Opioid prescribing for cnp speakers notes

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Opioid prescribing for cnp speakers notes

  1. 1. 1
  2. 2. 2
  3. 3. http://tinyurl.com/6d9yxgz 3
  4. 4. 2. http://www.cdc.gov/homeandrecreationalsafety/rxbrief/ 4
  5. 5. 3. http://www.ncbi.nlm.nih.gov/pubmed/23031398 5
  6. 6. http://tinyurl.com/lrkcdql 6
  7. 7. http://tinyurl.com/lrkcdql 7
  8. 8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129653/ 8
  9. 9. 8. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm 9
  10. 10. http://www.ncbi.nlm.nih.gov/pubmed/21751058 10
  11. 11. http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf 11
  12. 12. http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf 12
  13. 13. http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf 13
  14. 14. 14
  15. 15. http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf 15
  16. 16. http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf 16
  17. 17. 6. http://www.samhsa.gov/data/2k12/NSDUH115/sr115-nonmedical-use-painrelievers.htm 17
  18. 18. http://www.cdc.gov/nchs/data/databriefs/db22.pdf 18
  19. 19. http://tinyurl.com/mr9dttb Y axis = Opioid Prescriptions/1000 Residents 15. Tillamook 23. Marion 36 Total Counties 19
  20. 20. http://preview.tinyurl.com/mza7766 Approximately 150/yr in OR. 20
  21. 21. 21
  22. 22. Opioids are not the final common pathway for all chronic non-malignant pain. 22
  23. 23. http://tinyurl.com/lr9hwhh 23
  24. 24. 24
  25. 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. 26. DIRE: Diagnosis, Intractability, Risk, Efficacy http://tinyurl.com/lks94bf 26
  27. 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. 28. Opioid dose conversion calculators: http://agencymeddirectors.wa.gov/mobile.html http://opioidcalculator.practicalpainmanagement.com/ 28
  29. 29. http://tinyurl.com/mmazr8y 29
  30. 30. http://www.ncbi.nlm.nih.gov/pubmed/22213274 30
  31. 31. http://tinyurl.com/kzvs443 31
  32. 32. http://gov.oregonlive.com/bill/2013/SB384/ 32
  33. 33. http://tinyurl.com/mb2lj6r 33
  34. 34. http://tinyurl.com/kpuh547 34
  35. 35. http://tinyurl.com/abnywac The CDC estimates that 30% of all prescription painkillers deaths in 2010 involved benzodiazepines. 35
  36. 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. 37. 18. http://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=5 37
  38. 38. http://www.oregon.gov/omb/pdfforms/materialrisknotice.pdf 38
  39. 39. 20. http://www.oregon.gov/omb/newsletter/winter2011.pdf 39
  40. 40. Safety surveillance measures. 40
  41. 41. http://www.fda.gov/ohrms/dockets/ac/02/slides/3820s2_05_passik.ppt 41
  42. 42. 42
  43. 43. 43
  44. 44. 44
  45. 45. http://www.ncbi.nlm.nih.gov/pubmed/14635824 45
  46. 46. http://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=3 46
  47. 47. http://www.ncbi.nlm.nih.gov/pubmed/19663620 47
  48. 48. http://www.ncbi.nlm.nih.gov/pubmed/23070654 48
  49. 49. Doctor shopping is an aberrant behavior and grounds for discharge. 49
  50. 50. Thanks to Dr. David Russo, Columbia Pain Management 50
  51. 51. http://tinyurl.com/klx8vn5 51
  52. 52. http://tinyurl.com/modae4l The CDC estimates that less than 1% of all prescription painkillers deaths in 2010 involved marijuana. 52
  53. 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. 54. http://preview.tinyurl.com/k48rkys 30% of heavy users co-utilize other illicit drugs. 54
  55. 55. http://preview.tinyurl.com/k48rkys 40% of heavy users use alcohol heavily. 55
  56. 56. http://preview.tinyurl.com/k48rkys The 20% of all users consume 80% of the marijuana sold. 56
  57. 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. 58. http://preview.tinyurl.com/lweycl7 58
  59. 59. http://www.ncbi.nlm.nih.gov/pubmed/24076302 59
  60. 60. http://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=6 2x compared to alcohol’s 9x 60
  61. 61. http://www.ncbi.nlm.nih.gov/pubmed/19793342 61
  62. 62. http://tinyurl.com/lr9hwhh 62
  63. 63. 24. http://www.deadiversion.usdoj.gov/fed_regs/rules/2006/fr0906.htm 63
  64. 64. Special thanks to my reviewers for their critical input. 64
  65. 65. Special thanks to my reviewers for their critical input. 65
  66. 66. Physicians for responsible opioid prescribing. An excellent resource for responsible opioid prescribing. 66

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