Pain Pod

On this episode of the Pain Pod, we discuss the details of the PhARM OUD Guidelines with our special guest Dr. Tyler Varisco. We're ready to dive into buprenorphine in community pharmacies, so buckle up and enjoy the ride! Come one, come all, to the Pain Pod!!! PhARM OUD Guidelines • https://forefdn.org/grantee-spotlight-engaging-community-pharmacists-in-improving-treatment-outcomes-for-patients-with-opioid-use-disorder/  Pain Guy • www.painguy.us • PhARM OUD Guideline Link on Pain Guy Website: https://painguy.us/resources  

This episode of the Pain Pod takes a moment to sit down with THE Pharmacist Athlete, Dr. Brandon Welch! What is sports pharmacy? Patient athletes? Where does a pharmacist fit into sports teams? All of this and much, much more. Perhaps even a little inspiration to figure out your dreams and live them out! Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us Pharmacy Athlete • https://pharmacyathlete.com/ 

Extra Extra, Read all about it! Actually, it's a podcast, Listen all about it!  New Pain Med! New Pain Med! New Non-Opioid Pain Med! Suzetrigine (Journavx) is now FDA Approved for Moderate to Severe Acute Pain in Adults, but what fun facts come along with it????? We turn to the Simpsons, Brugada, and enjoy some club seats while succinctly reviewing everything there is to know about this new non-opioid pain medication on the Pain Pod! Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us  

Clinical Pearls, Pain Pod edition: Pain Pearls Part 1 (of many)! A cornucopia of pain conundrums and potential solutions and/or tools to help mitigate. All here, nicely packaged, randomly, in one episode of the Pain Pod! One of many more to come, in a miniseries titled: “Pain Pearls”, only here on the Pain Pod! Come one, come all, to the Pain Pod!!! P.S. Want to contribute or hear about a pain pearl of your own? Message Pain Guy on www.painguy.us to directly reach Mark and have your voice heard! Pain Guy • www.painguy.us DVPRS (Pain Scale) • https://www.va.gov/PAINMANAGEMENT/docs/DVPRS_2slides_and_references.pdf  Opioid Risk Screenings • www.opioidrisk.com  2022 CDC Opioid Guideline Update • Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep 2022;71(No. RR-3):1–95. Buprenorphine Induction Resources • Kampman K and Jarvis M. American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. J Addict Med. Sep-Oct 2015;9(5):358-67. • Ahmed, S. Bhivandkar S, et. al. Microinduction of Buprenorphine/Naloxone: A Review of the Literature. The American Journal on Addictions, 30: 305–315, 2021. • Privia A. Randhawa, Rupinder Brar and Seonaid Nolan. Buprenorphine–naloxone “microdosing”: an alternative induction approach for the treatment of opioid use disorder in the wake of North America's increasingly potent illicit drug market CMAJ January 20, 2020 192 (3) E73. MOUD Minimum Durations Study • Michael L. Dennis, Mark A. Foss, and Christy K. Scott. An Eight-Year Perspective on the Relationship Between the Duration of Abstinence and Other Aspects of Recovery. Evaluation Review 2007 31:6, 585-612

GABBA, GABBA, GABBA!!! It's time to enter the matrix with Pain Guy, the matric of the neural synaptic cleft, that's where it's at for this episode of the Pain Pod folks! We'll chat through all types of gabapentinoids including roofies, benzos, and of course gabapentin amongst others. So get out of your seat and jump around before the Gabba receptor sits you down! You're not going to want to miss this one! Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us

Topical medications are utilized around the globe at appreciatively higher rates than in our country, so what's the barriers?  “Knowledge” is a great place to start, so join us on this episode of the Pain Pod to go deeper (pun completely intended) into topical pain medications, and in this sequel episode we'll build upon the OTC topical pain medications discussed in the last episode by diving into the Rx's! Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us

Topical medications are utilized around the globe at appreciatively higher rates than in our country, so what's the barriers?  “Knowledge” is a great place to start, so join us on this episode of the Pain Pod to go deeper (pun completely intended) into topical pain medications! Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us

Is every red flag Red a fire or smoke? Controlled substance red flags alert a clinician to needed further conversation, but is every red flag (smoke) investigated for the fire? This episode of the Pain Pod continues the conversation on controlled substance red flags, corresponding legal responsibility, and the opioid crisis, yet with the expertise of a very well-known legal expert, Ron Chapman. You're not going to want to miss this chat! Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us Pain Guy's Practical Pain Management “Controlled Substance Concerns” Article • Garofoli MP, “Prescribing and Dispensing Controlled Substances: When to Pump the Brakes”. Practical Pain Management. 2022; 22(6). • https://www.practicalpainmanagement.com/issue202206/prescribing-and-dispensing-controlled-substances-when-to-pump-the-brakes  Drug Topics Chain Pharmacies Red Flags Article • https://www.drugtopics.com/view/national-pharmacy-chain-opioid-settlements-poised-to-affect-independent-pharmacies  Chapman Law Group  https://www.chapmanlawgroup.com/

Remember Pain Guy's TEDx talk “Mise en Scene: Pain, Addiction, and YOU”? It was all about the cinematic experience, right? Well on this episode of the Pain Pod, we welcome Helen Sairany, an author and pharmacist known all across our globe (yes, internationally!) for her countless efforts to educate and help folks improve and save lives in respect to trauma. Helen digs into the roots of pain, addiction, trauma, and childhood experiences like no other! Pain Guy knows many people that just couldn't put her books down. So now it's time to hear directly from her on the Pain Pod! Come one, come all, to the Pain Pod!!!

FORTY-FIVE BILLION DOLLARS (approximately of course) and an appreciable number of concrete efforts and responsibilities, that's the National Opioid Settlement! On this episode of the Pain Pod, we discuss the details of the National Opioid Settlement in respect to financials, controlled substance programs, and specifically the “red flags” stated within.  We're American (although, there are Pain Pod international listeners!), and this affects literally everyone in our communities, families, friends, and professions, so let's take a moment to review the in's and out's of the $45B and much, much more. Come one, come all, to the Pain Pod!!! National Opioid Settlement • www.nationalopioidsettlement.com Pain Guy • www.painguy.us • National Opioid Settlement Link on Pain Guy Website: https://painguy.us/resources  Pain Guy's Practical Pain Management “Controlled Substance Concerns” Article • Garofoli MP, “Prescribing and Dispensing Controlled Substances: When to Pump the Brakes”. Practical Pain Management. 2022; 22(6). • https://www.practicalpainmanagement.com/issue202206/prescribing-and-dispensing-controlled-substances-when-to-pump-the-brakes 

On the last episode of the Pain Pod, we succinctly reviewed all things Cannabis and Cannabinoids including the history, botany, regulations, pharmacology, and clinical utilizations of Cannabis, THC, and CBD. Now it's time to go one giant leap forward in the realm of pain management, with THE international expert Dr. Kenneth Finn! You're not going to want to miss this one! Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us Cannabis in Medicine: An Evidence-Based Approach (2020) • https://link.springer.com/book/10.1007/978-3-030-45968-0 2021 International Association for the Study of Pain Task Force • https://journals.lww.com/pain/fulltext/2021/07001/international_association_for_the_study_of_pain.1.aspx CBD for Pain: Ineffective, Expensive, and with Potential Harms (Journal of Pain, October 2023) • https://www.jpain.org/article/S1526-5900(23)00582-5/fulltext   

Let's clear the smoke on Cannabis, all things Cannabis and Cannabinoids. Time for a higher education! On this episode of the Pain Pod, Mark “Pain Guy” Garofoli will cover the history, botancy, regulations, pharmacology, and clinical utilizations of Cannabis, THC, and CBD.  You're not going to want to miss this one! Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us Cannabis History • Russo EB. History of cannabis and its preparations in saga, science, and sobriquet. Chem Biodivers. 2007 Aug;4(8):1614-48. Cannabis Taxes • https://learnaboutsam.org/wp-content/uploads/2019/01/15Jan2019-v3-Revenues-vs-Reality-1.pdf  Consumer Reports Shopping for CBD Recommendations • https://www.consumerreports.org/cbd/cannabis-and-cbd-guide/ www.consumerreports.org/marijuana/hot-to-shop-for-cbd/  2020 AHA Cannabis/Cannabinoid Clinical Utilization Review • Robert L. Page. Circulation. Medical Marijuana, Recreational Cannabis, and Cardiovascular Health: A Scientific Statement from the American Heart Association, Volume: 142, Issue: 10, Pages: e131-e152 Mark "Pain Guy" Garofoli, PharmD, MBA, BCGP, CPE, CTTS  

Red Light, Green Light, GO! On this follow-up episode of the Pain Pod, we discuss the infamous DEA Red Flags with Dr. Jay K Joshi, a doctor who has been in front of our U.S. Supreme Court to discuss this genre.   You're not going to want to miss this chat!   Come one, come all, to the Pain Pod!!!   Pain Guy painguy.us   Pain Guy's Practical Pain Management “Controlled Substance Concerns” Article Garofoli MP, “Prescribing and Dispensing Controlled Substances: When to Pump the Brakes”. Practical Pain Management. 2022; 22(6). https://www.practicalpainmanagement.com/issue202206/prescribing-and-dispensing-controlled-substances-when-to-pump-the-brakes   Drug Topics Chain Pharmacies Red Flags Article https://www.drugtopics.com/view/national-pharmacy-chain-opioid-settlements-poised-to-affect-independent-pharmacies   Daily Remedy (Dr. Jay K Joshi) https://www.daily-remedy.com/author/admin/   Ruan vs United States https://www.supremecourt.gov/opinions/21pdf/20-1410_1an2.pdf  

Mark "Pain Guy" Garofoli, PharmD, MBA, BCGP, CPE, CTTS Red Light, Green Light, GO! On this episode of the Pain Pod, we discuss the infamous DEA Red Flags, their respective color, where to find them documented, and the multitude of other general controlled substance concerns. We all have our stories, so this episode is right up everyone's alley. Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us Pain Guy's Practical Pain Management “Controlled Substance Concerns” Article • Garofoli MP, “Prescribing and Dispensing Controlled Substances: When to Pump the Brakes”. Practical Pain Management. 2022; 22(6). • https://www.practicalpainmanagement.com/issue202206/prescribing-and-dispensing-controlled-substances-when-to-pump-the-brakes Drug Topics Chain Pharmacies Red Flags Article • https://www.drugtopics.com/view/national-pharmacy-chain-opioid-settlements-poised-to-affect-independent-pharmacies

On this episode of the Pain Pod, we discuss the intersection of pain management, our geriatric patient population, and the 2023 AGS Beers Criteria Update. Let's face it, if you're not geriatric (65yo or even more experienced), you hope to be one day! So, this episode is right up everyone's alley. A discussion of Centenarians (not the Roman soldier Centurions, rather those living to be at least 100yo)! Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us 2023 AGS Beers Criteria (Article •https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18372 JAGS • https://agsjournals.onlinelibrary.wiley.com/journal/15325415 AGS • https://www.americangeriatrics.org/  

Guests: Mark Garofoli, PharmD, MBA, BCGP, CPE, CTTS DeLon Canterbury, PharmD, MBA, BCGP Episode Description On this episode of the Pain Pod, we welcome Dr. DeLon Canterbury CEO of GeriatRx to discuss the intersection of pain management, our geriatric patient population, and the 2023 AGS Beers Criteria Update.  Let's face it, if you're not geriatric (65yo or even more experienced), you hope to be one day! So, this episode is right up everyone's alley.  A discussion of Centurions (not the Roman soldiers, rather those living to be at least 100yo)! Come one, come all, to the Pain Pod!!! 2023 AGS Beers Criteria (Article • https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18372  JAGS • https://agsjournals.onlinelibrary.wiley.com/journal/15325415 AGS • https://www.americangeriatrics.org/  GeriatRx o https://www.geriatrx.org/ 

THUG DRUGS! With a name like that, it has to be good! Even better than Smuckers (Age old ad slogan for jelly/jam)! From OTC and prescription opioids to controlled substance opioids, Heroin to Oxy, the PAIN GUY on the PAIN POD will discuss legal and illicit opioids in the realms of pain management, substance use disorder (addiction), and our communities, and globe for that matter. Get ready for some homework, as you'll definitely end up watching American Pain, Dopesick, Drugs Inc., Hamilton's Pharmacopeia, and maybe even Lord of the Rings, wait, Lord of the Rings, yup, addiction, the entire time. Come one, come all, to the Pain Pod!!! Drug/Overdose Trends • https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates • https://www.iqvia.com/insights/the-iqvia-institute/reports/prescription-opioid-trends-in-the-united-states Illicit Substances Resources • Erowid • DEA Reports o Drugs of Abuse o National Drug Threat Assessment • INCB (International Narcotics Control Board) • UNODC (United Nations Office on Drugs and Crime) • European Monitoring Centre for Drugs and Drug Addiction • CESAR (Center for Substance Abuse Research) • NIDA (National Institute on Drug Abuse) • Online Blogs o Blue Light o Drug Forum

Naloxone! Literally everywhere! Naloxone is now OTC, so what now??? The PAIN GUYTM will discuss all things opioid antagonists including naloxone, naltrexone, and even nalmefene in this episode of the PAIN POD! This episode is for all of society, with the usual sprinkle of pharmacology. Come one, come all, to the Pain Pod!!!   References • https://www.medpagetoday.com/neurology/generalneurology/60632 • Moss, R.B., Carlo, D.J. Higher doses of naloxone are needed in the synthetic opioid era. Subst Abuse Treat Prev Policy 14, 6 (2019). • https://www.cnn.com/2018/11/06/health/naloxone-expiration-date-potency-study/index.html • Hossain MF, Rashid M, Mullins R, Davis T, Kimble C, Sarkar S; Charles “CK” Babcock. Chemical stability of naloxone products beyond their labeled expiration dates. J Opioid Manag. 2022 Jan-Feb;18(1):39-46. • Comparison of Relapse Rates Between Drug Addiction and Other Chronic Illnesses JAMA. 284: 1689-1695, 2000. • https://www.vice.com/en/article/qv7jmp/heroin-overdose-parties-are-a-dehumanizing-myth • https://naloxoneautoinjector.com/ • https://www.statnews.com/2023/03/28/opioid-overdose-naloxone-industry-profits/ • Katzman JG, Takeda MY, Bhatt SR, Moya Balasch M, Greenberg N, Yonas H. An Innovative Model for Naloxone Use Within an OTP Setting: A Prospective Cohort Study. J Addict Med. 2018 Mar/Apr;12(2):113-118. • Hatfield E, et. al. Use of low-dose naltrexone in the management of chronic pain conditions. JADA. December 2020. JADA 151(12). • https://www.reuters.com/business/healthcare-pharmaceuticals/addiction-drug-shows-promise-lifting-long-covid-brain-fog-fatigue-2022-10-18/ • https://www.painmedicinenews.com/Online-First/Article/09-21/FDA-Orphan-Drug-Low-Dose-Naltrexone/64707 • https://www.investopedia.com/ask/answers/06/orphandrugstatus.asp • https://www.statnews.com/2023/03/28/opioid-overdose-naloxone-industry-profits/

Remember Pain Guy's TEDx talk “Mise en Scene: Pain, Addiction, and YOU”? It was all about the cinematic experience, right? Well on this episode of the Pain Pod, we welcome another movie enthusiast known all across our country for his countless efforts to educate and help folks improve and save lives in respect to our opioid epidemic, none other than, Jake Nichols, author of “Unfit for Recover” which released at the beginning of 2023.   Pain Guy couldn't put the book down. Seriously, even Dr. Gretchen Garofoli (Pain Guy's Wife!) noted that he couldn't put the darn thing down, although he was done reading it within 24 hours (would've been less, but gotta work and have some family time of course)!   Come one, come all, to the Pain Pod!!!   Drug/Overdose Trends https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates https://www.iqvia.com/insights/the-iqvia-institute/reports/prescription-opioid-trends-in-the-united-states   Jake Nichol's Book “Unfit for Recover” can be purchased on Amazon at: https://www.amazon.com/Unfit-Recovery-Fighting-Addiction-Unforgiving/dp/B0BPVTVH6G/ref=sr_1_1?crid=SC1I222C7TQ4&keywords=unfit+for+recovery&qid=1677860166&sprefix=unfit+for+%2Caps%2C176&sr=8-1  

Can anyone truly explain the dynamic comprehensive pharmacology of buprenorphine in 30 minutes or less? This isn't pizza delivery folks, its pharmacology, brought to you by the Pain GuyTM! In this episode of the Pain Pod, we'll run down the recent MAT/MATE Acts in respect to the elimination of the X-Waiver, and then dive into the pharmacological phun of buprenorphine including its synthesis, mechanisms of action, Mu receptor affinity, metabolism (half-life), max daily dose, induction/micro dosing, MME factor, ceiling effect, side effects, mcg vs mg approvals, misuse, diversion, abuse, costs, and access. Can it be done in less than a half hour? You betcha! Join Mark “Pain Guy” Garofoli on this episode of the Pain Pod. Come one, come all, to the Pain Pod!!! DEA Letter • https://www.deadiversion.usdoj.gov/pubs/docs/A-23-0020-Dear-Registrant-Letter-Signed.pdf MAT/MATE Acts (Presidential Ink) • https://www.pewtrusts.org/en/research-and-analysis/articles/2022/12/30/president-signs-bipartisan-measure-to-improve-addiction-treatment Buprenorphine Pain Management Products Narrative Review • Hale M, Garofoli MP, Raffa R. Benefit-Risk Analysis of Buprenorphine for Pain Management. Journal of Pain Research. 24 May 2021 Volume 2021: 14 Pages 1359-1369.

Paging all urine experts, all urine experts please report to the Pain Pod! Actually, if you believe that you could benefit from a thorough discussion on the complexities of urine drug screening and testing, then “you're in” luck! Everyone gets a cup! Everyone fills a cup! But then what? Shouldn't a practitioner know what cross-reactants could create possible false-positives? Are there methods to “beat the system” and outsmart urine drug screenings and testings? Join us for a lively discussion on the most useful strategies for incorporating urine drug screenings, or preferably testings, into your own practice. If “you're in” over your head, then this episode is for you! In this episode of the Pain Pod, Mark “Pain Guy” Garofoli chats through the multiple nuances of all thing's urine in respect to patient care. Come one, come all, to the Pain Pod!!!

BREAKING NEWS: The 2022 CDC Opioid Guideline Update is published!!!   Unless you'd like to read all 100 pages of the guideline publication on your own, you may want to start by listening to this episode at least once.   Join the Mark “Pain Guy” Garofoli on the Pain Pod for a dynamic dissection of the 2022 CDC Opioid Guideline Update. Not a ton of actual updates compared to the 2016 guideline, but a half dozen that every clinician needs to be aware of, along with a handful a very specific reference checks leading to rather riveting conversations in the near future for you. “Pain Guy” will review all aspects of this incredibly important advancement in pain management so that you can correlate to your own patient care, educational efforts, or whatever setting you're in NOW.   You may want to listen to this episode twice, and share it will everyone (seriously, all clinicians need to listen in, and patients in pain alike)!!!   Come one, come all, to the Pain Pod!!!   2022 CDC Opioid Guideline Revision Resources 2022 CDC Opioid Guideline Update: CDC Chronic Pain Opioid Guidelines: MMWR March 2016. http://dx.doi.org/10.15585/mmwr.rr7103a1 CDC Opioid Guideline Update Timeline: https://www.cdc.gov/opioids/guideline-update/index.html CDC Drug Overdose Deaths Data (Including Prescription Opioids): https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm Initial Rx Opioid Duration compared to Probability of Continued Use: Shah A, et al. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017; 66: 265–269. Opioid and Benzo Combination tripling overdose death rate: Tae Woo Park, et al. Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study. BMJ 2015;350:h2698. 2016 CDC Chronic Pain Opioid Guideline: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

Vegas Baby!!! The vibe at PAINWeek 2022 was electric! Electricity flowing through the Cosmo Hotel and Casino on Las Vegas Boulevard (“the strip”), similar to what's generated by the Colorado River, Lake Meade, and a miles and miles of electrical wires! Pain Guy was the beat on the street” strolling through the PAINWeek presentations, exhibit hall, and Cosmo hallways chatting it up with fellow faculty, exhibitors, and attendees alike! Dr. A.J. Gupta (an attendee), Barby Ingle (author, speaker, and overall dynamic iPain exhibitor and attendee), Nicole Hemmenway (CEO of our U.S. Pain Foundation), and Richard Tuorto (Pain Medicine News) join us for energized conversations revolving around what their organizations do for healthcare professionals and patients in pain, pain management in general, and of course, their experiences at PAINWeek 2022. Checkout this mobile mic episode of the Pain Pod as we team up with the folks of PAINWeek to give you, Pain Pod Nation, the audio vibe of the electricity of being there in person. Come one, come all, to the Pain Pod (and PAINWeek 2023)!!! Episode References  PAINWeek: https://www.painweek.org/  iPain (International Pain Foundation): https://internationalpain.org/  Barby Ingle: https://barbyingle.com/  US Pain Foundation: https://uspainfoundation.org/about-us/our-team/  Pain Medicine News: https://www.painmedicinenews.com/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Earl Simmons (DMX) gonna give it to ya, a new definition of pain that is!   Back in 2009, a prominent study showed that U.S. Schools of Medicine were barely covering the topic of pain management in respective curricula (weighing in at a mere 9 hours on average), which paled in comparison to numerous other medical conditions. Obviously, the rest of healthcare professional schools, that's us in pharmacy too, had a reconning to take action and amp up the education on pain management, and of course substance use disorder (SUD), commonly referred to as addiction.   It's been a wild ride, and in this episode of the Pain Pod, Mark “Pain Guy” Garofoli sits down for a chat with Dr. Lucas Hill, PharmD on the intersection of Academia (the Ivory Tower) and SUD.   Come one, come all, to the Pain Pod!!!   Episode References   ·     June 10th, 2022 Time Magazine article “Fewer Than Half of U.S. Pharmacies Carry One of the Most Effective Drugs for Opioid Abuse”: https://time.com/6186319/buprenorphine-overdoses-pharmacy-drug-treatment/ ·     AACP Opioid Efforts Database Submission: https://www.aacp.org/opioid ·     APhA Institute on SUD: https://aphainstitute.pharmacist.com/ ·     Chronicle of Higher Education Article: https://www.chronicle.com/article/one-university-takes-on-the-opioid-crisis/ 2011 Article on U.S. Schools of Medicine 9 hours of Pain Education: https://pubmed.ncbi.nlm.nih.gov/21945594/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Let's face it, when it comes to pain management, one of the most painful efforts of the last few years has involved, in one way, shape, form, or fashion: Morphine Milligram Equivalents (MMEs). As we discussed with the PharmD author of the 2022 CDC Opioid Guideline Update , there are no MME factor changes on the horizon, so just when will we have our minds wrapped around the concept?!?   Join the Mark “Pain Guy” Garofoli on the Pain Pod for a dynamic discussion on wrestling (yes, you read that right!), pain management, our healthcare system, and the “street” version of MMEs. Wait, there's a street version of MMEs? Yes, yes there is, so tune in now to the Pain Pod as you'll only utilize the edge of your seat even though ya paid for the whole seat!   Come one, come all, to the Pain Pod!!!   Episode Notes   Pre-2016 MME Charts Review · Nielson S. et. al. A synthesis of oral morphine equivalents (OME) for opioid utilization studies. Pharmacoepidemiology and drug safety 2016; 25: 733–737  2016 CDC Chronic Pain Opioid Guideline MME Chart ·      CDC Chronic Pain Opioid Guidelines: MMWR March 2016. Updated 2017. o   Tramadol: 0.1 o   Codeine: 0.15 o   Tapentadol: 0.4 o   Morphine: 1 o   Hydrocodone: 1 o   Oxycodone: 1.5 o   Oxymorphone: 3 o   Hydromorphone: 4 o   Methadone (Up to: 20mg, 40mg, 60mg, >60mg): 4, 8, 10, 12 o   Transdermal Fentanyl: 7.2 (Divided by the # of Days Applied) o   Transdermal Buprenorphine: 12.6 (Divided by the # of Days Applied) o   Buprenorphine (SL or Buccal): 0.03 (for mcg calculations) or 30 (for mg calculations)   2015 Cat and Dog MME Article · https://burrardvet.com/2015/04/08/pain-control-in-dogs-cats   2016 CDC Chronic Pain Opioid Guideline MME Chart · CDC Chronic Pain Opioid Guidelines: MMWR March 2016. Updated 2017.   2022 CDC Opioid Guideline Revision Resources · https://www.federalregister.gov/documents/2022/02/10/2022-02802/proposed-2022-cdc-clinical-practice-guideline-for-prescribing-opioids   2010 to 2014 MME Relative Risk of Overdose/Death · https://i1.wp.com/face-facts.org/wp-content/uploads/2017/04/Opioid-dose-vs-overdose-risk.jpg   Missouri Marijuana Equivalents (MMEs) · https://north.life/demystifying-missouri-medical-marijuana-equivalency-units-mmes/     Audio Add-in's Let's Get Ready to Rumble (Michael Buffer) · https://www.youtube.com/watch?v=jgopHWACUXs   Cash sound · https://www.youtube.com/watch?v=ZeET7Z1ZGlw   Ron Burgundy “That Escalated Quickly” · https://www.youtube.com/watch?v=FONN-0uoTHI Learn more about your ad choices. Visit megaphone.fm/adchoices

https://www.rx-summit.com/ Dr. Mark Garofoli was live and in person at the 2022 RxSummit Conference which hosted anyone and everyone affiliated with and touched by our country's Drug Crisis. The "Pain Guy" spoke with many federal and state leaders (including our U.S. Drug Czar Dr. Gupta, our NIDA Director Dr. Volkow, DEA leadership, and so on), along with fellow conference presenters and attendees alike. Many of those conversations were recorded and contained within this dynamic conference summary episode of the Pain Pod! Learn more about your ad choices. Visit megaphone.fm/adchoices

MAJOR ANNOUNCEMENT (in Pain Management)!!! The 2022 CDC Opioid Guideline Revision (from 2016)!!! Join the Mark “Pain Guy” Garofoli on the Pain Pod with special guest Dr. Christopher Jones, PharmD, DrPH, MPH from the CDC for a dynamic discussion on the 2022 CDC Opioid Guideline Revision. No questions avoided, no topic left behind, as Mark and Chris review all aspects of this incredibly important advancement in pain management. You may want to listen to this episode twice, if not ten times!!! Come one, come all, to the Pain Pod!!! 2022 CDC Opioid Guideline Revision Resources • https://www.federalregister.gov/documents/2022/02/10/2022-02802/proposed-2022-cdc-clinical-practice-guideline-for-prescribing-opioids • Email: opioids@cdc.gov Learn more about your ad choices. Visit megaphone.fm/adchoices

THUG DRUGS! With a name like that, it has to be good! Even better than Smuckers (Age old ad slogan for jelly/jam)! Grab your Cup of Joe and sit back, or better yet, work out, go for a jog, as this episode will pump, you, UP! From Caffeine to Cocaine with a jolt of Meth, the PAIN GUY on the PAIN POD will discuss legal and illicit stimulants in the realms of pain management, substance use disorder (addiction), and our communities, and globe for that matter. Get ready for some homework, as you'll definitely end up watching Breaking Bad, The Wire, and maybe even Scarface for the 222nd time (only pharmacists will get the pun there!).  Come one, come all, to the Pain Pod!!! FreeCE Substances of Abuse Specialty Pharmacist (SASP) Certificate https://www.freece.com/Programs/SeriesCertification/ab66a419-b5e5-458b-9494-0acb6af1be92 Drug/Overdose Trends https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates https://www.iqvia.com/insights/the-iqvia-institute/reports/prescription-opioid-trends-in-the-united-states 2005 Combat Meth Act & State Pseudoephedrine Restrictions https://www.deadiversion.usdoj.gov/meth/cma2005_general_info.pdf https://odcp.ky.gov/Pages/Cold-Allergy-Medication-Restrictions.aspx Wasping https://amp-livescience-com.cdn.ampproject.org/c/s/amp.livescience.com/65954-wasp-spray-overdose-meth.html https://abcnews.go.com/Health/dangerous-drug-trend-called-wasping-combines-meth/story?id=54068422 Methgators!!! https://time.com/5627237/tennessee-flush-drugs-meth-gators/ Illicit Substances Resources Erowid DEA Reports Drugs of Abuse National Drug Threat Assessment INCB (International Narcotics Control Board) UNODC (United Nations Office on Drugs and Crime) European Monitoring Centre for Drugs and Drug Addiction CESAR (Center for Substance Abuse Research) NIDA (National Institute on Drug Abuse) Online Blogs Blue Light Drug Forum Learn more about your ad choices. Visit megaphone.fm/adchoices

What do Mexico, drugs, society, the Bible, and whiskey have in common? Join us on this episode of the PAIN POD, as Mark “Pain Guy” Garofoli chats with Sam Quinones, author of “Dreamland” and “The Least of Us”, with the later having just released in October 2021. It's often hard to see the forest within the trees, but Sam clears the fog for all of us to whittle it down on how to provide patient care for those in pain and/or with addiction. Come one, come all, to the Pain Pod!!! Sam Quinones https://samquinones.com/ Drug/Overdose Trends https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates https://www.iqvia.com/insights/the-iqvia-institute/reports/prescription-opioid-trends-in-the-united-states FreeCE Substances of Abuse Specialty Pharmacist (SASP) Certificate https://www.freece.com/Programs/SeriesCertification/ab66a419-b5e5-458b-9494-0acb6af1be92 CDC Opioid Guideline Updated Draft for Public Comment https://www.regulations.gov/docket/CDC-2022-0024/document Learn more about your ad choices. Visit megaphone.fm/adchoices

On this episode of the PAIN POD, Mark “Pain Guy” Garofoli will chat with Dr. Eric Christianson, a nationally recognized pharmacology expert, about drug interactions with particular attention in the pain management realm. CYP-450, of course, Serotonin Syndrome, we'll give the down and dirty on explain what all the hub bub is about, and might even have a conversation for our snowbirds out there and everyone else who enjoys grapefruit juice! Considering drug interaction database flag every medication known to mankind, and yet with completely different recommendations, it's best to hear it from the source as to how in the world to best help our patients in pain. Listen in, right here, right now, on the Pain Pod. Come one, come all, to the Pain Pod!!! MedEd101 https://www.meded101.com/ Real Life Pharmacology (Grapefruit Juice Interaction Podcast Episode) https://www.reallifepharmacology.com/grapefruit-juice-interactions/ AGS Beers List (2019) https://geriatricscareonline.org/toc/american-geriatrics-society-updated-beers-criteria/CL001 Chicago Tribune Drug Interaction Secret Patient Article (2016) https://www.chicagotribune.com/investigations/ct-drug-interactions-pharmacy-met-20161214-story.html Learn more about your ad choices. Visit megaphone.fm/adchoices

On this episode of the PAIN POD, Mark Pain Guy Garofoli chats with Dr. Laura Meyer-Junco, PharmD, BCPS, CPE, an international expert on Over-the-Counter (OTC) self-care pain management, about the complexities of pain medications that are readily available for anyone and everyone in our society in dollar stores, gas stations, grocery stores, hotel gift shops, and pharmacies alike. Just how much info can be crammed into one analgesic pharmacy aisle? Tons! Laura provides some pearls and pointers to help us all help others with OTC pain medications. Join the discussion right here, right now, on the Pain Pod. Come one, come all, to the Pain Pod!!! Resources Pediatric OTC Pain Medication Dosing https://medlineplus.gov/ency/patientinstructions/000783.htm Dr. Laura Meyer-Junco Bio https://www.painweek.org/media/read/laura-meyer-junco Pain News Network (Pain Guy's Recent PAINWeek Poster Video Interview) https://www.painnewsnetwork.org/ Learn more about your ad choices. Visit megaphone.fm/adchoices

On this episode of the PAIN POD, Mark Pain Guy Garofoli will chat with Dr. David Brushwood, a world-renowned pharmacy law expert, about all things pain management, controlled substances, drug diversion, and pharmacy law. You may be sitting down listening, but it turns out you'll only be using the edge of the seat! Corresponding legal responsibility, check. Professional conversations between prescribers and dispensers alike, check. DEA Red Flags, check. An attempted prescription from a zoo, check, wait, what? Yes, check. You name it, if it's pharmacy law and pain management related, it's discussed, right here, right now, on the Pain Pod. Come one, come all, to the Pain Pod!!! DEA Red Flags Info Prescribers Cash only patients and/or no acceptance of worker's compensation or insurance Prescribing of the same combination of highly-abused medications Prescribing the same (high) quantities of pain drugs to most/every patient High number of prescriptions issued per day Geographically out-of-area patient population Dispensers High percentage controlled to non-controlled medications High volumes of controlled substances generally Same Medication(s)/Quantities prescribed by the same prescriber for many patients Large geographical distances between pharmacy, prescriber(s), and patient Multiple patients with the same last name or address Sequential prescription #s for highly diverted drugs from the same prescriber Patients receiving controlled substances from multiple prescribers Patients seeking early prescription refills paying out-of-pocket NABP ”Red Flags” Video https://nabp.pharmacy/initiatives/awarxe/pharmacist-resources/ Learn more about your ad choices. Visit megaphone.fm/adchoices

PAINWeek remains the US pain conference with the most expansive curriculum and is the favorite destination for frontline practitioners to enhance their competence in pain management.  Dr. Mark Garofoli, PharmD, the host of the Pain Pod, is joined by the Public Health Pharmacist, Dr. Christina Madison, PharmD interviewing participants of the event September 7—11 at The Cosmopolitan in Las Vegas. See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

On this episode of the PAIN POD, Mark Pain Guy Garofoli will take you on a journey of a pain guy in pain, and just what our patients hear from us as healthcare professionals, and what the healthcare system experience can be like when not being the one wearing the stethoscope, and rather being the patient in pain. Can anyone imagine being dropped off at the ER by your Wife and toddler on Friday the 13th during a pandemic to only begin a 3 month long excruciating journey of pain? Pain Guy Garofoli can tell you all about it, and provide a few clinical pearls to improve patient care along the way! This is not a campfire conversation, but you can feel free to download and listen while camping, swimming, biking, walking, or however, you'd like, just be forewarned that Mark will not be sparing any painful details. You're welcome and he's sorry, all at once! COVID & NSAIDs Info https://www.bbc.com/news/51929628 Jeong HE, et al. Association between NSAIDs use and adverse clinical outcomes among adults hospitalized with COVID-19 in South Korea: A nationwide study. Clin Infect Dis. 2020 Jul 27. https://clinicaltrials.gov/ct2/show/record/NCT04334629 NSAID COX-1 & COX-2 Studies Feldman, M, et al. Do Cyclooxygenase-2 Inhibitors Provide Benefits Similar to Those of Traditional Nonsteroidal Anti-Inflammatory Drugs, with Less Gastrointestinal Toxicity. Ann Intern Med. 2000; 132: 134-143 Herndon, C. et al. Management of Chronic Nonmalignant Pain with Nonsteroidal Anti-inflammatory Drugs. Pharmacotherapy. 2008; 28 (6): 788-805. Masso Gonzalez EL, et al. Variability among nonsteroidal anti-inflammatory drugs in risk of upper gastrointestinal bleeding. Arthritis Rheum 2010; 62: 1592-601. See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

How many times a day are YOU asked if you're the pharmacist? Countless! Well join us in this episode of the PAIN POD while Mark “Pain Guy” Garofoli chats with literally THE Pharmacist, Dan Schneider, famous for all of his amazing efforts within the Opioid Crisis, as highlighted on the Netflix series “THE Pharmacist”. Every 7 minutes an American dies of a drug overdose, and that's soon to be every 5 or 6 minutes based on upcoming data confirmation. Conversely, every 30 minutes a baby is born dependent, not addicted, to opioids. Headline after headline sensationalizes a reality that many times heroin utilizers begin their respective diacetylmorphine (that's Heroin folks!) utilization via prescription opioids. Check out this JAMA article as the foundation for so very many headlines: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1874575. Dan Schneider's life work, and “story”, were first highlighted in this article: https://www.nola.com/news/crime_police/article_934b7d20-a78a-535a-8691-26cfc7f9bee7.html, and he joins us in this podcast to dive much, much deeper into the saga, culminating with avenues for all of us to join the efforts, via his “Tunnel of Hope” organization: https://tunnelofhope.org/. How did we get into the “War on Drugs”, or perhaps better yet, how in the world do we get ourselves out? There's 330 million Americans waking up everyday, living day in and day out as the solution. If every one of us helped one person, imagine the world. So listen in to this episode of the PAIN POD now, to hear THE Pharmacist chat with the Pain Guy, in an effort to do just that, help save and improve lives, one at a time! This episode is sponsored by the Ultiguard Safe Pack. UltiGuard Safe Pack is the only pen needle product that comes with an all-in-one sharps container. Learn more about why UltiGuard Safe Pack is the best choice for your patients and your pharmacy.,  Learn more about the UltiGuard Safe Pack:  https://www.ulticare.com/ultiguard-safe-pack/podcast See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

March Madness inspired us, and our audience has waited long enough. What better time, than during a pandemic, to dive into “OPIOID MADNESS” and crown “The Greatest Opioid of All Time”!!! In this episode of the “PAIN POD”, Mark “Pain Guy” Garofoli will continue the conversation from Opioid Madness Part 1, the opioid bracketology, or perhaps an “Opioidology”, but definitely a whole bunch of “Opioid Madness”. The battle of poppy versus poppy, and of course a bunch of man-made opioid opponents as well. Cool names and fancy formulations only get one so far, and we simply have no room for bias, thus pharmacology will rule as law of the land, to ultimately crown, “THE GREATEST OPIOID OF ALL TIME”. The blood thirsty, constipating, yet definitely not sedating championship opioid brawl continues. One opioid, an opioid of all opioids, will remain standing atop the mountain of Mu, declaring its victory over all other opioids from all lands near and far. Which opioid will it be? The PAIN POD crowns the champ! See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

March Madness is upon us, and what better time, than during a pandemic, to dive into “OPIOID MADNESS”!!!   In this episode of the “PAIN POD”, Mark “Pain Guy” Garofoli will talk us through an opioid bracketology, perhaps an “Opioidology”, but definitely a whole bunch of “Opioid Madness”, in order to pit one opioid against another. A battle of poppy versus poppy, and of course a bunch of man-made opioid opponents as well. Cool names and fancy formulations only get one so far, and we simply have no room for bias, thus pharmacology will rule as law of the land, to ultimately crown, “THE GREATEST OPIOID OF ALL TIME”.   We'll start with a “Sweet 16” of opioids, mention a few bubble busting first four out, and navigate our way through the “Elite 8” and “Final 4” to culminate in a blood thirsty, constipating, yet definitely not sedating championship opioid brawl. One opioid, an opioid of all opioids, will remain standing atop the mountain of Mu, declaring its victory over all other opioids from all lands near and far. Just as Rocky Balboa declared his presence on top of the mountains of Russia, there will remain one opioid for all ages. Yet, all this opioid bracketology madness may not be the main point after all, tune in today to enjoy a brief journey through all things opioids, and learn more about what this madness is actually all about. Let the brackets begin!!!   To get amped up for this “PAIN POD” episode, checkout Rocky training for “OPIOID MADNESS” in Russia via this Fandango Movie Clip: https://www.youtube.com/watch?v=hHC_R7ATGuI (No anabolic steroids were used in the development of this episode, as we have learned from Drago that cheaters never win!) See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

PAIN POD EPISODE 0 One of the most common definitions of pain describes pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” When we are exposed to something that causes pain, if able, we quickly or reflexively withdraw. The sensory feeling of pain is called nociception. What Does It Mean to Call Chronic Pain a Brain Disease? by Mark D. Sullivan https://www.jpain.org/article/S1526-5900(12)00560-3/pdf Multiple investigators have recently asked whether neuroimaging has shown that chronic pain is a brain disease. We review the clinical implications of seeing chronic pain as a brain disease. Abnormalities noted on imaging of peripheral structures have previously misled the clinical care of patients with chronic pain. We also cannot assume that the changes associated with chronic pain on neuroimaging are causal. When considering the significance of neuroimaging results, it is important to remember that ‘‘disease'' is a concept that arises out of clinical medicine, not laboratory science. Our Host: Mark Garofoli, PharmD Clinical Assistant Professor WVU School of Pharmacy (Department of Clinical Pharmacy) WV School of Pharmacy curriculum education in areas of expertise such as pain management, substance-use disorder, medication therapy management, managed care, geriatric care, management, leadership, and experiential learning. Brian Regan - The Emergency Room https://youtu.be/d2Vg3iSd5ms See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices