 Renee Physical examination: Both knees stable, no significant bony enlargement Pain-free hip range of motion Evidence of muscle tenderness with trigger points in vastus medialis and vastus lateralis Quadriceps weakness Patellofemoral pain with patellar compression and quads activation No abnormal sensitivity to light touch Radiographs: findings consistent with mild to moderate osteoarthritis no recent change
11 The Pain Management Challenge Benefit Risk
12 Opioid Trial Assuming you believe she might benefit from an Opioid Trial, How would you go about prescribing opioids for her? What would your medical record contain?
13 Prescribing Opioid for Opioid Naïve Patients AN OPIOID RX
14 Optimal Approach to Initiating Opioids for Chronic Non-Cancer Pain AN OPIOID RX Assessment biopsychosocial Non-opioid treatments Opioid risks vs. benefits Psychological assessment Informed consent (signed agreement) Order Urine Drug Testing (and other labs as required) Individualize opioid titration 50 mg and 90 mg MED Document outcomes of treatment Reassess and monitor regularly. exit strategy if goals not met or problematic behaviours
15 Assessment biopsychosocial Do a comprehensive assessment to ensure opioids are a reasonable choice and to identify risk/benefit balance for the patient Document results of history, physical exam and results of relevant investigations Formulate Differential and Working Diagnosis Document Pain Diagnosis (e.g. predominantly nociceptive or neuropathic) Assess Home Environment (e.g. co-inhabitants risk of misuse of Opioids) /. Involve family and/or caregiver in management (e.g. obtain consent from patients to communicate with family)
16 Non-Opioid treatments Maximize and Continue with Non-pharmacological therapies, including patient self-management and life style management (weight loss, exercise, nutrition, sleep hygiene) Non-Opioid analgesics and/or adjuvants, as appropriate Review Patient co-morbidities (e.g. renal function, /. cardiovascular risk, ) Concomitant medications with respect to potential drug interactions
17 Opioid risks vs. benefits Inform patient of their role in safe use and monitoring effectiveness Set Goals of Treatment (Improved Functions) and Realistic Expectations (e.g. 30 % decrease in pain scores) Inform patient of potential Nausea, constipation, drowsiness, dizziness, itching Adverse Effect on driving and operating machinery Medical complications such as sexual dysfunction, sleep apnea, opioid-induced hyperalgesia, and hormonal effects Overdose, diversion, addiction, withdrawal Potentiation of harm with alcohol.
18 Psychological assessment Consider a tool to diagnosis and monitor mental disorders (e.g. PHQ- 9 for depression) Assess both any past and present mental disorders Treat any present mental disorders before initiating Opioids Assess Suicide and/or Accidental overdose risk based on any mental disorders Taper or avoid benzodiazepines if Opioids are to be initiated Assess Sleep and Environmental Stressors (e.g. work environment)
19 Informed consent (signed agreement) Obtain Informed Consent about the prescribing of Opioids Discuss and have patient review/sign an Opioid Treatment Agreement Be explicit about characterizing opioid prescribing as a trial and that opioid therapy will be be discontinued if it is not effective or benefits are outweighed by harms
20 Order Urine Drug Testing (and other labs as required) Consider using urine drug screening (UDS) To set a baseline measure of substance use that may help assess risk for addiction For ongoing monitoring of the patient s compliance with Opioids prescribed Point of care testing, normal lab urine drug testing and gas chromatography can all be useful depending on the clinical situation
21 Individualize Opioid titration Initiate with a low dose; increase gradually; monitor Opioid effectiveness and recognize optimal dose. Watch for any emerging risks/complications to prevent unwanted outcomes including misuse and addiction Track daily dose in morphine equivalents (MED) per day Consult a colleague if daily morphine equivalent dose exceeds 90 mg Consider Immediate Release vs. Controlled Release Consider Abuse- Deterrent Formulation vs. Non Abuse-Deterrent Oral vs. Transdermal (Fentanyl must not be used in Opioid Naïve Patients)
22 Document outcomes of treatment Analgesic Effect and Score Adverse Effects Discussed and attempts to manage Affect (mood and cognitive function) Aberrant Behaviour (lost Rx s, requests for early refills) Activities of Daily Living (Effect of Treatment)
23 Reassess and monitor regularly Function and Pain Scores ( e.g. Brief Pain Inventory) Employment Recreational Activities Interpersonal Relationships Overall Quality of Life Any evidence of abuse, misuse or diversion
24 Exit Strategy A trial of opioid therapy implies an exit strategy is understood from the beginning Opioid Treatment Agreement indicates common reasons for either reduction of opioid dose (tapering to lower dose) or stopping opioids (tapering to Zero) o Misuse, Abuse or Diversion of Opioids o Opioid Tolerance o Opioid Induced Hyperalgesia o Development of Co-Morbid Medical Conditions (sleep apnea, endocrine issues) o Adverse Effects (constipation, other GI issues, cognitive issues,
25 Renee Options/Summary Start on low dose IR Opioid or Start on low dose CR Opioid Function and Adverse Effects Monitored Signs of misuse or abuse Monitored Other non-opioid Treatments continued
Prescribing Opioid for. Opioid Naïve Patients AN OPIOD RX
Prescribing Opioid for Opioid Naïve Patients AN OPIOD RX Optimal Approach to Initiating Opioids for Chronic Non-Cancer Pain AN OPIOID RX Assessment biopsychosocial Non-opioid treatments Opioid risks vs.
More informationCanadian Guideline for Opioids for Chronic Non-Cancer Pain. Speaker Disclosure. Objectives. Canadian Guideline for Opioids for Chronic Non-Cancer Pain
Canadian Guideline for Opioids for Chronic Non-Cancer Pain John Fraser Community Hospital Program New Glasgow November 1, 2017 This speaker has been asked to disclose to the audience any involvement with
More informationCanadian Guideline for Opioids for Chronic Non-Cancer Pain. Speaker Disclosure. Objectives. Canadian Guideline for Opioids for Chronic Non-Cancer Pain
Canadian Guideline for Opioids for Chronic Non-Cancer Pain John Fraser Community Hospital Program North Sydney April 12, 2018 This speaker has been asked to disclose to the audience any involvement with
More informationChronic Pain Pharmacist role in the clinic
Chronic Pain Pharmacist role in the clinic WSPA Annual Meeting 2015 Alvin Goo, PharmD Clinical Associate Professor University of Washington Schools of Pharmacy and Family Medicine Speakers Declaration
More informationSafe Prescribing of Drugs with Potential for Misuse/Diversion
College of Physicians and Surgeons of British Columbia Safe Prescribing of Drugs with Potential for Misuse/Diversion Preamble This document establishes both professional standards as well as guidelines
More informationOpioid Review and MAT Clinic CDC Guidelines
1 Opioid Review and MAT Clinic CDC Guidelines January 10, 2018 Housekeeping Use chat feature to inform everyone who s at your clinic Click chat on Zoom option bar Chat Everyone the names of those who are
More informationOrganizing your Practice for Efficient Pain Assessment. Session #4 Roman D. Jovey, MD
Organizing your Practice for Efficient Pain Assessment Session #4 Roman D. Jovey, MD 2 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored,
More informationHOPE. Considerations. Considerations ISING. Safe Opioid Prescribing Guidelines for ACUTE Non-Malignant Pain
Due to the high level of prescription drug use and abuse in Lake County, these guidelines have been developed to standardize prescribing habits and limit risk of unintended harm when prescribing opioid
More informationJennifer Wyman, MD, Academic Lead, Opioids Clinical Primer Assistant Professor, Dept. of Family & Community Medicine, University of Toronto
Team Based Approaches to Chronic Pain Management: Opioid Stewardship Jennifer Wyman, MD, Academic Lead, Opioids Clinical Primer Assistant Professor, Dept. of Family & Community Medicine, University of
More informationPain, Opioids and the EMR. Dr. Gordon Schacter April 12, 2018
Pain, Opioids and the EMR Dr. Gordon Schacter April 12, 2018 Faculty/Presenter Disclosure Faculty: Gordon Schacter Relationships with commercial interests: Grants/Research Support: None Speakers Bureau/Honoraria:
More informationUniversal Precautions and Opioid Risk. Assessment. Questions: How often do you screen your patients for risk of misuse when prescribing opioids?
Learning objectives 1. Identify the contribution of psychosocial and spiritual factors to pain 2. Incorporate strategies for identifying and mitigating opioid misuse 3. Incorporate non-pharmaceutical modalities
More information5 A s Opioid therapy monitoring tool
5 A s Opioid therapy monitoring tool Once initiating opioid therapy, it should be monitored regularly by assessing what has been called the 5As of Analgesia therapy. This monitoring tool, will assist you
More informationNew Guidelines for Opioid Prescribing
New Guidelines for Opioid Prescribing What They Mean for Elders with Chronic Pain Manu Thakral, PhD, ARNP Kaiser Permanente Washington Health Research Institute Kaiser Permanente Washington Health Research
More informationKnock Out Opioid Abuse in New Jersey:
Knock Out Opioid Abuse in New Jersey: A Resource for Safer Prescribing GUIDELINE FOR PRESCRIBING OPIOIDS FOR CHRONIC PAIN IMPROVING PRACTICE THROUGH RECOMMENDATIONS CDC s Guideline for Prescribing Opioids
More informationOpioids in the Management of Chronic Pain: An Overview
Opioids in the Management of Chronic Pain: An Overview Appropriate treatment of chronic pain may include both pharmacologic and non-pharmacologic modalities. The Board realizes that controlled substances,
More informationGG&C Chronic Non Malignant Pain Opioid Prescribing Guideline
GG&C Chronic Non Malignant Pain Opioid Prescribing Guideline Background Persistent pain is common, affecting around five million people in the UK. For many sufferers, pain can be frustrating and disabling,
More informationStandard of Practice for Prescribing Opioids (Excluding Cancer, Palliative, and End-of-Life Care)
Standard of Practice for Prescribing Opioids (Excluding Cancer, Palliative, and End-of-Life Care) Preamble This Standard establishes the standards of practice and ethical requirements of all physicians
More informationSubject: Pain Management (Page 1 of 7)
Subject: Pain Management (Page 1 of 7) Objectives: Managing pain and restoring function are basic goals in helping a patient with chronic non-cancer pain. Federal and state guidelines require that all
More informationOpioid Analgesics: Responsible Prescribing in the Midst of an Epidemic
Opioid Analgesics: Responsible Prescribing in the Midst of an Epidemic Lucas Buffaloe, MD Associate Professor of Clinical Family and Community Medicine University of Missouri Health Care Goals for today
More informationMedication Management
Marina Treglia, AGPCNP BC April 4, 2019 Medication Management Identify patient criteria for risk mitigation in a medication management program at a multidisciplinary pain clinic Discuss opioid discontinuation
More informationBest Practices in Prescribing Opioids for Chronic Non-cancer Pain
Best Practices in Prescribing Opioids for Chronic Non-cancer Pain Disclosures S C O T T S T E I G E R, M D, F A C P, D A B A M A S S I S T A N T C L I N I C A L P R O F E S S O R D I V I S I O N O F G
More informationPrescribing drugs of dependence in general practice, Part C
HO O Prescribing drugs of dependence in general practice, Part C Key recommendations and practice points for management of pain with opioid therapy H H HO N CH3 Acute pain Acute pain is an unpleasant sensory
More informationCDC Guideline for Prescribing Opioids for Chronic Pain. Centers for Disease Control and Prevention National Center for Injury Prevention and Control
CDC Guideline for Prescribing Opioids for Chronic Pain Centers for Disease Control and Prevention National Center for Injury Prevention and Control THE EPIDEMIC Chronic Pain and Prescription Opioids 11%
More informationSection I. Short-acting opioid Prior Authorization Criteria
Request for Prior Authorization for Opioid analgesics Website Form www.highmarkhealthoptions.com Submit request via: Fax - 1-855-476-4158 Requests for opioid analgesics may be subject to prior authorization
More informationUrine Drug Testing (UDT) to Monitor Opioid Use. Feb 2018
Urine Drug Testing (UDT) to Monitor Opioid Use Feb 2018 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or
More informationNBPDP Drug Utilization Review Process Update
Bulletin # 802 December 1, 2010 NBPDP Drug Utilization Review Process Update The New Brunswick Prescription Drug Program (NBPDP) employs a Drug Utilization Review (DUR) process which identifies, investigates
More informationPractical Pain Assessment- Screening for Psychosocial Risk. Session #3 Roman D. Jovey, MD
Practical Pain Assessment- Screening for Psychosocial Risk Session #3 Roman D. Jovey, MD Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored,
More informationProposed Revision to Med (i)
Proposed Revision to Med 501.02 (i) I. Purpose This rule has been adopted to enable the Board to best protect public health and safety while providing a framework for licensees to effectively treat and
More informationManagement of Pain - A Comparison of Current Guidelines
Management of Pain - A Comparison of Current Guidelines The Centers for Disease Control and Prevention (CDC) released a guideline in 2016 regarding the prescribing of opioids for chronic non-cancer pain
More informationControlled Substance and Wellness Agreement
Controlled Substance and Wellness Agreement You and your provider have agreed on the use of controlled substance medications to treat your: We want to make sure you know how to manage your new prescription(s)
More informationSUMMARY OF ARIZONA OPIOID PRESCRIBING GUIDELINES FOR THE TREATMENT OF CHRONIC NON-TERMINAL PAIN (CNTP)
9 SUMMARY OF ARIZONA OPIOID PRESCRIBING GUIDELINES FOR THE TREATMENT OF CHRONIC NON-TERMINAL PAIN (CNTP) SUMMARY OF ARIZONA OPIOID PRESCRIBING GUIDELINES FOR THE TREATMENT OF ACUTE PAIN NONOPIOID TREATMENTS
More informationRule Governing the Prescribing of Opioids for Pain
Rule Governing the Prescribing of Opioids for Pain 1.0 Authority This rule is adopted pursuant to Sections 14(e) and 11(e) of Act 75 (2013) and Sections 2(e) and 2a of Act 173 (2016). 2.0 Purpose This
More informationPain Management Wrap-Up Chronic Care. David Tauben, MD Medicine Anesthesia & Pain Medicine
Pain Management Wrap-Up Chronic Care David Tauben, MD Medicine Anesthesia & Pain Medicine Objectives Understand that Pain is Complex Know how to select Rx based on Pain type Be aware that Rx only reduces
More informationChronic Pain Care Management in Primary Care 12/16/2010. Jürgen Unützer, MD, MPH, MA UW Psychiatry and Behavioral Sciences
CARE MANAGEMENT FOR CHRONIC PAIN Jürgen Unützer, MD, MPH, MA UW Psychiatry and Behavioral Sciences Dec 16, 2010 Agenda Physical and Emotional Pain Collaborative Care and Care Management for Pain Treatments
More informationMANAGING PAIN IN PATIENTS WITH SUBSTANCE USE DISORDER Melissa B. Weimer, DO, MCR Chief of Behavioral Health & Addiction Medicine St.
MANAGING PAIN IN PATIENTS WITH SUBSTANCE USE DISORDER Melissa B. Weimer, DO, MCR Chief of Behavioral Health & Addiction Medicine St. Peter s Health Partners, Albany, NY Assistant Professor of Medicine,
More informationDoctor Discussion Guide
Doctor Discussion Guide Getting the pain relief you need to stay active is important. Keeping track of your symptoms can help you and your healthcare provider determine if there is a need to adjust your
More information3/3/2015 CHRONIC PAIN MARGARET ZOELLERS, MSN, APRN
CHRONIC PAIN MARGARET ZOELLERS, MSN, APRN 1 Pain that persists or recurs > 3-6 months Pain that persists >1 month after injury/event Commonly seems out of proportion to the physical process Cause may be
More informationTreatment of Anxiety (without benzos)
Treatment of Anxiety (without benzos) Alison C. Lynch MD MS Clinical Professor Departments of Psychiatry and Family Medicine University of Iowa Health Care None Disclosures Overview/objectives Review common
More informationUrine Drug Testing (UDT) in Pain Management. Nov 5, 2017
Urine Drug Testing (UDT) in Pain Management Nov 5, 2017 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or
More informationTapering Opioids Best Practices*
Tapering Opioids Best Practices* Chuck Hofmann, MD, MACP 5 th Annual EOCCO Office Staff and Provider Summit September 28, 2017 Disclosure No Conflicts of Interest to report Learning Objectives Understand
More informationPractical Tools to Successfully Taper Prescription Opioids. Melissa Weimer, DO, MCR
Practical Tools to Successfully Taper Prescription Opioids Melissa Weimer, DO, MCR Objectives Understand how to calculate morphine equivalents per day Understand the steps necessary to plan a successful
More informationWisconsin Opioid Prescribing Guideline Draft Scope and purpose of the guideline
Wisconsin Opioid Prescribing Guideline Draft Scope and purpose of the guideline: To help providers make informed decisions about acute and chronic pain treatment -pain lasting longer than three months
More informationQ&A: Opioid Prescribing for Chronic Non-Malignant Pain
NHS Hastings and Rother Clinical Commissioning Group Chair Dr David Warden Chief Officer Amanda Philpott NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group Chair Dr Martin Writer Chief Officer
More informationThe Prescription Review Program and College Expectations. Dr. Rashmi Chadha MBChB MScCH CCFP MRCGP Dip. ABAM
The Prescription Review Program and College Expectations Dr. Rashmi Chadha MBChB MScCH CCFP MRCGP Dip. ABAM April 28, 2017 Disclosure Relationship with commercial interests: None Professional roles: Addictions
More informationThe Utility of Urine Drug Screening
The Utility of Urine Drug Screening Treating Addiction, Saving Lives Sea Cruises Bye Tazmania, still far from New Zealand February 8 th, 2018 Mandy Manak, MD FASAM, ISAM, CSAM, MRO Medical Director, ICDO
More informationUse of Opioids for Chronic Non Malignant Pain (CNMP)
I. PURPOSE Use of Opioids for Chronic Non Malignant Pain (CNMP) We the Safe Opioid Prescribing and Review Committee (SOPARC) are inspired to support a shift in opioid prescribing that improves clinical
More informationten questions you might have about tapering (and room for your own) an informational booklet for opioid pain treatment
ten questions you might have about tapering (and room for your own) an informational booklet for opioid pain treatment This booklet was created to help you learn about tapering. You probably have lots
More informationPain Management: Overview of A Practical Approach
Pain Management: Overview of A Practical Approach Michael B. Potter, M.D. Department of Family and Community Medicine University of California, San Francisco What is Pain? An unpleasant sensory and emotional
More informationObjectives. When to Refer. PISA Physicians 1/25/17. Financial Disclosures: None. PISA & THMEP January 28, 2017 Kenneth B. Gossler M.D.
1/25/17 PISA & THMEP January 28, 2017 Kenneth B. Gossler M.D. PISA Physicians Kenneth B. Gossler M.D. Education University of Arizona Med School 1992. THMEP Intern 1993 Anesthesiology Residency at Financial
More informationOpioids: Use and Misuse/Steven Feinberg, MD; Scott Levy, MD, MPH, FACOEM
Western Occupational Health Conference September 14, 2012 Opioid - Use & Misuse Scott Levy, MD MPH FACOEM Steven Feinberg, MD, MPH Disclosure Information Western Occupational Health Conference 2012 Steven
More information2017 Opioid Guideline Update
2017 Opioid Guideline Update The 2017 Canadian Guideline for Opioid Therapy and Chronic Non-Cancer Pain (CNCP) Dr. Lydia Hatcher, MD, CCFP, FCFP, CHE, D-CAPM Associate Clinical Professor of Family Medicine,
More informationSummary of Recommendations...3. PEG: A Three-Item Scale Assessing Pain (Appendix A) Chronic Pain Flow Sheet Acute Pain Flow Sheet...
Table of Contents Summary of Recommendations....3 PEG: A Three-Item Scale Assessing Pain (Appendix A)...12 Chronic Pain Flow Sheet...13 Acute Pain Flow Sheet...14 Pocket Guide: Tapering Opioids for Chronic
More informationClinical Trial Results with OROS Ò Hydromorphone
Vol. 33 No. 2S February 2007 Journal of Pain and Symptom Management S25 Advances in the Long-Term Management of Chronic Pain: Recent Evidence with OROS Ò Hydromorphone, a Novel, Once-Daily, Long-Acting
More informationINFORMED CONSENT FOR OPIOID TREATMENT FOR NON-CANCER/CANCER PAIN Texas Pain and Regenerative Medicine
INFORMED CONSENT FOR OPIOID TREATMENT FOR NON-CANCER/CANCER PAIN Texas Pain and Regenerative Medicine The purpose of this agreement is to give you information about the medications you will be taking for
More informationNew Guidelines for Prescribing Opioids for Chronic Pain
New Guidelines for Prescribing Opioids for Chronic Pain Andrew Lowe, Pharm.D. CAPA Meeting October 6, 2016 THE EPIDEMIC Chronic Pain and Prescription Opioids 11% of Americans experience daily (chronic)
More informationUtah. Prescribing and Dispensing Profile. Research current through November 2015.
Prescribing and Dispensing Profile Utah Research current through November 2015. This project was supported by Grant No. G1599ONDCP03A, awarded by the Office of National Drug Control Policy. Points of view
More informationRecommendations in Opioid Prescribing Guidelines for Chronic Pain
Recommendations in Opioid Prescribing Guidelines for Chronic Pain The use of opioids for treating chronic pain has been increasing. 1 In 2010, an estimated 20% of patients presenting to physician offices
More informationOPIOIDS, BENZODIAZEPINES AND THE ELDERLY:
OPIOIDS, BENZODIAZEPINES AND THE ELDERLY: A pocket guide www.nicenet.ca Opioids, benzodiazepines and the elderly: A pocket guide Opioids and Chronic Pain Chronic pain is a major cause of disability in
More information1/26/2016. These are my own thoughts! Safe Workplace Safe Workforce Proven benefits of Stay At Work / Return To Work Process (SAW/RTW)
Dr. Paul A. Farnan farnan@mail.ubc.ca HealthQuest Occupational Health Corporation Alliance Medical Monitoring I have no financial interests or affiliation with any pharmaceutical industry or manufacturer
More informationD. Janene Holladay, M.D. Board Certifications: American Board of Anesthesiology American Board of Pain Medicine American Board of Addiction Medicine
D. Janene Holladay, M.D. Board Certifications: American Board of Anesthesiology American Board of Pain Medicine American Board of Addiction Medicine Financial Disclosure I have no relevant financial relationships
More informationROLE PLAY #1: ASSESSMENT WITH THE 6 A s PATIENT ROLE
ROLE PLAY #1: ASSESSMENT WITH THE 6 A s PATIENT ROLE You are a 58 year old man/woman and have a history of severe chronic low back pain for 20 years. You injured your back 20 years ago at work and have
More informationOpioid Prescribing Tips & Tricks CANDY STOCKTON, MD MAY 2018
Opioid Prescribing Tips & Tricks CANDY STOCKTON, MD MAY 2018 Disclosures None Educational Objectives Understand CA state medical board guidelines for prescribing opioids for chronic pain Understand the
More informationTest User got 22 of 22 possible points on the Risk Reduction Strategies for ER/LA Opioids Post-Test. Total score: 100 %
Published on OpioidRisk (https://www.opioidrisk.com) Home > Results Test User got 22 of 22 possible points on the Risk Reduction Strategies for ER/LA Opioids Post-Test. Total score: 100 % Question Results
More informationReadopt with amendment Med 502, effective (Document #11090), to read as follows:
Adopted Rules 11-2-16 1 Readopt with amendment Med 502, effective 5-3-16 (Document #11090), to read as follows: PART Med 502 OPIOID PRESCRIBING Med 502.01 Applicability. This part shall apply to the prescribing
More informationWHEN AND HOW TO USE BENZODIAZEPINES IN TREATING ANXIETY: AM I WITHHOLDING TREATMENT IF I DON'T USE BENZODIAZEPINES?
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences WHEN AND HOW TO USE BENZODIAZEPINES IN TREATING ANXIETY: AM I WITHHOLDING TREATMENT IF I DON'T USE BENZODIAZEPINES?
More informationClinical Policy: Opioid Analgesics Reference Number: CP.PMN.97 Effective Date: Last Review Date: 02.19
Clinical Policy: Reference Number: CP.PMN.97 Effective Date: 02.11 Last Review Date: 02.19 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important regulatory
More informationOPIOIDS FOR PERSISTENT PAIN: INFORMATION FOR PATIENTS
OPIOIDS FOR PERSISTENT PAIN: INFORMATION FOR PATIENTS This leaflet aims to help you understand your pain, so that you can work with your health care team to self-manage your symptoms and improve your quality
More informationPrescription Opioid Addiction
CSAM-SCAM Fundamentals Prescription Opioid Addiction Presentation provided by Meldon Kahan, MD Family & Community Medicine University of Toronto Conflict of interest statement I received funds from Rickett
More informationOpiate Use Disorder and Opiate Overdose
Opiate Use Disorder and Opiate Overdose Irene Ortiz, MD Medical Director Molina Healthcare of New Mexico and South Carolina Clinical Professor University of New Mexico School of Medicine Objectives DSM-5
More informationTaking Opioids Responsibly for Your Safety and the Safety of Others: Patient Information Guide on Long-term Opioid Therapy for Chronic Pain
Taking Opioids Responsibly for Your Safety and the Safety of Others: Patient Information Guide on Long-term Opioid Therapy for Chronic Pain Department of Veterans Affairs (VA) and Department of Defense
More informationOverview of Essentials of Pain Management. Updated 11/2016
0 Overview of Essentials of Pain Management Updated 11/2016 1 Overview of Essentials of Pain Management 1. Assess pain intensity on a 0 10 scale in which 0 = no pain at all and 10 = the worst pain imaginable.
More informationUrine Drug Testing (UDT) in Pain Management. Nov 27, 2017
Urine Drug Testing (UDT) in Pain Management Nov 27, 2017 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or
More informationObjectives. A Standardized Approach for the Chronic Pain Patient. Visit Overview. Case. Four serial chronic pain visits
A Standardized Approach for the Chronic Pain Patient Traci Dieckmann, DO Family Medicine Spring Symposium April 10, 2015 Objectives A Standardized Approach for the Chronic Pain Patient Traci Dieckmann,
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationVirginia. Prescribing and Dispensing Profile. Research current through November 2015.
Prescribing and Dispensing Profile Virginia Research current through November 2015. This project was supported by Grant No. G1599ONDCP03A, awarded by the Office of National Drug Control Policy. Points
More informationOpioid Analgesics. Recommended starting dose for opioid-naïve patients
Opioid Analgesics Goals: Restrict use of opioid analgesics to OHP-funded conditions with documented sustained improvement in pain and function and with routine monitoring for opioid misuse and abuse. Promote
More informationWelcome - we will begin the webinar shortly Please read the participation tips below:
Welcome - we will begin the webinar shortly Please read the participation tips below: All guest phones have been muted: Background noises, conversations, white noise etc., can be disruptive to a webinar.
More information``Considerations for using opioid drug therapy in workers compensation include patient safety, drug effectiveness and financial impacts
Opioids Effective Case Management Opioids RELEVANCE IN WORKERS COMP Opioids are a diverse group of drugs that represent the strongest pain medications available. They are frequently prescribed for pain
More informationPatient Information Leaflet. Opioid leaflet. Produced By: Chronic Pain Service
Patient Information Leaflet Opioid leaflet Produced By: Chronic Pain Service November 2012 Review due November 2015 1 Your Pain Specialist has recommended treatment with strong pain killers (opioids).
More informationPAIN TERMINOLOGY TABLE
PAIN TERMINOLOGY TABLE TERM DEFINITION HOW TO USE CLINICALLY Acute Pain Pain that is usually temporary and results from something specific, such as a surgery, an injury, or an infection Addiction A chronic
More informationTennessee. Prescribing and Dispensing Profile. Research current through November 2015.
Prescribing and Dispensing Profile Tennessee Research current through November 2015. This project was supported by Grant No. G1599ONDCP03A, awarded by the Office of National Drug Control Policy. Points
More informationPrescription Review Program and College Expectations
Prescription Review Program and College Expectations Dr. Rashmi Chadha MBChB MScCH CCFP MRCGP ABAM Consultant, Prescription Review Program Prescribers Course May 13, 2016 Disclosure Never had any commercial
More informationTHE PROS & CONS OF THE CDC GUIDELINES FOR SAFE OPIOID PRESCRIBING
THE PROS & CONS OF THE CDC GUIDELINES FOR SAFE OPIOID PRESCRIBING Ernest J Dole, PharmD, PhC, FASHP, BCPS Clinical Pharmacist University of New Mexico Hospitals And Clinical Associate Professor University
More informationPOST OPERATIVE PAIN MANAGEMENT: PAIN AND COMPLICATIONS
POST OPERATIVE PAIN MANAGEMENT: PAIN AND COMPLICATIONS November 9, 2018 Aimee LaMere, CNP Molly McNaughton, CNP Leslie Weide, MSW, LICSW, ACM Disclosures: Conflict of interest statement: We certify that,
More informationPROCEDURE REF NO SABP/EXECUTIVE BOARD/0017
PROCEDURE REF NO SABP/EXECUTIVE BOARD/0017 NAME OF GUIDELINE REASON FOR GUIDELINE WHAT THE GUIDELINE WILL ACHIEVE? WHO NEEDS TO KNOW ABOUT IT? Medicines Guideline: Hypnotic Medication Compliance with NICE
More informationSAFE PRESCRIBING: RULES AND REGULATIONS. Michelle Y. Owens, MD MS State Board of Medical Licensure June 30, 2017
SAFE PRESCRIBING: RULES AND REGULATIONS Michelle Y. Owens, MD MS State Board of Medical Licensure June 30, 2017 DISCLOSURES I have no financial disclosures. OBJECTIVES Discuss the significance of the opiate
More informationVermont. Prescribing and Dispensing Profile. Research current through November 2015.
Prescribing and Dispensing Profile Vermont Research current through November 2015. This project was supported by Grant No. G1599ONDCP03A, awarded by the Office of National Drug Control Policy. Points of
More informationChanging the Tide. An EMR facilitated process supporting safe and effective prescribing and de-prescribing of controlled drugs
Changing the Tide An EMR facilitated process supporting safe and effective prescribing and de-prescribing of controlled drugs Ken Hahlweg MD, CCFP, FCFP Assistant Professor Department of Family Medicine
More information1. Comprehensive assessment undertaken prior to initiating an opioid (Pain assessment as per UCLH history taking Performa)
OPIOID TRACKER CARD Name DOB Sex Hospital Number Diagnosis FOR NEW PRESCRIPTIONS OPIOID PRESCRIPTION CHECKLIST 1. Comprehensive assessment undertaken prior to initiating an opioid (Pain assessment as per
More informationOPIOIDS: THE GOOD, THE BAD, AND EVERYTHING IN-BETWEEN
OPIOIDS: THE GOOD, THE BAD, AND EVERYTHING IN-BETWEEN ANTOINETTE BROWN, RPH LAUREL RAMER, 2019 PHARMD CANDIDATE 2018 WYOMING CONFERENCE ON AGING LARAMIE, WY OCTOBER 3, 2018 OBJECTIVES 1. Understand the
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Reference Number: CP.CPA.259 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Commercial Revision Log See Important Reminder at the end of this policy for important regulatory
More informationNeuropathic Pain Treatment Guidelines
Neuropathic Pain Treatment Guidelines Background Pain is an unpleasant sensory and emotional experience that can have a significant impact on a person s quality of life, general health, psychological health,
More informationSafe and Competent Opioid Prescribing
MILITARY Military Safe and Competent Opioid Prescribing Education (M-SCOPE) Program Safe and Competent Opioid Prescribing For Providers Working with Veterans and Military Service Personnel Daniel P. Alford,
More informationScope of the Opiate Problem 6/5/18. Chronic Pain Management and the Use of Opioid Medications: The CDC Guideline and Beyond. Overview.
Chronic Pain Management and the Use of Opioid Medications: The CDC Guideline and Beyond David Anisman, MD Medical Director, Farmington Health Center (Primary Care) Associate Medical Director, Community
More informationPain Care Doesn t Have to Be Torture
Pain Care Doesn t Have to Be Torture How explaining pain to your patient can change the conversation and promote alliance and self-efficacy efficacy PRESENTED BY NORA STERN, PT, MSPT PROVIDENCE ST. JOSEPH
More informationAhsan U. Rashid, M.D., F.A.C.P.
Ahsan U. Rashid, M.D., F.A.C.P. OPIOID MAINTENANCE AND CONSENT Instructions: Review this document before signing. This document will help both the patient and caregivers in establishing a medical program
More informationChronic Pain, Opioids, & Addiction: Assessing and Managing Risk
Chronic Pain, Opioids, & Addiction: Assessing and Managing Risk Randy Brown MD, PhD, FASAM Associate Professor, Dept of Family Medicine Director, Center for Addictive Disorders, UWHC Director, UW Addiction
More informationSouth African guideline for the use of chronic opioid therapy for chronic non-cancer pain. Quick Reference Guide
South African guideline for the use of chronic opioid therapy for chronic non-cancer pain M Raff, 1 BSc, MB ChB, FCA (SA); J Crosier, 1 MB ChB, ChM, FRCS, FCS (SA); S Eppel, 1 MB ChB, FRCS (Edin), ABU
More informationTaking the pain out of prescribing: An opioid primer for the primary care provider
Taking the pain out of prescribing: An opioid primer for the primary care provider Amy K. Paul, PharmD PGY1 Pharmacy Resident Pharmacy Grand Rounds April 26, 2016 2016 MFMER slide-1 Objectives Describe
More informationThe Prescription Review Program and College Expectations. Dr. Rashmi Chadha MBChB MScCH CCFP MRCGP Dip. ABAM
The Prescription Review Program and College Expectations Dr. Rashmi Chadha MBChB MScCH CCFP MRCGP Dip. ABAM October 13, 2017 Disclosure Relationship with commercial interests: None Professional roles:
More information