Opioid prescribing for cnp speakers notes
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  • 1. 1
  • 2. 2
  • 3. http://tinyurl.com/6d9yxgz 3
  • 4. 2. http://www.cdc.gov/homeandrecreationalsafety/rxbrief/ 4
  • 5. 3. http://www.ncbi.nlm.nih.gov/pubmed/23031398 5
  • 6. http://tinyurl.com/lrkcdql 6
  • 7. http://tinyurl.com/lrkcdql 7
  • 8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129653/ 8
  • 9. 8. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm 9
  • 10. http://www.ncbi.nlm.nih.gov/pubmed/21751058 10
  • 11. http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf 11
  • 12. http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf 12
  • 13. http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf 13
  • 14. 14
  • 15. http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf 15
  • 16. http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf 16
  • 17. 6. http://www.samhsa.gov/data/2k12/NSDUH115/sr115-nonmedical-use-painrelievers.htm 17
  • 18. http://www.cdc.gov/nchs/data/databriefs/db22.pdf 18
  • 19. http://tinyurl.com/mr9dttb Y axis = Opioid Prescriptions/1000 Residents 15. Tillamook 23. Marion 36 Total Counties 19
  • 20. http://preview.tinyurl.com/mza7766 Approximately 150/yr in OR. 20
  • 21. 21
  • 22. Opioids are not the final common pathway for all chronic non-malignant pain. 22
  • 23. http://tinyurl.com/lr9hwhh 23
  • 24. 24
  • 25. DIRE: Diagnosis, Intractability, Risk, Efficacy COMM: Current opioid misuse measure SOAPP-R: Screener and Opioid Assessment for Patients with Pain Naïve = < 60MED Tolerant = > 60MED 25
  • 26. DIRE: Diagnosis, Intractability, Risk, Efficacy http://tinyurl.com/lks94bf 26
  • 27. http://preview.tinyurl.com/lhxtoju http://www.ncbi.nlm.nih.gov/pubmed/21467284 http://www.ncbi.nlm.nih.gov/pubmed/21482846 http://www.ncbi.nlm.nih.gov/pubmed/22026451 http://www.fda.gov/downloads/Drugs/N.../UCM307844.pdf Dosages in excess of 100MED/day warrant a pain management consultation. MED = Milligrams Equivalent Dose (Morphine) University of Washington Opioid Dose Calculator: http://agencymeddirectors.wa.gov/mobile.html Practical Pain Management Opioid Dose Calculator: http://opioidcalculator.practicalpainmanagement.com/ 27
  • 28. Opioid dose conversion calculators: http://agencymeddirectors.wa.gov/mobile.html http://opioidcalculator.practicalpainmanagement.com/ 28
  • 29. http://tinyurl.com/mmazr8y 29
  • 30. http://www.ncbi.nlm.nih.gov/pubmed/22213274 30
  • 31. http://tinyurl.com/kzvs443 31
  • 32. http://gov.oregonlive.com/bill/2013/SB384/ 32
  • 33. http://tinyurl.com/mb2lj6r 33
  • 34. http://tinyurl.com/kpuh547 34
  • 35. http://tinyurl.com/abnywac The CDC estimates that 30% of all prescription painkillers deaths in 2010 involved benzodiazepines. 35
  • 36. http://tinyurl.com/ly6o6vj The CDC estimates that 20% of all prescription painkillers deaths in 2010 involved alcohol. (http://www.pbs.org/newshour/rundown/prescription-drug-abuse-cdc-answers-yourquestions/) 36
  • 37. 18. http://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=5 37
  • 38. http://www.oregon.gov/omb/pdfforms/materialrisknotice.pdf 38
  • 39. 20. http://www.oregon.gov/omb/newsletter/winter2011.pdf 39
  • 40. Safety surveillance measures. 40
  • 41. http://www.fda.gov/ohrms/dockets/ac/02/slides/3820s2_05_passik.ppt 41
  • 42. 42
  • 43. 43
  • 44. 44
  • 45. http://www.ncbi.nlm.nih.gov/pubmed/14635824 45
  • 46. http://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=3 46
  • 47. http://www.ncbi.nlm.nih.gov/pubmed/19663620 47
  • 48. http://www.ncbi.nlm.nih.gov/pubmed/23070654 48
  • 49. Doctor shopping is an aberrant behavior and grounds for discharge. 49
  • 50. Thanks to Dr. David Russo, Columbia Pain Management 50
  • 51. http://tinyurl.com/klx8vn5 51
  • 52. http://tinyurl.com/modae4l The CDC estimates that less than 1% of all prescription painkillers deaths in 2010 involved marijuana. 52
  • 53. http://preview.tinyurl.com/k48rkys NSDUH: National Survey on Drug Use and Health The CDC estimates that less than 1% of all prescription painkillers deaths in 2010 involved marijuana. 70% of heavy users are white males under the age of 35. For an impartial analysis of marijuana use/legalization: http://www.amazon.com/Marijuana-Legalization-Everyone-NeedsKnow%C2%AE/dp/0199913730/ref=sr_1_1?ie=UTF8&qid=1393092023&sr=81&keywords=marijuana+and+kilmer 53
  • 54. http://preview.tinyurl.com/k48rkys 30% of heavy users co-utilize other illicit drugs. 54
  • 55. http://preview.tinyurl.com/k48rkys 40% of heavy users use alcohol heavily. 55
  • 56. http://preview.tinyurl.com/k48rkys The 20% of all users consume 80% of the marijuana sold. 56
  • 57. http://www.martin.uky.edu/centers_research/Capstones_2012/Farley.pdf Study included the 16 states with both MM & PDMP’s in 2011. Look back was 1996 – 2006. …”I conclude that the implementation of Medical Marijuana Programs does not cause a decline in prescription controlled substance utilization.” James Farley, Martin School of Public Policy “ 57
  • 58. http://preview.tinyurl.com/lweycl7 58
  • 59. http://www.ncbi.nlm.nih.gov/pubmed/24076302 59
  • 60. http://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=6 2x compared to alcohol’s 9x 60
  • 61. http://www.ncbi.nlm.nih.gov/pubmed/19793342 61
  • 62. http://tinyurl.com/lr9hwhh 62
  • 63. 24. http://www.deadiversion.usdoj.gov/fed_regs/rules/2006/fr0906.htm 63
  • 64. Special thanks to my reviewers for their critical input. 64
  • 65. Special thanks to my reviewers for their critical input. 65
  • 66. Physicians for responsible opioid prescribing. An excellent resource for responsible opioid prescribing. 66