Podcasts about prescribing opioids

This episode we are joined by Dr Margaret McCartney a practising General Practitioner and a Senior Clinical Lecturer in General Practice at the University of St Andrews. Margaret is a vocal advocate for Evidence Based Medicine and regular journal / newspaper columnist and contributor to the BBC Radio 4 programme Inside Health. Does accepting money for a view affect a healthcare professional's ability to make unbiased decisions in the patient's interest? Should those with a conflict of interest be barred from producing guidelines or providing education? Should it be allowed at all? A controversial issue and an edgy conversation you will not want to miss! For our micro-discussion we get into the equally controversial subject of Weight-Loss jabs. A useful public health intervention or patient safety crisis in the making? We pick up on a recent episode of the BBC Radio 4 Programme Inside Health (https://www.bbc.co.uk/programmes/m001jsly) that examines the impact on the NHS of allowing  widespread prescribing of  the new weight-loss drugs. Links mentioned in the episode:Financial Conflicts of Interest and the Centres for Disease Control and Prevention's 2016 Guideline for Prescribing Opioids for Chronic Pain: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2598092#ild160076r5Listen to Margaret talk about , and change other Doctors' minds about Conflicts of Interest on the BMJ podcast: https://thebmjpodcast.podbean.com/e/taking-on-the-van-tullekens-how-margaret-mccartney-changed-their-minds-about-cois/As with all of our guests, Margaret shares with us her Memory Evoking Medicine, a career anthem and book that has influenced her career or life. Her drug will almost certainly have an effect on you…!The Apothecaries are on the road again! Come and see our next live show at the Clinical Pharmacy Congress on the 10th May in London. Book your tickets and find out more here: https://www.pharmacycongress.co.uk/london   Don't forget to check out Steve's impressive TV debut where he describes the role of a Clinical Pharmacist to none other than Professor Green on BBC Morning Live. This is a must watch for anyone who wants to understand this role and the impact of polypharmacy. A new career beckons… You can watch it here: https://www.rpharms.com/about-us/news/details/polypharmacy-featured-on-bbcs-morning-live. You can listen to the Aural Apothecary playlist here; https://open.spotify.com/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=tiHXrQI7QsGtSQwPyz1KBg You can view the Aural Apothecary Library here;   https://litalist.com/shelf/view-bookcase?publicId=KN6E3O Our website is https://www.theauralapothecary.com/ To get in touch follow us on Bluesky and X @auralapothecary or email us at auralapothecarypod@gmail.com . Don't forget to rate us and comment wherever you have got this podcast from. 

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

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

In part two of this series, physicians continue their discussion on the recent updates the Federation of State Medical Boards made to its recommendations relating to opioids and pain care. Physicians from the Federation include Humayun Chaudhry, DO, president and CEO, Sarvam TerKonda, MD, past chair, and Sherif Zaafran, MD. They join Dr. Michael Suk, Chair of the AMA Board of Trustees to discuss the updates.    ⭐⭐⭐⭐⭐

Host Dr. Amanda Redfern welcomes oculoplastic surgeons Drs. Davin Ashraf and Natalie Hoesly to discuss their approaches to postoperative pain management, with the help of a pain and addiction medicine specialist, Dr. Pat Liu. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

A one-size-fits-all approach to caring for patients with pain is not a prudent way to manage care. In this episode, physicians discuss the recent updates the Federation of State Medical Boards made to its recommendations relating to opioids and pain care. Physicians from the Federation include Humayun Chaudhry, DO, president and CEO, Sarvam TerKonda, MD, past chair, and Sherif Zaafran, MD. They join Dr. Michael Suk, Chair of the AMA Board of Trustees to discuss the updates.    ⭐⭐⭐⭐⭐

In this episode Scott Hadland, MD, MPH, MS, FAAP, and Rita Agarwal, MD, FAAP, explain the first-ever clinical practice guideline on safely prescribing opioids to children and teens. Hosts David Hill, MD, FAAP, and Joanna Parga-Belinkie, MD, FAAP, also speak with Hilary Brown, PhD, about her research on how maternal disability affects children's access to health care. For resources go to aap.org/podcast.

This century drug overdose deaths have equaled roughly 1.1 million largely due to overdose deaths among men that increased from 15,000 to 80,000.  As Dr. LeBaron notes drug overdose fatalities this century have exceeded the sum of all service member deaths in all wars in US history.  The vast majority of drug overdoses were opioid related that, e.g., increased from 50,000 to 82,000 between 2019 and 2022.  While opioid drugs have been available for decades, the opioid - or the opioid use disorder epidemic is strongly correlated with opioid prescribing.  As Dr. LeBaron notes between Purdue Pharma's 1996 introduction of OxyContin and 2010, opioid prescriptions and overdose deaths increased fourfold, or in almost exact parallel.  The CDC, only agency charged with controlling epidemics, published in 2016 its “Guideline for Prescribing Opioids for Chronic Pain in the US.”  Tragically, the guideline was quickly weaponized, by payers and states.  This led to significant decreases in prescribing that in turn led to dramatic increases in undertreated pain and not surprisingly increased suicides.  In 2022 CDC updated its opioid guideline but as Dr. LeBaron notes in his conclusion reduced prescribing without improvements in prevention and treatment programming will backfire.  Though the CDC last month announced preliminary data showing drug overdose deaths may have dropped by 10% or to 70,000 over the 12-month period ending this past April, the epidemic continues largely unabated.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Episode 65: Guidelines for Safe Prescribing of Controlled Substances Evaluation and Credit:  https://www.surveymonkey.com/r/MedChat65   Target AudienceThis activity is targeted toward primary care and geriatric healthcare providers and advanced providers. Statement of Need This activity will discuss the steps to safe prescribing of opioids for providers. In that chronic pain is commonly treated in the primary care office and back pain is one of top ten reasons patients visit health care providers, providers should be aware of how to safely prescribe controlled substances if selected as the treatment for these patients. Objectives At the conclusion of this offering, the participant will be able to: Describe the risks and benefits of prescribing and tapering controlled substances. Identify the key components of safe prescribing of controlled substances. ModeratorGregory E. Cooper, M.D., Ph.D. Chief of Adult Neurology Medical Director, Memory Center Norton Neuroscience Institute Norton Healthcare Louisville, Kentucky SpeakerKelly C. Cooper, M.D., MPH, FASAM Addiction Specialist Norton Behavioral Health Louisville, Kentucky Moderator, Speaker and Planner Disclosures  The planners, moderators and speakers of this activity do not have any relevant financial relationships to disclose.  Commercial Support  There was no commercial support for this activity.  Physician Credits Accreditation Norton Healthcare is accredited by the Kentucky Medical Association to provide continuing medical education for physicians. Designation Norton Healthcare designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nursing CreditsNorton Healthcare Institute for Education and Development is approved with distinction as a provider of nursing continuing professional development by the South Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. This continuing professional development activity has been approved for 0.75 contact hours. In order for nursing participants to obtain credits, they must claim attendance by attesting to the number of hours in attendance.   For more information related to nursing credits, contact Sally Sturgeon, DNP, RN, SANE-A, AFN-BC at (502) 446-5889 or sally.sturgeon@nortonhealthcare.org. HB1 / Prescribing Controlled SubstancesThe Kentucky Board of Medical Licensure has approved the podcast Guidelines for Safe Prescribing of Controlled Substances for .75 HB1 credit hours. ID# 0723-H.75-NHC2i Resources for Additional Study: The Impact of Increased Hydrocodone Regulation on Opioid Prescribing in an Urban Safety-Net Health Care System    https://pubmed.ncbi.nlm.nih.gov/31068400/ CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022 https://pubmed.ncbi.nlm.nih.gov/36327391/   Norton Healthcare, a not for profit health care system, is a leader in serving adult and pediatric patients throughout Greater Louisville, Southern Indiana, the commonwealth of Kentucky and beyond. Five Louisville hospitals provide inpatient and outpatient general care as well as specialty care including heart, neuroscience, cancer, orthopedic, women's and pediatric services. A strong research program provides access to clinical trials in a multitude of areas. More information about Norton Healthcare is available at NortonHealthcare.com.   Date of Original Release | March 2024; Information is current as of the time of recording. Course Termination Date | March 2027 Contact Information | Center for Continuing Medical, Provider and Nursing Education; (502) 446-5955 or cme@nortonhealthcare.org      

AP correspondent Norman Hall reports on the sentencing of a Tennessee nurse practitioner for illegally prescribing opioids

The CDC's Guideline for Prescribing Opioids for Chronic Pain excludes those undergoing cancer treatment, palliative care, and end-of-life care. In doing so, it seems to give the impression that pain seen in cancer is inherently different than pain seen in other conditions and that those with cancer may not have the same risk for opioid use disorder as compared to other conditions. Today's podcast tackles these issues and more with three amazing guests: Katie Jones, Jessica Merlin, and Devon Check.   We start off the conversation by talking about whether patients with cancer and cancer pain are really that different, and their paper that was just published on January 11th in JAMA Oncology showing that substance use disorder is not uncommon in individuals with cancer. After discussing screening options for substance use disorder, we go on to talk about both the treatments for it and the issues that arise.  In particular, we talk about Katie's and Jesica's paper in NEJM titled “Juggling Two Full-Time Jobs — Methadone Clinic Engagement and Cancer Care,” which described the difficulty in managing cancer pain and methadone for opioid use disorder. Lastly, we discuss Katie's paper on substance use disorder in an aging population and how one can incorporate the 5 Ms (ie, matters most, medications, mind, mobility, and multicomplexity) into a framework for age-friendly care for older adults with substance use disorder. If you want to do a deeper dive, here are some other references we talk about in the podcast: Previous podcasts on substance use disorder Buprenorphine Use in Serious Illness: A Podcast with Katie Fitzgerald Jones, Zachary Sager and Janet Ho  Substance Use in Older Adults: A Podcast with Ben Han  Palliative Care, Chronic Pain, and the Opioid Epidemic: GeriPal Podcast with Jessie Merlin    Expert consensus-based guidance Expert consensus-based guidance on approaches to opioid management in individuals with advanced cancer-related pain and nonmedical stimulant use Consensus-Based Guidance on Opioid Management in Individuals With Advanced Cancer-Related Pain and Opioid Misuse or Use Disorder Expert Panel Consensus on Management of Advanced Cancer-Related Pain in Individuals With Opioid Use Disorder  

Speaker: Alix Schnibben, PharmD, BCACP, CTTS Director, Clinical Quality and Ambulatory Pharmacy Services Ambulatory Care Pharmacist No disclosures. Objectives: -Discuss the growing Opioid Epidemic and related statistics. -Review Federal and Georgia State laws and NGHS policies regarding prescribing controlled substances. -Review how to calculate Morphine Milliequivalent Per Day (MME/day). -Summarize the new 2022 CDC Guidelines for Prescribing Opioids for Chronic Pain. -Discuss nonpharmacologic, nonopioid and opioid pharmacologic therapy options. -Discuss Office Visit Workflow for treatment of chronic pain with opioids.

Adrianna Evans, ASTHO's Director of Preparedness and Disability Integration, says cybersecurity is an emerging topic in preparedness planning; Dr. Natasha Bagdasarian, Chief Medical Executive for the State of Michigan, explains that suicide prevention is a year-round effort; an ASTHO webinar outlines how data equity can help improve maternal and infant health outcomes; and ASTHO has a full list of resources related to 2022 Clinical Practice Guideline for Prescribing Opioids for Pain.   ASTHO Webpage: Preparedness Policy Highlights for Trending Public Health Threats American Foundation for Suicide Prevention: National Suicide Prevention Week ASTHO Webpage: Supporting Mental Health: Addressing a New Public Health Crisis ASTHO Webpage: The Youth Mental Health Crisis: States Invest in Suicide Prevention, Intervention, and Postvention Strategies ASTHO Webinar: Advancing Maternal Health with Data Equity ASTHO Webpage: CDC Clinical Practice Guideline for Prescribing Opioids for Pain, 2022: Resources for Decision-Makers  

Physicians face many challenges in treating people living with pain, especially in light of the U.S. opioid overdose epidemic. In today's episode, we speak with Dr. Chris Jones on how physicians are handling these challenges, and the steps CDC is taking at a community level to help address the issue. Dr. Chris Jones is Director of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC). Dr. Jones's career in public health includes leadership and advisory roles at the Substance Abuse and Mental Health Services Administration, the U.S. Food and Drug Administration and the U.S. Department of Health and Human Services and Mental Health.  This month's episode is hosted by Dr. Judy Monroe, president and CEO of the CDC Foundation. For full episode transcription, visit Contagious Conversations.   Key Takeaways: [1:39] Dr. Jones talks about his role at CDC. [3:15] Dr. Jones discusses the impact of the opioid epidemic in the United States. [5:05] Dr. Jones speaks of CDC's Clinical Practice Guideline for Prescribing Opioids for Pain that was released last November. [5:41] What challenges do physicians face when treating people dealing with chronic pain during the opioid epidemic? [9:24] What was the response from physicians and pharmacists to the opioid prescribing guidelines released in 2022? [12:50] Dr. Jones talks about the work CDC is doing regarding the opioid epidemic at a community level. [17:48] Dr. Jones highlights the value of collaboration. [19:58] What is the greatest opportunity to address the opioid overdose epidemic?   Mentioned in This Episode: Learn more about the work of CDC regarding the opioid epidemic  

Claudia and Bev discuss the updated CDC Guidelines with Dr. Sarah from Maryland. They answer the following questions: Is it an improvement? Are the 2022 Guidelines more or less restrictive? Will it help pain patients? Were limits from the 2016 Guidelines a misapplication or was it intentional? Did the CDC violate their own guidelines on how to create guidelines? Links from discussion: Telebriefing for updated CDC Guidelines Nov 9, 2022 CDC Guidelines for Prescribing Opioids for Chronic Pain - Dr. David Tauben UW TelePain - March 23, 2016 Dr. Jane Ballantyne - TelePain - What the New CDC Guideline Mean for Prescribers - April 27, 2022 Dr. Jane Ballantyne - Alternatives to Opioids - PDFNJ - March 30, 2023 2016 CDC Guidelines 2022 CDC Guidelines The Doctor Patient Forum's docket comment on 2022 CDC Guidelines Study by Dr. Jason Doctor - Effect of Prescriber Notifications on Patient's Fatal Overdose on Opioid Prescribing at 4-12 Months Have you been force tapered or have you lost your pain provider? Please fill out this survey Suicide hotline: 988 or 911 Disclaimer: The information that has been provided to you in this podcast is not to be considered legal or medical advice. --- Send in a voice message: https://podcasters.spotify.com/pod/show/the-doctor-patient-forum/message Support this podcast: https://podcasters.spotify.com/pod/show/the-doctor-patient-forum/support

Giriş Ağrı, hastaneye başvurularının en önemli sebeplerinden biridir. Akut ağrı, klasik olarak akut hastalık, travma veya cerrahi ile ilişkili olumsuz bir kimyasal, termal veya mekanik uyarana normal olarak öngörülen fizyolojik tepki olarak tanımlanır. Akut ağrı sıklıkla ani başlamaktadır ve alta yatan sorunun ortadan kalkmasıyla yavaşça geriler, zamansal olarak ise bir ayın altındaki ağrılar olarak tanımlanır. Eğer bu bir aylık süre içerisinde geçmez ve çözülemezse de 1-3 aylık süre içerisinde subakut ağrı olarak adlandırılır. Üç aydan daha uzun süreçler ise kronik ağrı olarak tanımlanır. Kronik ağrı altta yatan durum/hastalığa bağlı olabileceği gibi, uygulanan tedavi veya inflamasyona da bağlı olabilir, bazı olgularda da altta yatan sebepler tanımlanamayabilir. Amerika Birleşik Devletleri'ndeki verilere göre her 14 hastadan birinde kronik ağrı sorunu mevcuttur. Bu ağrı hayat kalitesini düşürmekte ve günlük hayatı kısıtlamaktadır.​1​ Aktivitelerdeki kısıtlamalar, iş gücü kaybı, yaşam kalitesinin düşmesi ve yaygın damgalama dahil olmak üzere ağrıyla ilişkili klinik, psikolojik ve sosyal sonuçlar göze alındığında; klinisyenlerin ağrılı hastalara uygun, bütüncül ve şefkatli bakım sağlamak için eğitim, öğretim, rehberlik ve kaynaklara sahip olması önemlidir. Bu yazımızda Centers for Disease Control and Prevention tarafından Kasım 2022'de yayımlanan “CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022” başlıklı yazıdan bahsedeceğiz.​2​ Yusuf Ali Altuncı'nın Acil Serviste Kronik Ağrı” başlıklı yazısı için burayı, Erkman Sanrı'nın “Geriatrik Hastada Ağrı Yönetimi” başlıklı yazısı için burayı, Şakir Hakan Aksu'nun “Acil Serviste Ağrı Yönetimi” başlıklı yazısı için burayı ziyaret edebilirsiniz. İyi okumalar diliyorum. Kılavuz Hakkında Genel Bilgiler Bu klinik uygulama kılavuzu, akut (3 ay süreli) ağrısı olan ≥18 yaşındaki ayaktan hastaları tedavi eden klinisyenler için hazırlanmıştır. Orak hücreli anemiye bağlı, kanser ilişkili, palyatif bakım dönemi ve yaşam sonu ağrı yönetimini öneriler dışında bırakmaktadır. Bu kılavuz güncellemesinin hedef kitlesi çok geniştir ve opioid reçete eden birçok klinisyeni içerir. Birinci basamak klinisyenleri (örneğin, dahiliyeciler ve aile hekimleri) ve ayakta tedavi ortamlarında ağrıyı yöneten diğer klinisyenleri (örneğin, cerrahlar, acil tıp klinisyenleri, işyeri hekimliği klinisyenleri, fiziksel tıp ve rehabilitasyon klinisyenleri ve nörologlar) içerir. Bu klinik uygulama kılavuzunda bu amaçla 12 öneri yapılmıştır. Bu öneriler yapılırken daha önceki çalışmalardan elde edilen veriler sistematik bir incelemeyle ele alınmış ve kesinlik düzeyi (yüksek, orta, düşük veya yetersiz) olarak değerlendirilerek kanıt gücü elde edilmiş. Bunlar ışığında kanıt tipleri 1'den 4'e kadar numaralandırılırken öneri kategorileri A ve B olarak sınıflandırılmıştır; Tip 1 Kanıt: Randomize klinik çalışmalar veya gözlemsel çalışmalardan elde edilen güçlü kanıtlar, Tip 2 Kanıt: Önemli sınırlamaları olan randomize klinik çalışmalar veya gözlemsel çalışmalardan elde edilen son derece güçlü kanıtlar, Tip 3 Kanıt: Gözlemsel çalışmalar veya kayda değer sınırlamaları olan randomize klinik çalışmalar, Tip 4 Kanıt: Klinik deneyim ve gözlemler, önemli sınırlamaları olan gözlemsel çalışmalar veya birkaç önemli sınırlaması olan randomize klinik çalışmalar. Kategori A tavsiyeleri, çoğu hasta için en uygun tavsiye edilen yönetim biçimini ifade ederken; kategori B tavsiyeler, farklı hastalar için farklı seçeneklerin uygun olacağını belirtir ve klinisyenlerin hastaların, hasta değerleri ve tercihleri ile belirli klinik durumlar ile tutarlı bir karara varmalarına yardımcı olacak şekilde önerilmiştir. Kılavuz içerisinde bir klinik eylemin avantajlarının dezavantajlardan büyük ölçüde ağır bastığı konusunda geniş bir fikir birliği olduğunda, tip 3 ve 4 kanıtlarla bile A kategorisi tavsiyelerde bulunulmuştur. ...

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-322 Overview: Patients deserve compassionate, safe, and effective pain management. But it's important to remember that safe prescribing does not mean no prescribing. Join us as we discuss the 2022 CDC Clinical Practice Guidelines for prescribing opioids in the adult population. The updated and expanded guidelines can assist you in delivering patient-centered care for management of acute, subacute, and chronic pain. Episode resource links: 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. DOI: http://dx.doi.org/10.15585/mmwr.rr7103a1 Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. 2016;315(15):1624–1645. doi:10.1001/jama.2016.1464 Guest: Jill Terrien PhD, ANP-BC    Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-322 Overview: Patients deserve compassionate, safe, and effective pain management. But it's important to remember that safe prescribing does not mean no prescribing. Join us as we discuss the 2022 CDC Clinical Practice Guidelines for prescribing opioids in the adult population. The updated and expanded guidelines can assist you in delivering patient-centered care for management of acute, subacute, and chronic pain. Episode resource links: 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. DOI: http://dx.doi.org/10.15585/mmwr.rr7103a1 Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. 2016;315(15):1624–1645. doi:10.1001/jama.2016.1464 Guest: Jill Terrien PhD, ANP-BC    Music Credit: Richard Onorato

Podcast: Updates in Chronic Pain Management   Evaluation and Credit:  https://www.surveymonkey.com/r/MedChat48   Target Audience This activity is targeted toward all physician specialties and advanced providers.   Statement of Need Chronic pain is one of the most common reasons that patients see their physician. A report by the Institute of Medicine indicated that one in three Americans suffer from chronic pain. Therefore, it is important for providers to understand key factors in treating patients with pain that would affect diagnosis and treatment plans. Additionally, providers should be aware of effective nonpharmacological and pharmacology treatment options as well as the latest guidelines in the use of opioids for chronic pain management.   Objectives At the conclusion of this offering, the participant will be able to: 1.         Differentiate between acute and chronic pain. 2.         Describe the types and major drivers of chronic pain. 3.         Discuss effective treatment options in the management of patients with chronic pain; including identification of red flags. 4.         Highlight the latest CDC recommendations in the use of opioids for chronic pain management.   Moderator James Jennings, M.D., MBA Executive Medical Director of Quality, Provider Development and Innovation Norton Medical Group   Speakers Don Teater, M.D., MPH Pain and Addiction Specialist Southeast Alaska Regional Health Consortium Owner of Teater Health Solutions.   Moderator, Speaker and Planner Disclosures The planners, speaker and moderator of this activity do not have any relevant relationships to disclose.   Commercial Support There was no commercial support for this activity.   Physician Credits Accreditation Norton Healthcare is accredited by the Kentucky Medical Association to provide continuing medical education for physicians.   Designation Norton Healthcare designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.   House Bill 1 credits The podcast Updates in Chronic Pain Management has been approved for .75 HB1 credit hours by the Kentucky Board of Medical Licensure. ID# 1122-H.75-NHc5h   Nursing Credits Norton Healthcare Institute for Education and Development is approved with distinction as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation (ANCC). This continuing professional development activity has been approved for 0.75 contact hours. In order for nursing participants to obtain credits, they must claim attendance by attesting to the number of hours in attendance.   Norton Healthcare is also a Kentucky Board of Nursing (KBN) Approved Provider: Activity Number 4-0002-12-24- 012. The activity has also been approved by Norton Healthcare for 0.75 contact hours which expires 12/31/2024. KBN approval of a continuing education provider does not constitute endorsement of program content. This activity meets 0.75 contact hours of approved dual subjects of pharmacology and pain management CE required by the Kentucky Board of Nursing (KBN) for annual license renewal for APRNs with a Collaborative Agreement for Advanced Practice Registered Nurse's Prescriptive Authority for Controlled Substances (CAPA-CS) – 201 KAR 20:215(5)(1)(c).   For more information related to nursing credits, contact Sally Sturgeon, DNP, RN, SANE-A, AFN-BC at (502) 446-5889 or sally.sturgeon@nortonhealthcare.org. Resources for Additional Study: Goldstick JE, Guy GP, Losby JL, Baldwin G, Myers M, Bohnert ASB. Changes in Initial Opioid Prescribing Practices After the 2016 Release of the CDC Guideline for Prescribing Opioids for Chronic Pain. JAMA Netw Open. 2021;4(7):   Rajput, K., Vadivelu, N. Acute Pain Management of Chronic Pain Patients in Ambulatory Surgery Centers. Curr Pain Headache Rep 25, 1 (2021)   Vargas-Schaffer G, Steverman A, Potvin V (December 12, 2021) Monitoring Pharmacological Treatment in Patients With Chronic Noncancer Pain. Cureus 13(12): e20358. DOI 10.7759/cureus.20358     Norton Healthcare, a not for profit health care system, is a leader in serving adult and pediatric patients throughout Greater Louisville, Southern Indiana, the commonwealth of Kentucky and beyond. Five Louisville hospitals provide inpatient and outpatient general care as well as specialty care including heart, neuroscience, cancer, orthopedic, women's and pediatric services. A strong research program provides access to clinical trials in a multitude of areas. More information about Norton Healthcare is available at NortonHealthcare.com.   Date of Original Release |January 2023; Information is current as of the time of recording.   Course Termination Date | January 2025 Contact Information | Center for Continuing Medical, Provider and Nursing Education; (502) 446-5955 or cme@nortonhealthcare.org

This episode is also available as a blog post: https://youarewithinthenorms.com/2022/12/19/how-prosecutors-use-fraudulent-data-to-manipulate-public-policy-and-charge-medical-providers-with-over-prescribing-opioid-and-healthcare-fraud-see-video/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/norman-j-clement/support

Larry Kobak, Esq. on CDC Guidelines: What You Need to Know! PendingDec 14, 2022 1 CME Available What you need to know: The Updated CDC Clinical Practice Guideline for Prescribing Opioids for Pain Monday, November 21 at 6:00 pm EDT NYSPS Legal Briefs  New 2022 CDC Guidelines on OPIOID USE FOR TREATMENT OF PAIN The CE experience for this Webinar is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/p1nfCi The Guidelines state very clearly: “Nonopioid therapies are preferred for subacute and chronic pain.” If you are using opioids for subacute or chronic pain, which including both terms, means treating pain for 1 month or more, your chart must contain some justification for the use of opioids. This is an extremely important matter. Appropriate reasons, such as a prior treater, attempted various nonopioid treatments of some kind that failed. There must be a very good reason why opioids were tried. It must be documented.   Larry Kobak, Esq. Senior Counsel Frier Levitt ATTORNEYS AT LAW 101 Greenwich Street, Suite 8B New York, NY 10006

1 CME Available What you need to know: The Updated CDC Clinical Practice Guideline for Prescribing Opioids for Pain Monday, November 21 at 6:00 pm EDT NYSPS Legal Briefs  New 2022 CDC Guidelines on OPIOID USE FOR TREATMENT OF PAIN The CE experience for this Webinar is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/p1nfCi The Guidelines state very clearly: “Nonopioid therapies are preferred for subacute and chronic pain.” If you are using opioids for subacute or chronic pain, which including both terms, means treating pain for 1 month or more, your chart must contain some justification for the use of opioids. This is an extremely important matter. Appropriate reasons, such as a prior treater, attempted various nonopioid treatments of some kind that failed. There must be a very good reason why opioids were tried. It must be documented.   Larry Kobak, Esq. Senior Counsel Frier Levitt ATTORNEYS AT LAW 101 Greenwich Street, Suite 8B New York, NY 10006 (516) 755-7553 direct (973) 618-1660 office lkobak@frierlevitt.com www.frierlevitt.com Course Calendar Regenerative Interventional Pain Course NYC- Jan, 28, 2023 Ultrasound Guided Regional Anesthesia and  Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023 Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023  

1 CME Available What you need to know: The Updated CDC Clinical Practice Guideline for Prescribing Opioids for Pain Monday, November 21 at 6:00 pm EDT NYSPS Legal Briefs  New 2022 CDC Guidelines on OPIOID USE FOR TREATMENT OF PAIN The CE experience for this Webinar is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/p1nfCi The Guidelines state very clearly: “Nonopioid therapies are preferred for subacute and chronic pain.” If you are using opioids for subacute or chronic pain, which including both terms, means treating pain for 1 month or more, your chart must contain some justification for the use of opioids. This is an extremely important matter. Appropriate reasons, such as a prior treater, attempted various nonopioid treatments of some kind that failed. There must be a very good reason why opioids were tried. It must be documented.   Larry Kobak, Esq. Senior Counsel Frier Levitt ATTORNEYS AT LAW 101 Greenwich Street, Suite 8B New York, NY 10006 (516) 755-7553 direct (973) 618-1660 office lkobak@frierlevitt.com www.frierlevitt.com Course Calendar Regenerative Interventional Pain Course NYC- Jan, 28, 2023 Ultrasound Guided Regional Anesthesia and  Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023 Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023  

Dr. Christopher Jones, Acting Director of the National Center for Injury Prevention and Control, discusses new guidelines that are meant to give providers more flexibility when it comes to treating pain with opioids; Brandi Hight Bank, Vice President for Public Health & Policy at Klick, explains the best ways to communicate with people in their late teens and early twenties; and we preview an ASTHO blog that addresses the tobacco policy. CDC News Release: CDC Releases UPDATED Clinical Practice Guideline for Prescribing Opioids for Pain ASTHO Webinar: Reaching Gen Z: Engaging Young Audiences in Public Health ASTHO Webpage: Be In The Know

This episode discusses five MMWR reports. The first report looks at CDC's updated Clinical Practice Guideline for Prescribing Opioids for Pain. The second report examines the prevalence and characteristics of arthritis among caregivers. The third report describes vaccination coverage among children worldwide. The fourth report examines the safety of the updated bivalent COVID-19 mRNA vaccine booster doses. And the last report looks at the clinical features of monkeypox in children and teens.

This episode is also available as a blog post: https://youarewithinthenorms.com/2022/10/11/doctors-lose-licenses-for-properly-prescribing-opioids-law-and-disorder/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/norman-j-clement/support

Global warming will probably mean that wildlife travels more and mixes with other species—and an effect will be to spread unfamiliar viruses; There is new guidance to help hospital doctors and clinicians prescribing opioids for pain; A disorder of the oesophagus creates symptoms similar to reflux or allergies, but the cause of the disorder is not known; The non-availability of a treatment for age-related macular degeneration has eye surgeons arguing for change.

Stay up to date on all the latest advocacy news by subscribing to AMA Advocacy Update: https://www.ama-assn.org/advocacy-news

This podcast episode is an interview with Dr. Christopher Jones, the Acting Director of the U.S. Centers for Disease Control & Prevention's Injury Center, about CDC's new draft clinical practice guideline (CPG) for prescribing opioids and what it means for current practice. Dr. Jones walks listeners through changes to the CPG from the 2016 version, the process for revising the CPG, and the types of input from members that will best assist CDC as they finalize the CPG. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

The CDC proposed new clinical practice guidelines for prescribing opioids for pain management. These guidelines are not yet official as the government has opened the docket to obtain comments from the public regarding the proposed guidelines. While the purpose of the guideline is to serve as a clinical tool for providers, the recommendations are voluntary. The CDC emphasized that they are intended as flexible standards of care and should not replace clinical judgment or individualized, patient-centered care. The new clinical practice guideline, CDC Guideline for Prescribing Opioids–United States, 2022, expands on the previous one, CDC Guideline for Prescribing Opioids for Chronic Pain–United States, 2016, by including updated, evidence-based recommendations for clinicians. The original guideline had a nationwide impact. Cindy Steinberg, National Director of Policy and Advocacy for the US Pain Foundation explains the changes and updates made to these proposed recommendations and how the process works. Now that the recommendations are open on the Federal Register, public comments can be submitted for 60 days through April 11, 2022. After the comments are reviewed by the agency, a finalized version can be expected by the end of 2022.

In this episode, Andrew Friedman, MD, provides an overview of safe and effective opioid prescribing for patients with pain and walks through key points of opioid prescribing from the initial to final stages. Listen as he discusses development of a treatment plan and opioid selection, followed by tips for medication initiation and acute monitoring. Dr Friedman then expands on managing patients who progress from acute opioid use to subacute use, as well as chronic opioid use. Finally, the risks for overdose and importance of continuous risk assessment are discussed, along with considerations for opioid tapering and the utility of medication-assisted therapy for patients who develop opioid use disorder.  Presenter:  Andrew Friedman, MDMedical Director, Physical Medicine and RehabilitationVirginia Mason Franciscan HealthDirector, Spine Clinic and ServicesVirginia Mason Health CenterClinical Associate ProfessorUniversity of WashingtonSeattle, WashingtonThis activity is supported by an independent educational grant from the Opioid Analgesic REMS Program Companies. Please seehttps://bit.ly/3mgrfb9for a listing of REMS Program Companies. This activity is intended to be fully compliant with the Opioid Analgesic REMS education requirements issued by the FDA.Provided by Clinical Care Options, LLC, and in partnership with the American Academy of Physical Medicine and Rehabilitation, Practicing Clinicians Exchange, and ProCE.Link to full program:https://bit.ly/3mcDHsi

João, Raphael e Marcela Belleza trazem quatro clinicagens importantes sobre um remédio muito comum da nossa prática médica: os opioides. Como prescrever? Quais efeitos adversos são comuns e como tratar? Como é a intoxicação por opioide? Como usar essa classe na dispneia e na tosse? Tudo isso nesse episódio! Minutagem em breve! Escala RIOSORD de risco de intoxicação por opioides https://paindr.com/wp-content/uploads/2015/09/RIOSORD-tool.pdf Referências: 1. Uptodate Dez 2021. Prevention and management of side effects in patients receiving opioids for chronic pain. Russell K Portenoy,Zankhana Mehta, Ebtesam Ahmed, Janet Abrahm, Diane MF Savarese 2. TASSINARI, Davide et al. Adverse effects of transdermal opiates treating moderate-severe cancer pain in comparison to long-acting morphine: a meta-analysis and systematic review of the literature. Journal of palliative medicine, v. 11, n. 3, p. 492-501, 2008 3. Uptodate Nov 2021. Approach to symptom assessment in palliative care. Victor T Chang, Thomas J Smith, Jane Givens 4. Manual de Cuidados Paliativos - Ministério da Saúde. 2020. 5. Uptodate 2021. Assessment and management of dyspnea in palliative care. Deborah Dudgeon, Eduardo Bruera, Jane Givens,Helen Hollingsworth. 6. JOHNSON, Miriam J.; CURROW, David C. Opioids for breathlessness: a narrative review. BMJ supportive & palliative care, v. 10, n. 3, p. 287-295, 2020. 7. Palliative care: Overview of cough, stridor, and hemoptysis in adults. Charles von Gunten, Gary Buckholz, Eduardo Bruera, Jane Givens. 8. MOLASSIOTIS, Alex et al. Interventions for cough in cancer. Cochrane Database of Systematic Reviews, n. 5, 2015. 9-YANCY JR, William S. et al. Efficacy and tolerability of treatments for chronic cough: a systematic review and meta-analysis. Chest, v. 144, n. 6, p. 1827-1838, 2013. 9. YANCY JR, William S. et al. Efficacy and tolerability of treatments for chronic cough: a systematic review and meta-analysis. Chest, v. 144, n. 6, p. 1827-1838, 2013. 10. Caraceni A, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. European Palliative Care Research Collaborative (EPCRC), on behalf of the European Association for Palliative Care (EAPC) - Lancet Oncol 2012; 13: e58–68 www.thelancet.com/oncology Vol 13 February 2012 11. Jost L, Rolia F. Management of cancer pain: ESMO Clinical Recommendations. Annals of Oncology Volume 19, Supplement 2, May 2008, Pages ii119-ii121 12. Zeppetella, Giovambattista Impact and management of breakthrough pain in cancer, Current Opinion in Supportive and Palliative Care: March 2009 - Volume 3 - Issue 1 - p 1-6 doi: 10.1097/SPC.0b013e3283260658 13. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1 14. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline Judith A. Paice, Russell Portenoy, Christina Lacchetti, Toby Campbell, Andrea Cheville, Marc Citron, Louis S. Constine, Andrea Cooper, Paul Glare, Frank Keefe, Lakshmi Koyyalagunta, Michael Levy, Christine Miaskowski, Shirley Otis-Green, Paul Sloan, and Eduardo Bruera Journal of Clinical Oncology 2016 34:27, 3325-3345 15. BABU, Kavita M.; BRENT, Jeffrey; JUURLINK, David N. Prevention of opioid overdose. New England Journal of Medicine, v. 380, n. 23, p. 2246-2255, 2019. 16. Osler, W. "Oedema of left lung-morphia poisoning." Montreal Gen Hosp Rep 1 (1880): 291

This episode is also available as a blog post: https://youarewithinthenorms.com/2021/09/30/doctors-in-united-states-being-arrested-imprisoned-at-record-number-by-corrupted-dea-opioid-guidelines-for-medical-professionals-persecuted-for-prescribing-opioids/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/norman-j-clement/support

From a published journal article from the American Journal of Health System Pharmacy, the data highlights the impact of a pharmacist directed pain management treatment plan within institutional opioid use. The report noted that with the pharmacist lead treatment there was improved patient satisfaction scores and indirect cost savings. Despite decreased opioid use, available patient satisfaction data suggested ongoing improvement in associated with pharmacist designed pain management plans. Today we continue to build upon the podcast series called: Pharmacists & Physicians Working Together for Responsible Opioid Usage Special guest: William Amarquaye, PharmD Clinical Pharmacist at Florida Regional Hospital Impact of a pharmacist-directed pain management service on inpatient opioid use, pain control, and patient safety https://academic.oup.com/ajhp/article-abstract/76/1/17/5257115?redirectedFrom=fulltext The CDC Opioid Guideline: Proponent Interpretation Has Led to Misinformation https://pubmed.ncbi.nlm.nih.gov/29608033/ Quantifying the Epidemic of Prescription Opioid Overdose Deaths https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844400/ CDC's Efforts to Quantify Prescription Opioid Overdose Deaths Fall Short https://pubmed.ncbi.nlm.nih.gov/33761120/ An Examination of State and Federal Opioid Analgesic and Continuing Education Policies: 2016–2018 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534855/ CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain https://www.cdc.gov/media/releases/2019/s0424-advises-misapplication-guideline-prescribing-opioids.html  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 #PROPRx See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

From a published journal article from the American Journal of Health System Pharmacy, the data highlights the impact of a pharmacist directed pain management treatment plan within institutional opioid use. The report noted that with the pharmacist lead treatment there was improved patient satisfaction scores and indirect cost savings. Despite decreased opioid use, available patient satisfaction data suggested ongoing improvement in associated with pharmacist designed pain management plans. Today we continue to build upon the podcast series called: Pharmacists & Physicians Working Together for Responsible Opioid Usage Special guest: William Amarquaye, PharmD Clinical Pharmacist at Florida Regional Hospital Impact of a pharmacist-directed pain management service on inpatient opioid use, pain control, and patient safety https://academic.oup.com/ajhp/article-abstract/76/1/17/5257115?redirectedFrom=fulltext The CDC Opioid Guideline: Proponent Interpretation Has Led to Misinformation https://pubmed.ncbi.nlm.nih.gov/29608033/ Quantifying the Epidemic of Prescription Opioid Overdose Deaths https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844400/ CDC's Efforts to Quantify Prescription Opioid Overdose Deaths Fall Short https://pubmed.ncbi.nlm.nih.gov/33761120/ An Examination of State and Federal Opioid Analgesic and Continuing Education Policies: 2016–2018 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534855/ CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain https://www.cdc.gov/media/releases/2019/s0424-advises-misapplication-guideline-prescribing-opioids.html  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 #PROPRx See omnystudio.com/listener for privacy information.

Join Erin and Michelle as they circle back to the topic of low back pain. In particular, acute episodes or sudden onsets of low back pain. That common phrase “I threw my back out” sounds much worse than what's actually happening in our bodies during an episode of low back pain. Sometimes these episodes can be kind of like a musculoskeletal cold, they come on a time or two every year, last a few days to a week and then they're gone. Just like all the things we can do to prevent colds, there are also ways to reduce the duration and frequency episodes of low back pain occur! References: - Chou, R., Qaseem, A., Owens, D. K., Shekelle, P., & Guidelines, C. (2011). Clinical Guideline Diagnostic Imaging for Low Back Pain : Advice for High-Value Health Care From the American College of Physicians. Annals of Internal Medicine, 154 (November 2010), 181–190. - Fritz, J. M., Childs, J. D., & Flynn, T. W. (2005). Pragmatic application of a clinical prediction rule in primary care to identify patients with low back pain with a good prognosis following a brief spinal manipulation intervention. BMC Family Practice, 6(1). https://doi.org/10.1186/1471-2296-6-29. - Fritz, J. M., Childs, J. D., Wainner, R. S., & Flynn, T. W. (2012). Primary care referral of patients with low back pain to physical therapy: Impact on future health care utilization and costs. Spine, 37(25), 2114–2121. - Haas, M., Vavrek, D., Peterson, D., Polissar, N., & Neradilek, M. B. (2014). Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial. The Spine Journal, 14(7), 1106–1116. https://doi.org/10.1016/j.spinee.2013.07.468. - Interagency Guideline on Prescribing Opioids for Pain. Agency Medical Directors' Group. (2015, June). http://www.agencymeddirectors.wa.gov/Files/2015AMDGOpioidGuideline.pdf. - Low Back Pain. AAFP Home. (2017, April). https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/back-pain.html. Disclaimer: This podcast contains general information for community education purposes only, and does not take into account your specific comorbidities that your current healthcare provider may be managing. Please contact your care provider with questions regarding anything particular to you.

Over half a million people in the US have died from an opioid overdose over the last 20 years, and a lot of the time they were prescribed those opioids by a doctor. So what makes these drugs so dangerous? And if we know they can be this dangerous, why are they still prescribed?  This month’s episode is about opioids—their history, their use, and the research that might help us emerge from this epidemic. Featuring opioid researcher Kelly Dunn, PhD

Forced downward titration has been broadly implemented throughout the country as a direct result of the CDC Guideline for Prescribing Opioids for Chronic Pain. Prescribing clinicians feel pressured to follow the CDC’s recommendations of dose limits to avoid regulatory sanctions, and pharmacists feel a corresponding obligation to intervene in accordance with the CDC guideline and corporate policies. In many instances, prescribers have refused to treat opioid-requiring pain patients, resulting in the patients’ discharge from the specialist’s practice or a consult refusal—the latter of which, by default, often leaves the most medically complex and challenging patients with only their primary care providers to manage their pain. Some patients have chosen to leave their existing providers because of mistrust, cynicism, disbelief, and abandonment, but they then find it difficult to secure any other provider willing to treat their pain. This presentation will chronicle the events that have delivered an unreasonable burden on patients and providers.

Forced downward titration has been broadly implemented throughout the country as a direct result of the CDC Guideline for Prescribing Opioids for Chronic Pain. Prescribing clinicians feel pressured to follow the CDC’s recommendations of dose limits to avoid regulatory sanctions, and pharmacists feel a corresponding obligation to intervene in accordance with the CDC guideline and corporate policies. In many instances, prescribers have refused to treat opioid-requiring pain patients, resulting in the patients’ discharge from the specialist’s practice or a consult refusal—the latter of which, by default, often leaves the most medically complex and challenging patients with only their primary care providers to manage their pain. Some patients have chosen to leave their existing providers because of mistrust, cynicism, disbelief, and abandonment, but they then find it difficult to secure any other provider willing to treat their pain. This presentation will chronicle the events that have delivered an unreasonable burden on patients and providers.

 The sun rises over the San Joaquin Valley, California, today is October 9, 2020. About one year ago, the American Thoracic Society and Infectious Diseases Society of America issued an official clinical practice guideline regarding the diagnosis and treatment of adults with community acquired pneumonia (CAP). There you can find the answer to 16 common questions about CAP in adults. For example, question 8 refers to the antibiotics recommended for empiric treatment of CAP in adults as outpatients. For healthy outpatient adults without comorbidities (chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; or asplenia) or risk factors for antibiotic resistant pathogens (prior respiratory isolation of MRSA or Pseudomonas, or recent hospitalization AND receipt of parenteral antibiotics in the last 90 d), It is recommended monotherapy with amoxicillin or doxycycline or a macrolide.For outpatient adults with comorbidities, the antibiotics recommended (without specific order) are 1. Combination of amoxicillin/clavulanate or cephalosporin (such as Cefuroxime) PLUS Macrolide (such as azithromycin) or doxycycline or2. Monotherapy with respiratory fluoroquinolone (such as levofloxacin).CAP with no comorbidities in adult: Monotherapy with amoxicillin, doxy or a macrolide. CAP with comorbidities: Combined Augmentin or cephalosporin PLUS a macrolide or doxycycline. It’s a tongue twister, may it’s better if you take a look at the official recommendation.This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program, from Bakersfield, California. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care since 1971. “Courage isn’t having the strength to go on – it is going on when you don’t have strength. – Napoleon Bonaparte.Dr. Arreaza: Courage means to keep going even when you don’t have strength. Feeling discouraged is not uncommon during residency. You may feel inadequate at times, you may feel like “you don’t know enough,” but don’t worry, it is not easy, but the extra work is worth it. Get the courage to keep going. Dr. Patel: Hi listeners, I’d like to introduce myself, name is Ravi Patel, I’m a non-practicing MD who recently moved to Bakersfield and just met Dr. Arreaza, and his quote resonates with me because my journey to practicing medicine has been quite long and I definitely feel the importance in not giving up in the face of discouragement. Dr. Arreaza: Can you tell us a little bit of your background on working with pain management and opioids?Dr. Patel: I have several years of experience working in pain management and primary care with the Vegas metro population, huge indigent population which faces unique challenges especially in regards to opiate therapy. I’m here to discuss with Dr. Arreaza issues involving opiate usage, when it is appropriate, when it is not appropriate, and the importance of limiting usage, and in what cases long term usage is appropriate.Dr. Arreaza: That’s going to be our first topic – opiate therapy. When is it appropriate? How do you screen patients for therapy?Dr. Patel: It’s important to follow CDC guidelines, great place to begin, in screening patients it is inevitable due to the nature of opiates, to have drug-seeking patients. I like to begin with CDC guidelines. It’s important to stay under 90 MMEs per day, just in terms of efficacy and of course legal reasons, and most importantly patient safety. I like to follow the rule of 3 and 7, meaning acute patients, acute care in acute care settings, more so ED settings rather than urgent care, where 3-day courses of opiates are more suitable. Of course, there are other reasons as well, such as peri-surgical pain, 1-2 weeks may be appropriate, and then going case by case basis for chronic opiate therapy. Dr. Arreaza: Acute pain is an indication for opiates, like a fracture, so do you say 2 weeks would be enough?Dr. Patel: Every patient is different, look at it on case by case basis. More so than the number of days it’s the MMEs and the strength of the medication being prescribed. We want to start with longer acting medications; short-term, short acting medications tend to produce that feeling of euphoria, that instant rush that has a psychological addiction factor. I have seen many patients that go in for something as simple as a fracture and come out with an addiction to opiates. It can happen very quickly, in less than a week, in a matter of few days, opiate addiction takes place.Dr. Arreaza: So, we can start an addiction by just prescribing one week of opiates.Dr. Patel: Correct.Dr. Arreaza: Well the symptoms you mentioned, the patients who get this energy bust or euphoria, those are the patients who are more at risk of being addicted, and of course there is a genetic and biological component to it as well. I can tell you by experience that my patients usually say they feel sleepy; it has a sedative effect. Those are usually the lower addiction risk, right? Dr. Patel: Correct.Dr. Arreaza: Well I’m glad to say that one day I took opioids, I had a cornea transplant, I had horrible pain, a leaky eye, and every time I took opioids I fell asleep, it was the only way to mitigate my pain, and it also gave me empathy for patients. I know that there is a big component of genetics, so when they have this euphoria because of opioids and become addicted to opioids, sometimes it’s out of their control, sometimes opioids is something they need to live. It’s described as needing water when you are thirsty. That is the addiction; we had an episode on suboxone with the residents and they explained it very well. So, let’s discuss ways and importance of incorporating multi modal treatment in therapy.Dr. Patel: I find in my experience that is important to limit patient’s expectations of how much pain can be relieved from the get-go. Develop an onboarding plan and discuss what the therapy will entail. Many patients go in with the expectation that opiates are a magic pill that will remove all their pain, which is true, which is responsible for a lot of this addiction as well, but it is important to have an end date, let them know what the maximum you will prescribe, because it is extremely difficult once the patient is in therapy one or two weeks, because they are not often dependent on the opiate, and suddenly you want to take away this magic pill that is making them feel better than they ever have – patients can become aggressive. It’s hard, and plus with this addiction now you have to wean the patient off the medication as well. It’s important to incorporate other treatment modalities as well. I personally think physical therapy is extremely important, and, depending on the nature of the pathology, the nature of the injury, things like epidural injections, steroid injections, things to address the source of the pain over the long term rather than just giving an opiate. An opiate is a blanket you put over the pain, and any kind of pain, it brings it down. But we as providers, we need to focus on the source of the pain, to eliminate or reduce the source of this pain so we can then wean the patient off opiates and they are not dependent on them for the long term.Dr. Arreaza: I had the opportunity to work in a clinic with a patient population who was using a lot of opioids. The provider had prescribed a lot of opioids, and he had left the clinic, so when the patients came to me, they wanted refills, so there was some friction and arguments because I was always concerned about the opioid epidemic. But now that you mention the multi-modal approach, it is probably something I applied without realizing it, incorporating things like gabapentinoids or physical therapy, and then referring a lot of those patients to pain management to get the proper treatment, etc. The way I explained it to my patients is that the opioid will mask the pain, but the pain will always be there, we must address the root of the pain to cure it (if possible).Dr. Patel: As primary care providers, we always see patients who are following up with us, so if they have an acute injury, they go to Urgent Care, they go to the Emergency Room, there are many providers unfortunately who will provide strong opiates to patients. Just as Dr. Arreaza mentioned, like a blanket to reduce all their pain. To get the patient out of the door, especially in larger cities, busier emergency rooms, many times I have seen patients go to the Emergency Room, then see their primary care and they now have an addiction, they want their refill.Dr. Arreaza: So how can we set realistic pain management levels? How can we have that discussion with the patients? Do we agree to a pain level? “Your pain level won't be a 0 it may be a 2”? How do you address that with the patient?Dr. Patel: I think it's important to start a discussion like that by helping the patient realize that pain is a part of life. Most people have some sort of aches and pains, as we get older, part of the aging process, it’s common to have aches and pains and no medication is going to remove 100% of that pain permanently. Having that conversation, make sure the patient understands that the therapy won't be permanent, it won't be chronic. Get the patient used to the idea that they may have to deal with some level of pain in the long term. The patient needs to realize that yes, the opiates will make the pain go away, but when we take you off of it, the pain may come back.Dr. Arreaza: They have to develop some coping mechanisms to deal with pain. There is a lot of evidence that if you practice yoga, you can reduce chronic pain. I have a great experience, I don’t know if it is evidence-based or not, hydrotherapy/water therapy - aquatics, so my patients with fibromyalgia they get a lot of relief with that therapy, and it’s part of that multi modal approach you are suggesting, so think of all different options for patients on opioids, to work on different receptors, different areas, to improve their quality of life.Dr. Patel: Patients with chronic pain will almost always have associated psychiatric issues, so bringing in social workers, psychiatrists, psychologists, someone the patient can speak with. In Vegas like Bakersfield there is a large indigent population, and in my experience, I find more drug seeking behavior in that population. We can help by providing them more resources, allowing their concerns to be heard. They have multiple issues which we may not be aware of, that are causing them to seek these medications, because the whole picture of the patient should be considered.Dr. Arreaza: I'm just thinking right now, even financial reasons, the problem with diversion, the patients could be using the opioid as a way to get some income, so there is a lot of factors implicated in the opioid usage of patients. How do you identify addiction to opioids?Dr. Patel: Well there are the typical signs like you mentioned earlier. The aggressive patient coming in for a follow-up in a primary care clinic looking for a refill on a medication that some doctor somewhere gave them. I think that’s important to be aware of one tool I used where pharmacies report to a central agency so we know if patients are doctor hopping. I’ve caught many patients myself who would visit more than one physician in the same day, and physicians who don’t pay attention to these databases, would refill their prescriptions, and some mentions would get 2-3 different prescriptions in one day and then go around filling them. But in terms of identifying behaviors that are indicative of addiction, patients will have vague complaints, patients who want to come see you once or twice a week, every week attempting to get the medication. Many patients employ different strategies. Patients try to play to your emotions. I would talk about primary care issues, general checkups, blood work, and you'll find that these patients are not interested in anything but getting their medication. Behavior definitely plays a role in identifying addiction patients.Dr. Arreaza: I was looking for the right term, Prescription Drug Monitoring Programs, PDMP. In California, it’s called CURES. We can check CURES for every patient, and now it is required by the DEA, it’s a good tool to have. Also for the residents, you can do a urine drug screening randomly for the patient to see if they are positive for any other illegal drugs or if they are being compliant with the opioids. Dr. Patel: Very important, because there's a lot of comorbid drug use as well. Patients will use opiates as currency to buy other medications, to get illicit drugs, random screening is very important. We would give patients 24 hours to show up, we randomly call them, they have 24 hours to show up with their pills in their pill bottle, we would count them, to verify that they are taking them as prescribed. And anytime you are prescribing any controlled substance, you want to check that database.Dr. Arreaza: People with addiction are not necessarily bad people, some people are regular people addicted to a substance. That’s why we have these programs to help people get those addictions under control. We have some replacements like buprenorphine and suboxone. We will probably have an opportunity to talk about that more in depth later. Let’s talk about the frequent flyers, we have patients who come all the time so what strategies can we use to assist these patients?Dr. Patel: That’s a bit more difficult to deal with because you cannot disregard patients like that. There are patients who have valid concerns that need to be seen frequently, but you develop a sense of judgment about these patients in the sense that, like I mentioned earlier, patient is not concerned about any other issues. They may have an infection or may be limping, but they don’t care at all, they are not interested in multi-modal therapy they just want their prescription and that’s it. It’s an obvious sign of addiction and drug-seeking behavior. Due to laws like ENTALA for example, patients cannot be turned away from the Emergency Room. I have friends in the ED who see the same patient 3 times a week, they come in regularly seeking some kind of medication whether it’s a Toradol shot, or even 1-2 doses of a narcotics. You can’t avoid that, sooner or later we will end up running into those patients, but with patients like that, I always get psychiatry on board to see if there's any underlying factors. Why are they seeking medication attention repeatedly? Is it just drug seeking or are there any other underlying issues? What's going on?Dr. Arreaza: Treating addictions is important but I think we can learn a lot on how to treat pain, as it is the root of the problem here. If you learn how to treat pain we will able to help in this opioid epidemic we are in right now. A reminder to residents; opioid use is linked to obesity as mentioned in a previous episode.Dr. Patel: Another note, as we see more geriatric patients especially in primary care it is a growing problem, opiate usage amongst the elderly because now you have this wonderful drug that makes them feel 20-30 years younger, because who would not want to take that? It’s a tough conversation to have because the elderly patients have valid concerns, growing old is painful, right? At some point, we have to draw a line in the sand, especially with the U.S. using upwards of 80% of the world’s opiate supply, it is unfortunately part of our culture that when something is wrong, something is hurting, we want a pill for that. It is hard to combat, but it is something we have to do every day with our patients.Dr. Arreaza: Maybe next time we can discuss the use of opioids in palliative care.Dr. Patel: Of course, that is a completely valid use Dr. Arreaza: Yea, different topic. Thanks Dr. PatelDr. Patel: Thanks for the opportunity.____________________________Speaking Medical: Hematospermiaby Dr Steven SaitoIn honor of Halloween, we are going to talk blood.  Blood in your ejaculate. Hematospermia is having blood in your semen.  I understand seeing red shoot from your snek is scary, but there are things that the doctor can evaluate you for.  Causes can include: Recent instrumentation. That means events like prostate surgery or a traumatic Foley placement.Infections: both sexual and nonsexual variety Excessive ejaculation particularly if you have been at home during a pandemic with nothing else to do. Cancer: particularly in men over 40 And sporadic: caused by nothing, totally benign.  And it usually resolves with time. After working it up, most commonly reassurance is all that is required for your patients.  So, tell them to suck it up, walk it off, and rub some dirt in it. Remember the medical word of this week, hematospermia. ____________________________Espanish Por Favor: Hongosby Dr Hector ArreazaThe letter H is usually silent in Spanish. So, my name “Hector” is actually pronounced “ek-tor” in English. Among our Spanish’speaking patients is common to hear the word “OS-pit-al” for hospital. Today, I want to teach you the word hongos. Hongos in medical terms refers to fungus or fungal infection. You can add a body part to the words hongos de and get, for example, hongos de las uñas for nail fungus or onychomycosis, hongos de los pies for tinea pedis… they are all hongos. Strangely, hongos is also the word commonly used in Latin America for mushrooms. So, remember the word of this week, hongos, which means fungus.   ____________________________For your Sanity: 789by Dr Tana ParkerWhat do you call a drug addiction counselor addicted to prescription opiates? An Oxymoron.Do you know what 50 did when he got hungry? 58.Have you noticed we don’t have an iPhone 9? Yes, it’s because 789.Of all the inventions in the last 100 years, the whiteboard must be the most remarkable.Conclusion: Now we conclude our episode number 31 “Opioids in Bako.” Talking about opioids is always educational and pertinent. Dr Patel explained the importance of multi-modal treatment of pain, and we discussed different strategies to decrease the use of opioids in our community. Dr Saito explained that hematospermia is the proper way to say bloody semen, a feared symptom in men with a low probability of malignancy, think of infections or trauma before getting into a complicated workup for hematospermia. Dr Arreaza then taught us the Spanish word hongos (pronounced ON-goes, do not pronounce the h) which means fungus. Did you get the joke about 789? You may ask Dr Parker for an explanation.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Ravi Patel, Steven Saito, and Tana Parker. Audio edition: Suraj Amrutia. See you next week! _____________________References:American Journal of Respiratory and Critical Care Medicine, Volume 200, Issue 7, 1 October 2019, Pages e45-e67, https://www.atsjournals.org/doi/full/10.1164/rccm.201908-1581STPublished: 01 October 2019. Download PDF: https://www.atsjournals.org/doi/pdf/10.1164/rccm.201908-1581STCDC Guideline for Prescribing Opioids for Chronic Pain, United States, 2016. https://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6501e1.pdf

As the SFO finally garners convictions at trial, Tom and Jay brave the surge in covid cases to stay safe they are back to look at top compliance articles and stories which caught their eye this week.  SFO finally garners convictions. Susan Hawley reports in the FCPA Blog. Did the SFO get played? Kristen Ridley considers in Reuters. EU Court of Justice invalidates Privacy Shield. Catherine Stupp in WSJ Risk and Compliance Journal. Cordery Compliance with a client alert. The SEC and its China Problem. Francine McKenna in The Dig. The biggest gold scandal ever? Jon Rausch in Dipping Through Geometries. UK imposes Magnitsky sanctions. Dick Cassin in the FCPA Blog. SEC has $3.8MM whistleblower payout. SEC Press Release. Is compliance in the need for a digital transformation? Adam Shinder shows the way in CCI. How to conduct an audit engagement in a high risk region. Alex Movchan in Risk and Compliance Platform Europe. How much did ego and greed lead to Wirecard scandal? Michael Tobee in CCI. This month on The Compliance Life, I am joined by Scott Sullivan, Chief Integrity and Compliance Officer at Newport Mining. In Part 1, we discussed the need for empathy in a CCO. In Part 2, we look at reading the tea leaves and staying ahead of the (corp) wolf pack. On the Compliance Podcast Network, Tom started the topic of 3rd party risk management this month.This week saw the following offerings: Monday-the how question in due diligence; Tuesday-metrics on 3rd party management, Wednesday-managing 3rd parties; Thursday-auditing of 3rd parties; and Friday-ongoing monitoring of 3rd parties. The month of July is being sponsored by Affiliated Monitors. Note 31 Days to a More Effective Compliance Program now has its own iTunes channel. If you want to binge out and listen to only these episodes, click here. Great Upcoming Webinars: Navigating the Risks of Prescribing Opioids for Chronic Pain in the COVID-19 Era, Wednesday, July 22, 2020 12:00 PM EDT; with Jesse Caplan, Deb Waugh and Amy Fogelman, M.D. Registration and Inforamtion here. Computer Say ‘No’: Mitigating Legal & Ethical Risks in Public Agency Use of Automated Decision-Making Tools, Tuesday, July 28, 2020 12:00 PM EDT; with David Shonka, Mikhail Reider-Gordon and Jonathan Redgrave. Registration and Information here. ECI's Best Practice Forum, a Q&A Session with Brian Rabbitt, Acting Assistant Attorney General for the Criminal Division on the FCPA Resource Guide, 2nd edition, Thursday, July 30, 2:00 - 4:00 p.m. EDT. Registration and Information here. Tom Fox is the Compliance Evangelist and can be reached at tfox@tfoxlaw.com. Jay Rosen is Mr. Monitor and can be reached at jrosen@affiliatedmonitors.com. Learn more about your ad choices. Visit megaphone.fm/adchoices

The DOJ/SEC drop the 2nd edition to the FCPA Resource Guide at 5 PM on July 2. As Tom and Jay brave the surge in covid cases to stay safe they are back to look at top compliance articles and stories which caught their eye this week.  FCPA Resource Guide, 2nd edition released. Tom takes a deep dive in a 5-part blog post series on the FCPA Complinace and Ethics Blog. Part 1-The New Hallmark, Part 2-FCPA Corporate Enforcement Policy, Part 3- the Accounting Provisions, Part 4- Policy and Case Law Updates, Part 5-What does it all mean? Jonathan Marks on Borad and Fraud. Tom and Matt Kelly in Compliance into the Weeds. After its FCPA settlement, Novatris pays another $678MM for corruption inside the US. Mike Volkov in Corruption Crime and Compliance. A plan to restore trust in South Africa ABC enforcement. Larry Kirsch guest posts in GAB. A reassessment of due diligence in China? Jenny Liang opines in the FCPA Blog. Venezuela can’t get its gold out of England. Jon Rausch in Dipping Through Geometries. Amazon settles OFAC sanctions enforcement action. Mengqui Sun in the WSJ Risk and Compliance Journal. How can you make a risk management committee effective? Jim DeLoach shows the way in CCI. Is Deutsche Bank the world’s most corrupt? Matt Kelly digs in on Radical Compliance. Going from disaster recovery to business continuity? Carrie Penman in Ethics and Compliance Matters. On Compliance and Coronavirus, I was joined this week by Paul Mueller on how to reset, restart and accelerate your business in the era of Coronavirus; Ian Denis on employment and communication during Covid-19 and Breeda Miller on caregiving in the era of Covid-19. On the Compliance Podcast Network, Tom started the topic of 3rd party risk management this month.This week saw the following offerings: Monday-Questionniare; Tuesday-Due Diligence,Wednesday-levels of DD; Thursday-evaluating DD and clearing red flags; and Friday-compliance terms and conditions. The month of July is being sponsored by Affiliated Monitors. Note 31 Days to a More Effective Compliance Program now has its own iTunes channel. If you want to binge out and listen to only these episodes, click here. Great Upcoming Webinars: Navigating the Risks of Prescribing Opioids for Chronic Pain in the COVID-19 Era, Jul 22, 2020 12:00 PM in Eastern Time (US and Canada); with Jesse Caplan, Deb Waugh and Amy Fogelman, M.D. Registration and Inforamtion here. Computer Say ‘No’: Mitigating Legal & Ethical Risks in Public Agency Use of Automated Decision-Making Tools, Jul 28, 2020 12:00 PM in Eastern Time (US and Canada); with David Shonka, Mikhail Reider-Gordon and Jonathan Redgrave. Registration and Information here. ECI's Best Practice Forum, a Q&A Session with Brian Rabbitt, Acting Assistant Attorney General for the Criminal Division on the FCPA Resource Guide, 2nd edition, Thursday, July 30 2:00 - 4:00 p.m. EDT. Registration and Information here. Tom Fox is the Compliance Evangelist and can be reached at tfox@tfoxlaw.com. Jay Rosen is Mr. Monitor and can be reached at jrosen@affiliatedmonitors.com. Learn more about your ad choices. Visit megaphone.fm/adchoices

RX Opioids: Even When Prescribed by a Doctor Some people might think prescription opioids are safer than alcohol or illegal drugs, but the truth is they carry serious risks and side effects. Talk with your doctor about your concerns and make informed decisions about pain management together. Prescription opioids can be prescribed by doctors to treat moderate to severe pain, but can also have serious risks and side effects. Refer to the CDC Guideline for Prescribing Opioids for Chronic Pain to minimize patient risk. Recovery starts with a call, call 1-800-662-HELP or visit battlingopioids.org #battlingopioids #opioids #Addiction #pain #drugs #healthcare #opioidaddiction #OpioidCrisis #PA Podcast Producer: JADonnelly

Guest: Thomas P. Pittelkow, D.O., M.P.H.Host: Jeffrey S. Brault, D.O. (@JeffBrault)How do you treat acute vs chronic pain? Dr. Thomas Pittlekow details how he approaches patient education around pain and treatment options for chronic pain including spinal cord and peripheral nerve stimulators and who stands to benefit most. Dr. Pittelkow outlines best practices for prescribing opioids and the reasons behind them. He shares how he’s helping patients “live better, feel better, and move better” using a multimodal approach.Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR.Deeper Dive: CDC Guidelines for Prescribing Opioids for Chronic Pain https://www.cdc.gov/drugoverdose/prescribing/guideline.htmlMayo Clinic Pain Rehabilitation Center https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/resources-for-physicians

When treating acute and chronic pain conditions, there is a need for “balanced” analgesia or multimodal analgesia. These are cases in which opioids as monotherapy are rarely appropriate. The therapeutic role of adjuvant analgesics is to increase the therapeutic index of opioids by producing an opioid-sparing effect. The use of nonopioid analgesics, adjuvant agents, and, in some cases antidepressants, may provide additional pain relief by opioid-sparing effects. Many of these agents have additional benefits in treating other related comorbid conditions present in those who suffer from chronic pain. Newer regulatory guidelines, like the CDC Guideline for Prescribing Opioids for Chronic Pain, recommend that first-line treatment for acute and chronic pain should be nonopioid analgesics as an initial trial, emphasizing the need to optimize multimodal analgesia including nonpharmacologic interventions to improve outcomes. It is vital to have an appreciation and knowledge of alternative pain treatments in an era where mass opioid use has been the norm. During the so-called opioid epidemic, practitioners should provide patients with effective tools to help manage pain while minimizing the negative effects of opioid exposure. Adjuvant agents are not primarily identified as analgesic in nature but have been found in clinical practice to have either an independent analgesic effect or additive analgesic properties when used with opioids. Adjuvants add a unique action in opioid-resistant pain and can play a role in reducing opioid side effects. Knowledge of this class of medications is critical for the prescriber to be able to document their thought process in treatment plan development in the event of regulatory review. The goal of this course is to provide you with the tools to successfully evaluate the appropriate role of these agents in your practice. (Recorded at PAINWeek 2018)

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Tim and Jeff are joined by Dr. Roger Chou on this week's episode of Pain Reframed! A professor and physician at Oregon Health & Science University (OHSU), Dr. Chou was part of the team that developed the CDC's Guideline for Prescribing Opioids for Chronic Pain in 2016. More recently, he co-published an editorial in the New England Journal of Medicine, examining the current state of opioid prescribing in the United States. Tim, Jeff, and Dr. Chou discuss the impact of both of these works and the steps we can take in our clinics to make sure we're always putting the patient first.  Dr. Roger Chou is a Professor in the Departments of Medicine, and Medical Informatics & Clinical Epidemiology at Oregon Health & Science University (OHSU) School of Medicine, and Staff Physician in the Internal Medicine Clinic at OHSU. He has served as Director of the Pacific Northwest Evidence-based Practice Center since 2012. He has conducted systematic reviews in a number of areas, including chronic pain and musculoskeletal conditions, screening and prevention, diagnostic testing, and prognosis. He has served as Director of the American Pain Society clinical guidelines program, the GRADE methodologist for the World Health Organization’s Division of Reproductive Health, is a member of the Cochrane Back Review Editorial Board, and co-chair of the National Quality Forum Musculoskeletal Standing Committee. Dr. Chou is on several journal editorial boards and is an author on numerous scientific articles published in peer-reviewed journals. LINKS: Twitter - @ISPITeam No Shortcuts to Safer Opioid Prescribing (New England Journal of Medicine) Learn more about the roles that physical therapists and physical therapy assistants can play in reducing the opioid epidemic

Dr. Greg Mancini joins Brian Fortenberry to discuss opioids and narcotics and what could have caused the crisis. Mancini discusses the complications and side effects of the drug, as well as alternatives the medical community could utilize to control the issue without compromising patient care. To see this episodes show notes or to get more information, go to SVMIC.com.

Restless legs syndrome (RLS) that is unresponsive to traditional therapies or in which the patients can't tolerate traditional therapies—can be frustrating for clinicians and patients alike. Opioids can be a viable therapy for these patients—and a paper published in the January 2018 issue of Mayo Clinic Proceedings aims to illuminate this treatment pathway.

Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories. Comp RICO Fails in California Federal Court, Irvine Physician Arrested for Prescribing Opioids, Opioid-Murder Conviction of LA Physician Affirmed, Sheriff's Lieutenant Arrested for Comp Fraud, Jury Convicts Uninsured Restaurant Owner, Study Finds 20% Annual Health Crimes Increase, A.B. 5 Seeks to Codify New "ABC" Employment Criteria, Unlicensed Comp Carrier Fined $4M, Early Physical Therapy Reduces Opiate Use, Comp Rates Decrease in 2019 - Except at the Race Track!

A Tustin doctor has been arrested for illegally prescribing opioids,and it looks like he gave some to the Thousand Oaks shooter, Actor/funnyman John Michael Higgns hangs out with us for an hour in-studio, President Trump says he's pulling troops out of Syria saying ISIS is defeated, SF Mayor London Breed wants to get her brother out of prison, and a much much more!

The College of Physicians and Surgeons of British Columbia issued a news release in which it instructs B.C. doctors to not refuse chronic pain patients and to not refuse prescribing opioid pain medication to such patients, because to do so violates human rights law. Meanwhile, the Institute for Clinical Evaluative Sciences released a study concerning newly prescribed opioids. The study was led by Dr. Tara Gomes and included Dr. David Juurlink. But Huff Post Canada medical writer Marvin Ross has discovered incorrect information in the study. Guests:  Andrew Koster, B.C. Chronic pain patient who challenged the issues surrounding prescribing opioids in British Columbia Marvin Ross, Discovered significant error in ICES study on chronic pain and prescribing opioids (Photo: Graeme Roy/Canadian Press) See omnystudio.com/listener for privacy information.

DEA and Controlled Substance Quotas      CDC Guidelines on Prescribing Opioids for Chronic Pain:https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf   TN Chronic Pain Guidelines on Opioids:   https://www.tn.gov/content/dam/tn/health/documents/ChronicPainGuidelines.pdf   Joseph T. Rannazzisi Due Diligence Compliance, LLC PO Box 292 Annandale, VA 22003

DEA and Controlled Substance Quotas      CDC Guidelines on Prescribing Opioids for Chronic Pain:https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf   TN Chronic Pain Guidelines on Opioids:   https://www.tn.gov/content/dam/tn/health/documents/ChronicPainGuidelines.pdf   Joseph T. Rannazzisi Due Diligence Compliance, LLC PO Box 292 Annandale, VA 22003 jralchemist@aol.com See omnystudio.com/listener for privacy information.

Don Teater is a family physician western North Carolina. In 2004 he started a clinic to treat those addicted to opioids in his primary care practice. He has worked as Medical Advisor at the National Safety Council addressing the national epidemic of opioid abuse, addiction, and overdose. Dr. Teater was lead facilitator for the expert panel discussion during the development of the CDC Guideline for Prescribing Opioids for Chronic Pain. He has also served on the World Health Organization Committee.He and his wife Martha created Teater Health Solutions to concentrate on educating prescribers and others on the science of opioids and how that should influence treatment and policy decisions. He works with the Center for Disease Control on the academic detailing of prescribers to educate them on the appropriate use of opioids for the treatment of pain. He continues to treate those afflicted by the disease of addiction at Meridian Behavioral Health Services.?Martha Teater is a licensed clinical addictions specialist, licensed professional counselor, and licensed marriage and family therapist. She is a diplomate of the Academy of Cognitive Therapy. She has been in private practice in Waynesville, NC, since 1990. A consultant and presenter, Martha has done trainings all over the U.S. and internationally on such topics as behavioral treatment of chronic pain, DSM-5, evidence-based treatment of trauma, compassion fatigue, and ethics. 

In this episode, we review the 12 recommendations from the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.  These recommendations are intended to help curb the opioid epidemic and provide guidance to healthcare providers regarding safer use o

Travis Rieder of the Johns Hopkins Berman Institute of Bioethics describes his experience of opioid withdrawal after a serious accident and outlines a bioethical framework for opioid prescribing. John Renner of Boston University explains how stories like Rieder's fit into the larger picture of opioid use in America, and what must be done to address the educational gap. You can learn more about substance use disorders and medication-assisted treatment at www.psychiatry.org/patients-families/addiction. Information about the Providers' Clinical Support System for Medication Assisted Treatment is at www.pcssmat.org. Funding for this initiative was made possible (in part) by Providers' Clinical Support System for Medication Assisted Treatment (1U79TI026556) 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. Music: "Sidecar" by Podington Bear

  Dr. Rosenblum discusses the CDC's Guidelines for Opiate Prescribing Download our iphone App! Download our Android App! For more information on Pain Management Topics and keywords Go to PainExam.com David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com 718 436 7246 DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.  You should regularly consult a physician in matters relating to yours or another's health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional.    Copyright © 2017 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.     Subscribe to our mailing list * indicates required Email Address *    

Emergency room physician and AM640 medical expert Brett Belchetz discusses the new guidelines with the John Oakley Show

Nursing Grand Rounds with Susan DiStasio DNP, ANP-BC APRN, Colleen Olson MS FNP-BC APRN, Bridget Meador, MSN FNP-BC APRN

Nursing Grand Rounds with Susan DiStasio DNP, ANP-BC APRN, Colleen Olson MS FNP-BC APRN, Bridget Meador, MSN FNP-BC APRN

Interviews regarding the CDC guidelines on prescribing opioids

Opioid addiction has a profound impact on many aspects of society. In this episode we examine the ways that doctors and other practitioners contribute to the epidemic and how we can be part of the solution. feedback@obgyn.fm   Links Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 Abuse-Deterrent Formulations and the Prescription Opioid Abuse Epidemic in the United StatesLessons Learned From OxyContin Impact of a Mandatory Prescription Drug Monitoring Program on Prescription of Opioid Analgesics by Dentists A Joint Statement From 21 Health Organizations and the Drug Enforcement Administration. Promoting pain relief and preventing abuse of pain medications: A critical balancing act. Primary Care Physicians’ Knowledge And Attitudes Regarding Prescription Opioid Abuse and Diversion

An opioid abuse epidemic now plagues US healthcare. It was caused, in part, by overzealous advocacy for controlling chronic pain resulting in overuse of narcotics. There are now 2 million Americans addicted to opioids. The approach for treating chronic pain must change. In this podcast, we summarize recent CDC guidelines for the proper use of opioids for treating chronic pain. Articles discussed in this episode: CDC Guideline for Prescribing Opioids for Chronic Pain— United States, 2016 The CDC Guideline on Opioid Prescribing: Rising to the Challenge (Yngvild Olsen, MD, MPH) The DSM-V definition for opioid use disorder and 11 point checklist

An opioid abuse epidemic now plagues US healthcare. It was caused, in part, by overzealous advocacy for controlling chronic pain resulting in overuse of narcotics. There are now 2 million Americans addicted to opioids. The approach for treating chronic pain must change. In this podcast, we summarize recent CDC guidelines for the proper use of opioids for treating chronic pain. Articles discussed in this episode: CDC Guideline for Prescribing Opioids for Chronic Pain— United States, 2016, The CDC Guideline on Opioid Prescribing: Rising to the Challenge (Yngvild Olsen, MD, MPH), The DSM-V definition for opioid use disorder and 11 point checklist

Opioid abuse is at an ever increasing high in the U.S. with overdose being a significant cause of death.  What role do physicians, pharmaceutical companies, and the drug users themselves play in this epidemic. We examine these questions and more in this episode on the opioid problem in the United States. Resources: Drug Overdose Deaths by State Draft CDC Guidelines for Prescribing Opioids for Chronic Pain Specific Populations and Prescription Drug Misuse and Abuse

Sample treatment agreement for prescription opioids from Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain available at http://health.utah.gov/prescription/guidelines.html

Guest: Daniel Alford, MD, MPH Host: Mary Leuchars, MD Treating pain is rarely an absolute science, and where opioid use is concerned, it is never risk-free for patients. How can physicians safely prescribe opioids for chronic pain, and what are the risks of addiction? Dr. Daniel Alford, associate professor of medicine and director of Chief Resident Immersion Training in Addiction Medicine section of general internal medicine at Boston University School of Medicine, speaks with host Dr. Mary Leuchars about opioid use for chronic pain.