This document summarizes findings from interviews conducted as part of a study evaluating a chronic pain management pilot program for Medicaid patients in Rhode Island. Key findings include:
1) Patients reported that complementary and alternative therapies like acupuncture, massage and chiropractic care helped them better understand the relationship between stress and pain and provided an opportunity to build trusting relationships with providers.
2) Providers noted that the program allowed patients to receive hands-on care and personal connections that they may not receive otherwise due to lack of trust in the medical system and limited therapeutic relationships.
3) The program addressed transportation barriers by having some providers conduct home visits, improving access to care for patients with mobility issues.
4)
This document summarizes a presentation on closing treatment gaps in the health care and criminal justice systems for opioid use disorders. It introduces the presenters and moderator and provides learning objectives focused on improving identification and treatment of opioid use disorders in health care settings and strategies for improving outcomes for frequently incarcerated individuals. Disclosures are provided for the presenters stating that they have no relevant financial relationships.
This document discusses strategies for reducing buprenorphine diversion and pill mills while improving access to treatment. It notes that limiting access to buprenorphine treatment is associated with increased diversion, while expanded access to quality treatment decreases diversion and overdose deaths. The document recommends educating prescribers, using medically-derived prescribing standards, ensuring adequate insurance coverage of safe prescribing practices, and addressing diversion risks for other controlled medications. It argues against onerous new regulations that could limit treatment access. The goal is to identify and support high-quality treatment while prosecuting criminal operations.
This document summarizes a presentation on preventing opioid abuse and the role of dentists. It discusses current prescribing practices for acute dental pain that can lead to leftover opioids and abuse. It reviews evidence that combining different analgesics like NSAIDs and acetaminophen is more effective than single agents for acute pain. Guidelines are provided for managing acute pain with a multimodal analgesic approach and only using opioids if needed. The document contrasts acute versus chronic pain and notes opioids are not the primary strategy for most chronic orofacial pain conditions. It introduces the University of Kentucky Orofacial Pain Center's multidisciplinary approach to chronic pain management.
Web only rx16 pdmp-tues_330_1_kreiner_2ringwalt-schiroOPUNITE
This document discusses three projects in North Carolina aimed at reducing harm from prescription drug abuse: 1) Identifying prescribers who prescribe very high levels of controlled substances using PDMP data and algorithms, in partnership with state agencies and the medical board. 2) Identifying prescribers with multiple patients who died from opioid-related overdoses. 3) Providing immediate feedback to prescribers on high-risk patients through electronic health records integrated with PDMP data, in partnership with health systems. The goals are to develop valid methods to identify problematic prescribing patterns using multiple data sources and address technical and policy hurdles to information sharing.
This document summarizes a presentation on health plan involvement in safe prescribing. It includes:
1) Presentations from medical experts on prescription drug abuse trends from medical examiner data and a tribal health system's safe prescribing program.
2) A discussion of health plan policies to reduce "red flag" medication combinations like opioids plus benzodiazepines through prior authorization, formulary changes, and provider restrictions.
3) Examples of one health plan's implementation of policies like restricting methadone prescriptions to pain specialists and removing carisoprodol from its formulary.
This document summarizes a presentation on closing treatment gaps in the health care and criminal justice systems for opioid use disorders. It introduces the presenters and moderator and provides learning objectives focused on improving identification and treatment of opioid use disorders in health care settings and strategies for improving outcomes for frequently incarcerated individuals. Disclosures are provided for the presenters stating that they have no relevant financial relationships.
This document discusses strategies for reducing buprenorphine diversion and pill mills while improving access to treatment. It notes that limiting access to buprenorphine treatment is associated with increased diversion, while expanded access to quality treatment decreases diversion and overdose deaths. The document recommends educating prescribers, using medically-derived prescribing standards, ensuring adequate insurance coverage of safe prescribing practices, and addressing diversion risks for other controlled medications. It argues against onerous new regulations that could limit treatment access. The goal is to identify and support high-quality treatment while prosecuting criminal operations.
This document summarizes a presentation on preventing opioid abuse and the role of dentists. It discusses current prescribing practices for acute dental pain that can lead to leftover opioids and abuse. It reviews evidence that combining different analgesics like NSAIDs and acetaminophen is more effective than single agents for acute pain. Guidelines are provided for managing acute pain with a multimodal analgesic approach and only using opioids if needed. The document contrasts acute versus chronic pain and notes opioids are not the primary strategy for most chronic orofacial pain conditions. It introduces the University of Kentucky Orofacial Pain Center's multidisciplinary approach to chronic pain management.
Web only rx16 pdmp-tues_330_1_kreiner_2ringwalt-schiroOPUNITE
This document discusses three projects in North Carolina aimed at reducing harm from prescription drug abuse: 1) Identifying prescribers who prescribe very high levels of controlled substances using PDMP data and algorithms, in partnership with state agencies and the medical board. 2) Identifying prescribers with multiple patients who died from opioid-related overdoses. 3) Providing immediate feedback to prescribers on high-risk patients through electronic health records integrated with PDMP data, in partnership with health systems. The goals are to develop valid methods to identify problematic prescribing patterns using multiple data sources and address technical and policy hurdles to information sharing.
This document summarizes a presentation on health plan involvement in safe prescribing. It includes:
1) Presentations from medical experts on prescription drug abuse trends from medical examiner data and a tribal health system's safe prescribing program.
2) A discussion of health plan policies to reduce "red flag" medication combinations like opioids plus benzodiazepines through prior authorization, formulary changes, and provider restrictions.
3) Examples of one health plan's implementation of policies like restricting methadone prescriptions to pain specialists and removing carisoprodol from its formulary.
This document discusses drug court models and the role of law enforcement in drug courts. It begins with introductions from presenters and outlines learning objectives about explaining drug court operations and benefits, how law enforcement can utilize drug courts, and identifying best practices. The following sections provide details on drug court models, including how they integrate treatment into the justice system using a non-adversarial approach. Key components of drug courts are outlined, and presenters discuss issues like prescription drug and heroin abuse as well as outcomes from drug courts in reducing recidivism and saving money. Law enforcement can play roles in prevention, addressing domestic violence, and targeting the right populations for drug court involvement through assessment.
The document discusses factors that can lead to transition from misuse of prescription opioid analgesics to heroin initiation. Through qualitative interviews with 31 individuals in New York City, four key factors were identified: 1) Use of high dose opioid analgesics; 2) Intranasal route of administration; 3) Development of physical opioid dependence; and 4) Dissolution of stigma regarding heroin in social networks. The trajectory toward heroin use was found to be similar regardless of whether opioid analgesic initiation was recreational or medical in nature.
This document summarizes a presentation on drugs to watch including tramadol, hydrocodone, and naloxone. It includes:
- Disclosures from presenters declaring no conflicts of interest.
- Learning objectives focused on analyzing the impact of schedule changes for tramadol and hydrocodone, educating on tramadol dangers, and evaluating pharmacist perspectives on naloxone.
- Information presented on the drugs including their classifications, potencies, risks of abuse and addiction, and impacts of rescheduling hydrocodone and tramadol in California. Data showed decreased hydrocodone prescriptions but increased tramadol and overall opioid prescriptions, as well as increased over
Drug Treatment Courts: How America’s Most Trusted Alternative to Incarceration is Providing Hope in the Midst of the Rx Drug Abuse and Opiate Epidemic - Vision Session Presented by National Association of Drug Court Professionals
The document discusses the opioid crisis in the United States, including rising rates of prescription opioid misuse and abuse, as well as heroin use and overdose deaths. It outlines how research can help address this crisis through developing less abusable analgesics, expanding access to treatment medications like naloxone and buprenorphine, and exploring new treatment approaches such as immunotherapies and precision medicine targeting genetic factors. The National Institute on Drug Abuse is supporting these research efforts and working to disseminate findings to improve prevention and intervention programs.
This document provides a summary of a presentation on the risks of medical marijuana and marijuana legalization. It begins with disclosures from the presenters and outlines six learning objectives. It then discusses concerns that marijuana is addictive, especially for those who start using it early, and impacts adolescent brain development. The document notes the lack of evidence that marijuana is effective for the conditions it is claimed to treat. It also discusses the risks of increased diversion of marijuana to youth and greater social acceptance of marijuana use negatively impacting public health. The document concludes with messages on how to discuss these issues with the public.
Rx16 federal tues_1115_1_fretwell_2gabbert-wilkebrownOPUNITE
This document summarizes a presentation on state and community-level programs for preventing prescription drug misuse and expanding treatment options like medication-assisted treatment. Speakers from Georgia and Iowa discussed their strategies for engaging stakeholders, implementing prevention initiatives in targeted communities, leveraging funding sources, and addressing challenges in data and addressing disparities. Iowa described their efforts to expand access to medication-assisted treatment for opioid use disorders through a new grant, including challenges implementing changes quickly.
This document summarizes a presentation on managing morphine equivalent dose (MED) and identifying high-risk opioid use through "red flagging." It discusses how calculating MED at the point of sale can help identify unsafe dosages and decrease opioid prescriptions. It also evaluates different methods to screen for overdose risk, finding that simple opioid use thresholds to flag patients may not accurately target those most likely to experience preventable overdoses. The presentation aims to explain MED management, describe payer solutions that reduced opioid use, and identify more precise ways to intervene with highest-risk patients.
The document discusses strategies for engaging opioid overdose patients in addiction treatment after receiving naloxone/an overdose reversal. It describes:
1) The Lifespan Opioid Overdose Prevention Program in Rhode Island which aims to reduce overdose deaths by increasing access to naloxone, expanding overdose education in EDs, and increasing referral to treatment. The program provides take-home naloxone, peer recovery coaching, and refers patients to treatment.
2) The Camden County Addiction Awareness Task Force's "Operation SAL" program which aims to engage overdose patients in treatment after being revived by first responders. It connects patients to resources like food/clothing banks and
This document summarizes a presentation on best practices for treating opioid addiction in the criminal justice population. It outlines the challenges of treatment in this population and identifies best practices for using medication-assisted treatment (MAT) and behavioral therapy. The presentation reviews key points from the ASAM National Practice Guideline, including that MAT is the standard of care for opioid use disorder and should be continued, initiated, or made available for inmates. Discontinuing treatment can be dangerous and contradicts evidence-based practices. The implications discussed are that the guideline supports higher quality care for inmates and a rehabilitative approach, while also helping to address the opioid epidemic.
This document summarizes a presentation on medication-assisted treatment for opioid addiction. It discusses the history of treatment approaches, including the development of methadone and buprenorphine maintenance therapies. Studies show that agonist therapies like methadone and buprenorphine are more effective at retaining patients in treatment and reducing illicit opioid use than non-medication approaches. While both methadone and buprenorphine are effective, buprenorphine has a safer side effect profile but its effectiveness may be limited by lower monitoring and adherence compared to methadone treatment. The document reviews several studies demonstrating the benefits of long-term agonist therapy over detoxification or short-term medication approaches for opioid
This document summarizes a CDC training on using digital and social media to address the opioid epidemic. It includes:
- Presenters from the CDC's National Center for Injury Prevention and Control who will discuss communication principles, planning tactics, and using social media best practices.
- Learning objectives around explaining the value of communication, demonstrating social media processes, identifying best practices, and preparing to use social media to impact the opioid problem.
- An agenda that covers surveys, introductions, an opioid epidemic overview, health communication basics, social media basics and best practices, and exercises.
Web rx16 prev_tues_330_1_lawal_2warren_3huddleston_4pershingOPUNITE
This document discusses the role of health departments in preventing neonatal abstinence syndrome (NAS). It notes that NAS rates have increased significantly in recent years, disproportionately affecting women. Health departments engage in surveillance to monitor NAS trends, partner with other organizations, support treatment and recovery programs, and provide education to prevent NAS, which is entirely preventable. The document outlines specific strategies health departments use across these areas to address the opioid epidemic and protect maternal and infant health.
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Rx16 federal tues_200_1_gladden_2halpin_3greenOPUNITE
This document provides information about the emerging fentanyl overdose epidemic in the United States from the national and state perspectives. It discusses the rise in fentanyl-related overdoses and seizures from 2013-2014 according to data from various sources. The learning objectives are to explain the epidemiology of the rise in fentanyl overdoses, identify lessons from an Ohio investigation, and describe one state's experience. Recommendations include improving detection of fentanyl through testing and surveillance, expanding naloxone access, and long-term efforts to reduce opioid overdoses through prescribing guidelines and treatment expansion.
Rx16 prev wed_330_workplace issues and strategiesOPUNITE
This document discusses workplace issues related to prescription drug abuse and strategies for prevention. It begins with introductions of the presenters and moderators. The learning objectives are then outlined as understanding challenges of prescription drug abuse in the workplace, identifying prevention strategies, and describing programs available through SAMHSA. The document then covers topics such as the scope of prescription drug misuse among workers, risks to the workplace, prevention strategies employers can consider, and available resources from SAMHSA.
Marathon training injuries and treatment-part1hamid afroozeh
This document provides information on common running injuries, how to prevent them, and how to treat them. It discusses the "big three" running injuries: iliotibial band friction syndrome (runner's knee), medial tibial stress syndrome (shin splints), and Achilles tendinopathy. It outlines risk factors, prevention strategies like training properly and strengthening muscles, and treatment approaches depending on if the injury is acute or chronic. The key is seeking medical advice early, modifying training, and having patience during recovery.
This document summarizes a panel discussion on improving utilization of prescription drug monitoring programs (PDMPs). The panel will discuss current practices for interstate sharing of PDMP data, strategies for integrating PDMP data into healthcare records, and lessons from Washington state's program providing organizations access to PDMP data. The goal is to identify best practices that can be implemented in other states to increase interoperability and utilization of PDMP data.
This document discusses drug court models and the role of law enforcement in drug courts. It begins with introductions from presenters and outlines learning objectives about explaining drug court operations and benefits, how law enforcement can utilize drug courts, and identifying best practices. The following sections provide details on drug court models, including how they integrate treatment into the justice system using a non-adversarial approach. Key components of drug courts are outlined, and presenters discuss issues like prescription drug and heroin abuse as well as outcomes from drug courts in reducing recidivism and saving money. Law enforcement can play roles in prevention, addressing domestic violence, and targeting the right populations for drug court involvement through assessment.
The document discusses factors that can lead to transition from misuse of prescription opioid analgesics to heroin initiation. Through qualitative interviews with 31 individuals in New York City, four key factors were identified: 1) Use of high dose opioid analgesics; 2) Intranasal route of administration; 3) Development of physical opioid dependence; and 4) Dissolution of stigma regarding heroin in social networks. The trajectory toward heroin use was found to be similar regardless of whether opioid analgesic initiation was recreational or medical in nature.
This document summarizes a presentation on drugs to watch including tramadol, hydrocodone, and naloxone. It includes:
- Disclosures from presenters declaring no conflicts of interest.
- Learning objectives focused on analyzing the impact of schedule changes for tramadol and hydrocodone, educating on tramadol dangers, and evaluating pharmacist perspectives on naloxone.
- Information presented on the drugs including their classifications, potencies, risks of abuse and addiction, and impacts of rescheduling hydrocodone and tramadol in California. Data showed decreased hydrocodone prescriptions but increased tramadol and overall opioid prescriptions, as well as increased over
Drug Treatment Courts: How America’s Most Trusted Alternative to Incarceration is Providing Hope in the Midst of the Rx Drug Abuse and Opiate Epidemic - Vision Session Presented by National Association of Drug Court Professionals
The document discusses the opioid crisis in the United States, including rising rates of prescription opioid misuse and abuse, as well as heroin use and overdose deaths. It outlines how research can help address this crisis through developing less abusable analgesics, expanding access to treatment medications like naloxone and buprenorphine, and exploring new treatment approaches such as immunotherapies and precision medicine targeting genetic factors. The National Institute on Drug Abuse is supporting these research efforts and working to disseminate findings to improve prevention and intervention programs.
This document provides a summary of a presentation on the risks of medical marijuana and marijuana legalization. It begins with disclosures from the presenters and outlines six learning objectives. It then discusses concerns that marijuana is addictive, especially for those who start using it early, and impacts adolescent brain development. The document notes the lack of evidence that marijuana is effective for the conditions it is claimed to treat. It also discusses the risks of increased diversion of marijuana to youth and greater social acceptance of marijuana use negatively impacting public health. The document concludes with messages on how to discuss these issues with the public.
Rx16 federal tues_1115_1_fretwell_2gabbert-wilkebrownOPUNITE
This document summarizes a presentation on state and community-level programs for preventing prescription drug misuse and expanding treatment options like medication-assisted treatment. Speakers from Georgia and Iowa discussed their strategies for engaging stakeholders, implementing prevention initiatives in targeted communities, leveraging funding sources, and addressing challenges in data and addressing disparities. Iowa described their efforts to expand access to medication-assisted treatment for opioid use disorders through a new grant, including challenges implementing changes quickly.
This document summarizes a presentation on managing morphine equivalent dose (MED) and identifying high-risk opioid use through "red flagging." It discusses how calculating MED at the point of sale can help identify unsafe dosages and decrease opioid prescriptions. It also evaluates different methods to screen for overdose risk, finding that simple opioid use thresholds to flag patients may not accurately target those most likely to experience preventable overdoses. The presentation aims to explain MED management, describe payer solutions that reduced opioid use, and identify more precise ways to intervene with highest-risk patients.
The document discusses strategies for engaging opioid overdose patients in addiction treatment after receiving naloxone/an overdose reversal. It describes:
1) The Lifespan Opioid Overdose Prevention Program in Rhode Island which aims to reduce overdose deaths by increasing access to naloxone, expanding overdose education in EDs, and increasing referral to treatment. The program provides take-home naloxone, peer recovery coaching, and refers patients to treatment.
2) The Camden County Addiction Awareness Task Force's "Operation SAL" program which aims to engage overdose patients in treatment after being revived by first responders. It connects patients to resources like food/clothing banks and
This document summarizes a presentation on best practices for treating opioid addiction in the criminal justice population. It outlines the challenges of treatment in this population and identifies best practices for using medication-assisted treatment (MAT) and behavioral therapy. The presentation reviews key points from the ASAM National Practice Guideline, including that MAT is the standard of care for opioid use disorder and should be continued, initiated, or made available for inmates. Discontinuing treatment can be dangerous and contradicts evidence-based practices. The implications discussed are that the guideline supports higher quality care for inmates and a rehabilitative approach, while also helping to address the opioid epidemic.
This document summarizes a presentation on medication-assisted treatment for opioid addiction. It discusses the history of treatment approaches, including the development of methadone and buprenorphine maintenance therapies. Studies show that agonist therapies like methadone and buprenorphine are more effective at retaining patients in treatment and reducing illicit opioid use than non-medication approaches. While both methadone and buprenorphine are effective, buprenorphine has a safer side effect profile but its effectiveness may be limited by lower monitoring and adherence compared to methadone treatment. The document reviews several studies demonstrating the benefits of long-term agonist therapy over detoxification or short-term medication approaches for opioid
This document summarizes a CDC training on using digital and social media to address the opioid epidemic. It includes:
- Presenters from the CDC's National Center for Injury Prevention and Control who will discuss communication principles, planning tactics, and using social media best practices.
- Learning objectives around explaining the value of communication, demonstrating social media processes, identifying best practices, and preparing to use social media to impact the opioid problem.
- An agenda that covers surveys, introductions, an opioid epidemic overview, health communication basics, social media basics and best practices, and exercises.
Web rx16 prev_tues_330_1_lawal_2warren_3huddleston_4pershingOPUNITE
This document discusses the role of health departments in preventing neonatal abstinence syndrome (NAS). It notes that NAS rates have increased significantly in recent years, disproportionately affecting women. Health departments engage in surveillance to monitor NAS trends, partner with other organizations, support treatment and recovery programs, and provide education to prevent NAS, which is entirely preventable. The document outlines specific strategies health departments use across these areas to address the opioid epidemic and protect maternal and infant health.
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Rx16 federal tues_200_1_gladden_2halpin_3greenOPUNITE
This document provides information about the emerging fentanyl overdose epidemic in the United States from the national and state perspectives. It discusses the rise in fentanyl-related overdoses and seizures from 2013-2014 according to data from various sources. The learning objectives are to explain the epidemiology of the rise in fentanyl overdoses, identify lessons from an Ohio investigation, and describe one state's experience. Recommendations include improving detection of fentanyl through testing and surveillance, expanding naloxone access, and long-term efforts to reduce opioid overdoses through prescribing guidelines and treatment expansion.
Rx16 prev wed_330_workplace issues and strategiesOPUNITE
This document discusses workplace issues related to prescription drug abuse and strategies for prevention. It begins with introductions of the presenters and moderators. The learning objectives are then outlined as understanding challenges of prescription drug abuse in the workplace, identifying prevention strategies, and describing programs available through SAMHSA. The document then covers topics such as the scope of prescription drug misuse among workers, risks to the workplace, prevention strategies employers can consider, and available resources from SAMHSA.
Marathon training injuries and treatment-part1hamid afroozeh
This document provides information on common running injuries, how to prevent them, and how to treat them. It discusses the "big three" running injuries: iliotibial band friction syndrome (runner's knee), medial tibial stress syndrome (shin splints), and Achilles tendinopathy. It outlines risk factors, prevention strategies like training properly and strengthening muscles, and treatment approaches depending on if the injury is acute or chronic. The key is seeking medical advice early, modifying training, and having patience during recovery.
This document summarizes a panel discussion on improving utilization of prescription drug monitoring programs (PDMPs). The panel will discuss current practices for interstate sharing of PDMP data, strategies for integrating PDMP data into healthcare records, and lessons from Washington state's program providing organizations access to PDMP data. The goal is to identify best practices that can be implemented in other states to increase interoperability and utilization of PDMP data.
There are many misconceptions about harm reduction. In this presentation, we will debunk the myths, explain what harm reduction is and provide examples of harm reduction in action throughout our province and nation. This presentation also includes how individuals can become volunteers with our agency.
The Buford Family church grew its membership by 20% in 2015, adding 30 new members to reach a total membership of 181. The church's average attendance was also higher than in previous years, exceeding 100% of its total membership. Additionally, the church saw increases in website views, online sermon views, live stream viewers, and tithes and offerings compared to previous years.
The Empower Veterans Program provides intensive, integrated self-care coaching through group and individual sessions for veterans suffering from chronic pain. Over 10 weeks, veterans receive training in whole health and well-being, acceptance and commitment therapy, and mindful movement. Preliminary results show improvements in pain, functioning, mental health, and quality of life for veterans, as well as decreased healthcare utilization and costs. The program aims to safely empower veterans with chronic pain through a multidisciplinary approach that promotes self-management over passive treatments.
Kana Enomoto, Acting Administrator, Substance Abuse and Mental Health Services Administration, keynote presentation at the National Rx Drug Abuse & Heroin Summit March 29, 2016
Web only rx16 len wed_1230_1_daugherty_2baier-haasOPUNITE
This document summarizes a presentation on investigating and prosecuting drug-related homicides. It discusses signs that can indicate an overdose death, such as the presence of drugs, track marks, and foam coming from the mouth. It emphasizes treating the death scene like a homicide scene by thoroughly photographing and collecting all potential evidence. This includes searching for drug packaging, needles, phones and surveillance footage. The document also outlines interviewing witnesses to build a timeline and identify the victim's source of drugs. It suggests attempting a controlled buy from suspects to obtain contemporaneous drug samples and strengthen cases.
This document summarizes a presentation on alternatives to opioids in pain management. It includes:
1) Disclosures from the three presenters stating they have no financial conflicts of interest.
2) Learning objectives which are to identify opioid alternatives, advocate avoiding opioids for acute pain, and teach counseling strategies to decrease pain and addiction.
3) A presentation by Dr. Don Teater on alternatives to opioids for pain management, the opioid epidemic, and the limited evidence for opioids' effectiveness in chronic pain. He advocates prescribing opioids less and using policy to reduce prescribing.
This document discusses the financial impact of opioid abuse on employers. It identifies the primary causes of increased healthcare costs related to opioid abuse as well as simple steps employers can take to reduce risks and costs. The document explains that prescription drug abuse can impact employers even if they are not currently dealing with issues in their workplace. It provides context on the costs of chronic pain and revenue from opioids. The document examines how cultural factors led to increased opioid prescribing and abuse. It discusses challenges in predicting outcomes for different patients prescribed opioids. Finally, it outlines guiding principles for employers to address opioid abuse, including education, enforcement, oversight, and statutory action if needed.
Presentation of our curricular integration, Interprofessional approaches and Student Leader Training strategies in the second year of our 3 year SBIRT Training Grant.
Challenges in Managing Cancer Pain: The Role of the Oncology Pharmacistflasco_org
The correct answer is E. All of the strategies listed can be used by oncology or supportive care pharmacists to better manage pain in patients in the hospital setting.
A presentation by Brian D Sites at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
This document summarizes a presentation given by Dr. Michael M. Miller on the prescription drug epidemic in the United States. It discusses how increased recognition of pain and addiction as medical conditions has led to more opioid prescriptions being written, resulting in higher rates of addiction, overdoses and deaths. While aiming to improve care, policies promoting greater opioid prescribing have had unintended consequences. The shortage of specialists means general physicians often lack training to safely evaluate and treat pain or addiction. Rising opioid prescription drug abuse now poses a major public health crisis in the U.S.
This clinical track presentation summarized the diagnosis of addiction and impact of pain. It covered the importance of precise diagnoses for both pain and substance use disorders to develop effective treatment plans. The presenters were Steven Moskowitz, MD and Robert Hall, MD, moderated by Christopher Jones, PharmD. It reviewed challenges around opioid use for chronic pain including physical dependence, addiction risk, and medical side effects impacting multiple body systems. Treatment strategies discussed included risk assessment, monitoring, non-opioid options, and considering both abstinence and medication-assisted treatment approaches.
This document summarizes a presentation about an interdisciplinary outpatient pain management program. The program was developed in response to high rates of chronic pain in post-acute populations and new regulations surrounding opioid prescriptions. The program utilizes 10 collaborating disciplines including physicians, psychologists, physical therapists, nurses, and social workers. Key aspects of the program include comprehensive assessments, a pain contract, urine drug screening, and emphasis on non-pharmacological treatments. Initial results after one year include improved capacity for adjunct treatments, integration of new specialists, and fewer demanding patients due to clear guidelines.
Pain Management in the Context of an Opioid Epidemic: Considerations and Tool...VITAS Healthcare
This presentation details how to conduct a comprehensive pain assessment, considerations when prescribing analgesics, and when opioids may be appropriate.
This document discusses strategies to curb prescription drug abuse, specifically opioid abuse, in West Virginia. It notes that West Virginia has the highest drug overdose mortality rate in the US and clinicians there write a high number of opioid prescriptions. It explores reasons for high prescribing rates and discusses solutions like improving education for patients and doctors, changing financial incentives, using prescription drug monitoring programs, and following CDC guidelines for safer opioid prescribing. Alternative therapies for pain management and the role of EDIE in monitoring patients and interfacing with PDMPs are also covered. The document advocates for internal referrals to pain specialists and multidisciplinary approaches to pain care.
This document discusses effective pain management and the challenges of treating chronic pain with opioids. It provides an overview of pain management principles, the risks of addiction, and approaches to assessing patients and monitoring opioid treatment. While opioids can help treat pain in some cases, providers must consider the risks and benefits for each patient due to the potential for abuse, addiction and undertreatment of pain.
This document discusses the challenges of treating chronic pain and opioid dependency. It notes that prior to 2011, addiction rates associated with prescription opioids were believed to be much lower than later studies found them to be. It also discusses the overprescription of pain medications and the high rates of illegal drug use and worse health outcomes among chronic pain patients prescribed opioids. The document advocates for more specialized treatment of chronic pain and opioid dependency as diseases, and notes the medical profession's unwitting role in exacerbating the problems.
The natural medicine physician plays an important role within a new healthcare paradigm focused on wellness rather than just disease treatment. Conventional medicine has had successes but also problems like high costs, side effects, and not addressing the root causes of disease. Patients increasingly seek natural medicine due to these issues with conventional care. A wellness-oriented approach to primary care that emphasizes prevention, lifestyle, and addressing underlying causes can help reduce the disease burden and rising healthcare costs crisis. Research supports that addressing modifiable risk factors through lifestyle and behavioral changes can significantly reduce mortality and morbidity from chronic diseases. Overcoming political and reimbursement barriers can help create a system that better facilitates this wellness-focused approach.
The document discusses knowledge and attitudes about pain management. It outlines what people need to know about pain, including pain as a human right, differences between acute and chronic pain, and effects of unrelieved pain. It examines knowledge of healthcare providers and patients. It suggests addressing gaps through surveys of provider attitudes and knowledge, as well as improving education about chronic pain conditions, undertreatment of pain, and the impact of pain on quality of life. Phenomenological studies highlight how chronic pain affects patients' sense of self, relationships, and coping strategies.
This document discusses a thesis examining the effects of mental health status and comorbidity on the perceived likelihood of hiring a healthcare advocate. It describes a study that presented participants with vignettes varying the mental health condition (dementia or depression) and presence of comorbid conditions. The results of an ANCOVA showed participants perceived a greater need for healthcare advocate services for dementia than depression. However, there was no effect for comorbidity. The study provides insights into perceptions of burden from various health conditions but more research is needed.
Pain points - Overcoming the Opioid CrisisCompleteRx
Today, 11 percent of Americans experience daily chronic pain, for which opioids are frequently prescribed. Unfortunately, what started as standard prescribing practice has become detrimental, and due to their highly addictive nature, we’ve seen a quadrupling number of opioid overdose deaths from 1999 to 2015, killing more than 90 people per day. While state and national legislatures continue to search for ways to combat this epidemic, significant change can be made at the community level starting with medical staff, hospitals and health systems. This webinar will provide a comprehensive overview of the pain crisis and how it affects various patient populations, outline CDC guidelines on opioid use for chronic pain and identify strategies to positively impact the use of opioids and outcomes.
Sources: NCCIH, NPR
Key Takeaways:
- Recognize the relationship between opioid use on clinical and economic outcomes in various patient populations and the community
- Outline recommendations suggested by CDC guidelines on opioid use in chronic pain and new pain standards just released by TJC
- Identify strategies to impact multiple drivers of the opioid crisis
PEG (Pain, Enjoyment, General activity) scale (0-10)
1. What number best describes your Pain on average in the past week? 5 → 5 (no change)
2. What number best describes how much you are Enjoying life?
3 → 7 (worsening)
3. What number best describes your General activity level?
4 → 9 (worsening)
Safe & Effective Management of Chronic Pain chshanah
I do not have access to the video cases you referenced. Could you please provide a brief summary of the key details in each case so I can try to understand and respond to your questions? Without more context it's difficult for me to analyze how the provider handled the situation or determine the diagnosis.
Similar to Rx16 clinical wed_200_1_hall_2green (20)
This document summarizes the opioid crisis in the United States from 2000 to 2014. It shows that the number of opioid-related overdose deaths more than tripled during this period, increasing from about 8,000 to over 28,000. Additionally, 7.9 million Americans aged 12 or older met the criteria for an illicit drug use disorder in 2013-2014 but only 20% received treatment. The document outlines actions by the Obama administration to address the crisis and increase funding for treatment. It emphasizes that stories can help reduce stigma and that recovery is possible through working together.
Web rx16 prev_tues_200_1_bretthaude-mueller_2scott_3debenedittis_4cairnes copyOPUNITE
This presentation covered multi-media prevention strategies for issues like prescription drug overdoses. It discussed the CDC's digital Rx drug prevention campaign, best practices for digital messaging, and programs using expectancy challenge theory and media literacy education in schools. Presenters included representatives from the CDC, Media Literacy for Prevention, and the Hanley Center Foundation who discussed their work developing and implementing digital communications and single-session prevention programs.
This document summarizes a presentation on linking and mapping prescription drug monitoring program (PDMP) data. It discusses the benefits of linking PDMP data to clinical data, including improving patient safety, evaluating prescribing decisions, and assessing the impact of PDMP interventions. It describes challenges with linking data, such as obtaining consent and negotiating data use agreements. It also discusses Washington State's MAPPING OPIOID AND OTHER DRUG ISSUES (MOODI) tool, which integrates PDMP data with other databases to map and target treatment and overdose prevention efforts at the community level.
Web only rx16 pharma-wed_330_1_shelley_2atwood-harlessOPUNITE
This document discusses a presentation on pharmacy burglary, robbery, and diversion of prescription drugs. The presentation covers trends in prescription drug diversion, particularly those involving robbery and burglary of pharmacies. It identifies preventative measures to enhance pharmacy security and safety. Strategies to reduce pharmacy crimes are outlined. The offender perspective is examined based on interviews with convicted offenders. Routine activities theory is discussed as relating to suitable targets, capable guardians, and motivated offenders. Partnerships between regulatory agencies and law enforcement are emphasized as key to prevention efforts.
Linking and mapping PDMP data can provide several benefits but also faces challenges. Linking PDMP and clinical data allows for evaluating the impact of PDMP interventions on outcomes and prescribing decisions. However, obtaining permissions and data is difficult due to legal and resource barriers. Mapping PDMP data using GIS tools in Washington identified areas for targeting overdose prevention efforts by visualizing patterns in prescribing risks, treatment availability, and overdoses. Stakeholders used these maps to guide education and funding decisions. Sustaining these tools requires ongoing funding and expanding included data sources.
This document summarizes presentations from two communities - Huntington, WV and Camden County, NJ - on their responses to heroin crises. It outlines programs implemented in Huntington, including a harm reduction program, centralized information system, and drug court expansion. It also discusses the region's history with prescription drug abuse and rise in heroin and associated issues like hepatitis and neonatal abstinence syndrome. Long-term strategies proposed include expanding treatment services, promoting career opportunities for those in recovery, and preventing relapse through environmental design changes.
This document discusses neonatal abstinence syndrome (NAS) and universal maternal drug testing. It provides background information on NAS including trends showing large increases in incidence and costs associated with NAS. It outlines objectives related to describing NAS trends, identifying legislative activities impacting NAS, describing family planning for women in substance abuse treatment, and explaining a hospital program using universal drug testing. The document then covers topics including NAS symptoms, incidence and geographic trends, costs of NAS, opioid use in women of childbearing age, unintended pregnancy rates, contraceptive use among opioid users, and maternal drug exposure sources.
Web only rx16-adv_tues_330_1_elliott_2brunson_3willis_4deanOPUNITE
This document outlines an advocacy track presentation on activating communities to address prescription drug abuse. It provides biographies of the presenters and moderators and discloses any conflicts of interest. The learning objectives are to identify best practices for implementing CADCA's seven strategies for community change to impact prescription drug issues. It then provides examples of how various coalitions across the country are utilizing each of the seven strategies, such as providing education, enhancing skills, supporting communities, and changing policies.
This document discusses recovery ready ecosystems and recovery community organizations. It introduces presenters from Young People in Recovery and Hope House Treatment Track who will discuss interventions, prevention, and recovery programs. Examples of Young People in Recovery chapters, programs, and services are provided, including employment workshops, education workshops, housing workshops, and recovery support services. The document also discusses recovery community organizations and initiatives in Texas and Georgia, such as the Association of Persons Affected by Addiction in Dallas and the Georgia Council on Substance Abuse.
This document summarizes a presentation on youth performance-enhancing drugs and ADHD medication. It discusses trends in misuse of these substances among young people. The presentation is given by representatives from various organizations focused on prevention, health promotion, and substance abuse issues among youth and college students. The presentation covers types of performance-enhancing drugs and their potential side effects. It also discusses trends in attitudes towards these substances and risks of misuse. Strategies are presented for helping adolescents pursue their goals without these drugs. The document concludes by outlining plans for addressing misuse of ADHD medication among college students through education and collaboration between various stakeholder groups.
Web only rx16 pharma wed_200_1_hagemeier_2fleming_3vernachioOPUNITE
Community pharmacists are well positioned to help address the growing problem of opioid and benzodiazepine addiction but face challenges. Early identification of at-risk patients, supportive benefit structures, and intervention training could empower pharmacists. While many recognize their responsibility, behavioral engagement in prevention is often lacking due to practice barriers, lack of patient information, and fear of responses. Standardizing communication expectations and screening tools could help pharmacists better fulfill their role on the treatment team.
1. Two states, South Carolina and Wisconsin, improved integration of PDMP data into electronic health systems by establishing connections between their PDMPs and various health IT platforms like EMR systems and pharmacy dispensing software.
2. States face challenges with PDMP integration like legal definitions of access, costs of integration projects, and establishing necessary agreements and user authorizations.
3. Florida operates drug surveillance systems through a medical examiners commission and PDMP. Analysis found declines in prescription opioid overdoses after implementation of legislative and regulatory interventions including a PDMP in 2011. However, heroin overdose deaths increased as some shifted to heroin.
Web only rx16 len wed_200_1_augustine_2napier_3darr - copyOPUNITE
This document summarizes a presentation about the Handle with Care program, which aims to help children who have been exposed to trauma. The presentation discusses how drug abuse and violence impact children, showing statistics on drug seizures and crimes in certain areas. It then describes the Handle with Care program, where law enforcement notifies schools of children who were exposed to a traumatic event so the school can provide trauma-informed support. School interventions discussed include therapy dogs, academic accommodations, and on-site therapy. The presenters emphasize that Handle with Care aims to help children succeed in school by providing trauma-sensitive support.
The document summarizes a Heroin Response Strategy presented by experts from various High Intensity Drug Trafficking Areas. The strategy involves 3 components: 1) Establishing a regional public health and public safety information sharing network through "Points of Light" teams in each state. 2) Implementing community education and prevention programs. 3) Creating a platform for regional public health and public safety partnerships through annual symposiums. The goal is to reduce drug overdoses through enhanced collaboration between law enforcement and health agencies.
This document provides information about an advocacy track presentation on advocating for change related to addiction issues. The presentation features Gary Mendell, founder and CEO of Shatterproof, and Kim Manlove from the Indiana Addictions Issues Coalition. They will discuss strategies for influencing legislation and how people in recovery can become advocates. The learning objectives focus on advocating for state laws on PDMP usage, explaining strategies to influence legislation, describing how people in recovery can advocate, and providing counsel as part of a treatment team. The presentation then provides details on Shatterproof's story, the overdose epidemic, solutions for different populations, and legislative accomplishments in various states related to expanding access to naloxone and mandating PDMP usage.
Rx16 federal wed_1230_1_kelly_2bohn-killorinOPUNITE
1) The National HIDTA Program provides assistance to law enforcement agencies in critical drug trafficking regions through 28 regional HIDTA programs. It facilitates cooperation among federal, state, local, and tribal law enforcement.
2) Each HIDTA program has an executive board that identifies threats, develops strategies, and requests funding for initiatives. It brings together over 7,400 federal agents, 15,700 state and local officers, and 500 agencies across the country.
3) In response to the opioid epidemic, HIDTA employs law enforcement targeting of heroin and fentanyl trafficking, public health prevention efforts, and training on investigating heroin organizations. It has committed additional funds to enhance intelligence sharing and public health partnerships.
1. Co-prescribing opioids and benzodiazepines poses serious health risks like respiratory depression and increased risk of overdose death. Delaware has high rates of prescriptions for these drugs.
2. Delaware's PDMP collects prescription data that can help identify patients and providers with troubling patterns of co-prescribing to reduce risks. Regular screening and urine tests can also help address misuse.
3. PDMP data analysis found that in 2013 over 12% of individuals in Delaware filled prescriptions for both drug classes, putting them at risk. The PDMP is a valuable tool to improve prescribing practices and detect misuse.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
Rx16 clinical wed_200_1_hall_2green
1. Chronic Pain and
Alternative Therapies
Presenters:
• Robert Hall, MD, Corporate Medical Director, Helios
• Traci Green, PhD, MSC, Deputy Director, Boston Medical
Center Injury Prevention Center, and Associate Professor of
Emergency Medicine, Boston University
Clinical Track
Moderator: Robert L. DuPont, MD, Founding President, Institute
for Behavior and Health, Inc., and Member, Rx and Heroin Summit
National Advisory Board
2. Disclosures
• Traci Green, PhD, MSC, and Robert Hall, MD, have
disclosed no relevant, real, or apparent personal or
professional financial relationships with proprietary
entities that produce healthcare goods and services.
• Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center
3. Disclosures
• All planners/managers hereby state that they or their
spouse/life partner do not have any financial
relationships or relationships to products or devices
with any commercial interest related to the content of
this activity of any amount during the past 12 months.
• The following planners/managers have the following to
disclose:
– John J. Dreyzehner, MD, MPH, FACOEM – Ownership
interest: Starfish Health (spouse)
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center
4. Learning Objectives
1. Explain the impacts of chronic pain and opioid
analgesics on body systems.
2. Identify strategies to mitigate the adverse effects of
chronic pain and opioid analgesics.
3. Describe findings of a chronic pain management pilot
program for high emergency-department utilizers.
4. Outlines barriers and facilitators to participation in
complementary and alternative therapies for chronic
pain.
5. Provide accurate and appropriate counsel as part of
the treatment team.
5. The Impact of Opioid Analgesics on
the Body Systems
Robert Hall, MD
Corporate Medical Director
National Rx Drug Abuse & Heroin Summit
Wednesday, March 30, 2016 │2:00 – 3:15 PM
6. Learning Objectives
• Review the impact of opioid analgesics and chronic pain on the
different body systems.
• Identify strategies to mitigate the adverse effects of opioid analgesics
and chronic pain.
8. Tom’s Story
49-year-old man injured his
back when he tripped while
unloading his truck. He lost his
balance, fell, and twisted his
lower back, causing immediate
right-sided, low-back pain.
Initially, the pain only affected the
lower spine and his symptoms were
effectively treated with non-steroidal
anti-inflammatories (NSAIDs).
9. Tom’s Story
A few weeks later, his low-back pain started
traveling down the back of his right upper thigh,
through his calf muscles, and onto the bottom of
his right foot. He developed right leg weakness
that, in combination with the pain, decreased his
balance and made walking difficult.
Treatment Course
• Physical therapy and epidural steroid injections
• Short and long-acting opioid analgesics,
muscle relaxant, benzodiazepine and a non-
steroidal anti-inflammatory drug (NSAID)
• Two lumbar spine fusions
• Spinal cord stimulator (later removed)
10. Tom’s Story
Tom experienced side effects from the opioids
that would eventually impact nearly every major
body system.
24. Managing Chronic Pain
1. Comorbid conditions
2. Plan of care
3. Medication patterns
4. Multiple prescribers and pharmacies
5. Medication monitoring
6. Nonpharmacologic treatment
7. Return to work
26. Traci C. Green, PhD, MSc
Deputy Director, Boston Medical Center Injury Prevention Center
Boston Medical School, Department of Emergency Medicine, Boston, MA
Associate Professor of Emergency Medicine & Epidemiology
The Warren Alpert School of Medicine at Brown University, Rhode Island Hospital
Complementary and Alternative
Therapies for a Medicaid Population
with Chronic Pain
27. Disclosures-Traci C. Green
• Traci C. Green PhD, MSc, wishes to disclose prior (past 5 year)
employment at Inflexxion, Inc., a small business that creates
behavioral health interventions using technology. She will
present this content in a fair and balanced manner.
• Funding: Research reported in this presentation was funded
through a Patient-Centered Outcomes Research Institute
(PCORI) Award #IHS-1306-02960
• The views in this work are solely the responsibility of the
authors and do not necessarily represent the views of the
Patient-Centered Outcomes Research Institute (PCORI), its
Board of Governors or Methodology Committee
28. Learning Objectives
• Describe findings of a chronic pain management
pilot program for high emergency-department
utilizers
• Outline barriers and facilitators to participation in
complementary and alternative therapies for
chronic pain
29. • Pain that lasts longer than 3 months
• Often linked to initial episode of acute pain that
becomes chronic
• Pain severity varies over time, may or may not have a
known relationship to a discernible, active
pathophysiologic or pathoanatomic process
• Profound impacts to quality of life
• Imposes greater economic impact than any other
disease: $635 billion per year
• RI spent $1.7 billion on Medicaid services serving
174,718 Rhode Islanders in FY2009, 24.2% of the total
state budget
Burden of Chronic Pain
30. • Opioid analgesics primary treatment modality, but associated
with addiction, diversion, overdose, death
• High rates of substance use among chronic pain patient samples
(20-50% in literature), non-adherence
• People with histories of mental health, substance use disorders
may be at higher risk of developing chronic pain conditions
• Strong need to extend behavioral health care, consider
alternative pain care strategies to better address chronic pain
• New draft CDC guidelines for chronic pain emphasize non-opioid
based therapies and non-pharmacological therapies
• Non-opioid and non-pharmacological therapies are often outside
of patients’ reach, are not incentivized, not well integrated into
care
Chronic Pain Treatment
31. • Many seek care for chronic pain at the ED, especially
those out of care, uninsured
– up to 42% of ED visits related to painful conditions (Pletcher,
Kertesz, Kohn, & Gonzales, 2008)
• EDs are significant source of dispensing and diversion
of prescription opioids
– Up to 20% of ED visits may involve patients seeking
medications for nontherapeutic purposes (Grover, Elder, Close, & Curry,
2012)
• Rhode Island multi-agency work group on ED
overutilization identified chronic pain as a key
condition driving overuse & RI Medicaid costs
ED use, overuse, & chronic pain
32. Communities of
Care (CoC)
Peer
Navigator
Health Plan
Case Management
Behavioral Health
Case Management
Integrated Pain Management Program/
Chronic Pain Initiative (CPI)
AMI Holistic Case
Management
Complementary & Alternative Medicine
(CAM) services:
Chiropractor, Acupuncture, Massage Therapy
Rhode Island Medicaid, 2010 to date
2012 to date
Incentives for attendance, surveys; pharmacy
lock-in program for heaviest ED users
33. • Non-opioid alternative
• Profound influences on patient quality of life (Hsu et al., 2010)
• Safe, widespread use
• Potentially effective across different pain conditions
– Systematic reviews indicate evidence base for CAM for
cancer pain, fibromyalgia, neck/back pain, chronic knee pain,
pediatric pain
• Evidence supports use of CAM for addiction
– Acupuncture indicated to treat addiction and pain by the
1998 NIH Consensus Development Panel on Acupuncture
Why CAM for chronic pain?
34. • Unprecedented CAM exposure for low SES, Medicaid
population
• 1500+ patients enrolled
• Unprecedented exposure to Medicaid population for
CAM providers
• How?
– Medicaid waiver granted for CAM
– Alternative Medicine Integration (AMI) performs billing,
certifies providers, carries out holistic case management
– Providers competitively compensated by Medicaid,
compensated for no-shows visits
Why CAM in CoC?
35. • Patient engagement in CPI lower than anticipated
(55% vs. 70% per month in prior FL pilot)
– Populations very different?
– Prevalence of behavioral health problems-~50% in RI?
– Resources inadequate in the community?
– Implementation differences?
– Preference for opioid therapies?
– Something else?
But…..
36. What are the current barriers and initiators to
involvement in the Chronic Pain Initiative (CPI)?
How could interventions -- such as a text-message
patient support tool or patient navigators -- help increase
patient participation in the CPI, support healthy coping
techniques during chronic pain care, and encourage self-
confidence and chronic pain self-management skill
development?
Do these interventions work, and for whom? Do they
improve patient care experience, healthcare systems?
Do they change how people experience chronic pain care
in RI?
S study:
Research Questions
37. Year 1:
March 2014 – Feb 2015
Interviews and Summary of Findings
Development of Text Message
Intervention
Year 2:
March 2015 – Aug 2016
Finalize Intervention
Open pilot testing
Participant Recruitment, Data
Collection
Year 3:
Sept 2016 – Feb 2017
Complete Data Collection &
Analyze
Final Study Results
Study Timeline
Partnered Development
& Planning Phase
Randomized
Control Trial
Community
Dissemination
39. • Barriers & facilitators to CPI participation, patient navigation,
text message prospects
• In-depth Qualitative interviews
– 24 patients (engaged, not engaged, new)
• Recruitment by AMI case management, ED
– 24 providers & administrators
• 45-60 min interviews, structured interview guide
– Audio-recorded, transcribed
– Analysis in NVivo
• Coding schema informed by theory, derived from interview
content
• Emergent themes & subthemes identified to inform the
intervention
Formative Interviews
40. In-depth
Interviews
(n=24)
%
Age (n=22)
21-34 5 23%
35-44 6 27%
45-54 8 36%
55-64 3 14%
Gender (n=24)
Female 14 58%
Male 10 42%
Race (n=23)
Black 2 9%
White 17 74%
Other* 4 17%
Hispanic (n=24)
Yes 4 17%
No 20 83%
Patients Interviewed
41. Provider Organization(s) No.
Nurse Case Management AMI,
Neighborhood
Health Plan RI
3
Behavioral Health Case
Management
Beacon Health
Strategies
1
Peer Navigator RIPIN 2
Alternative Medical
Provider: Acupuncture,
Massage, Chiropractic
Various
Alternative
Medical Providers
Contracted by
AMI
3
Mental Health Provider The Providence
Center
1
Emergency Dept Physician Hospitals 2
Other: Living Well
(Chronic pain self
management course)
Instructor
RI Department of
Health
1
TOTAL 13
Administrator/Provider Interviews
Administrator Organization(s) No.
Medicaid Executive Office
of Health and
Human services
(EOHHS)
4
Health Plans United
Healthcare,
Neighborhood
Health Plan
4
Mental Health Clinic The Providence
Center
1
Federally Qualified Health
Center
Thundermist 1
Alternative Medical
Treatment Management
AMI 1
TOTAL 11
42. Experience in the program: Patients
The Chronic Pain program helps illuminate the relationship
between stress and pain
Then massage, if it’s a muscle pain, I mean, massage is definitely
gonna help. Worst comes to worst, it will relieve stress, which—
stress causes muscle tenseness and pain…
Another patient reflects their knowledge of the stress-pain cycle:
Now [since receiving CAM services], when I get upset, or overly
anxious, or something like that, I learned to try to focus on what
my body—remember what my body feels like, and that my body's
okay, and not live so much in my mind.
43. Experience in the program: Patients
The Program provides an opportunity to build a trusting
relationship with a provider
She just inspires me to just—not even just with the massage, but just to do
what I wanna do in life. I was really abused, so that’s where a lot of my pain
comes from. She encourages me to write my books. I wanna write a book,
and she encourages me to do that and encourages me to lose weight and
just—she’s more than just giving me a massage.
Another patient describes learned techniques and coping skills :
…she taught me how to do different moves as if I was in pain...That was a
good part with the massage therapy. When I’m in pain, I put my mind
somewhere else so I don’t take the anger out on my kids.
44. Reducing patient medication exposure
Patients expressed interest in trying new modalities to
treat their pain without medication:
She just massages areas that just—ya know get right in there—that
you can’t just—you can take a pill and it’s good. It’s not gonna last.
It’s just gonna come back. She’s actually working on the problem.
Medication I know was basically for the brain. It’s not gonna help
the area. Once that wears off you’re back in pain again, but at least
a massage, she gets to the area unless—sometimes it lasts for
longer and I can take less of what I need to do.
45. Addresses lack of trust in medical system, limited therapeutic alliance,
few long-term relationships
People are getting more time, specifically with AMI Providers, that they may not
receive with traditional health care providers:
When they get to go to these modalities, these alternative modalities, they’re given
minimal half hour, more than likely an hour, with their provider. It is a hands-on and a
listening process. They get the touch. They get the person-to-person connection. A
lot of ‘em haven’t gotten that before.
For people who are homebound or have difficulty leaving the home they are able to
have providers come to them:
What I've particularly heard good things about, too, is when they're able to be flexible
and come to the patient and provide services in the member's home, as opposed to
them having to get out. For these people, transportation is almost always a barrier. If
you have somebody who has real, horrible chronic pain issues, sometimes that comes
with depression, either before or as a consequence. Just getting mobilized to get out
of the house may not happen. Even though they want the treatment, they may not be
able to access it unless the services come to them.
Positive Impact of CAM: Provider/ Admins
46. People are using CAM services for pain management because they have tried
but failed with other options:
Because they have utilized every other resource possible to make themselves
feel better, and it’s not working. We’ve got a lot of fibromyalgias, a lot of
diabetes, and a lot of lower back pain patients. Just from whatever has
happened to them. I’ve got some people that have—I think it’s Crohn’s, where
they have to have the remicade infusion. It’s painful, and they hurt. That’s why
they do it, is because nothing else is working.
Many CAM providers were able to meet these special patients “where they
are at” to provide their services
Thus we’ve got an array of people that—some of ‘em can’t leave their home, so
that’s great that AMI will find a provider to come into their home and help
them.
Why it’s working: Provider/ Administrator
47. Experience in the program: Providers
The Program provides a way to reach the disenfranchised
By contrast, an emergency department employee described her own experience
of having little to offer patients, now that there is a 3-day supply of opioid
medications, confirming that the Pain Management program is unique in its focus
on providing services to this particular population:
…Right now, because I don’t have much to offer them, I’m not sure what
they could say to me that could really be helpful. ‘Cause if they come in, say
“I have chronic pain, I’m out of my medications.” Or, “I have chronic pain,
and my doctor just cut me off.” They’re setting me up for just to say , “I
can’t give you narcotics”, and I don’t have any other resources to give
you…it’s horrendous.
48. Experience in the program: Patients
The Program contributes to increased quality of life
Slowly, over time, I noticed—well, not slowly. It was almost immediately.
Probably within the third or fourth visit I began noticing when I would
drive my car that I wasn't having to hold my head up….I was having less
headaches, and that's obviously—now I know where the tension
headaches were coming from. I'm not a huge fan of medication, so it's
helped me in that I'm—it can keep me off of medication, Tylenol. Even
things like that that "are considered safe." I don’t like to take those
either…It's kept me able to refrain from having to take those things. It
keeps the pain down, although like right now when it starts to come back
it's like I can't wait to go and get that relief... “Because I was always like
this. Very, very, very uncomfortable. Because I get massage on Friday,
they're [family] home on the weekends, so now it's a lot easier to do
things like go to the movies, or go to dinner, and stuff like that, and not
be in pain all the time
49. Experience in the program: Patients
Acupuncture is a cause of anxiety and discomfort
I’m hard of hearing, and my sight is not all that great. My
sense of touch is very sensitive. Acupuncture gave me a lot of
anxiety just getting the needles in. There were a couple of
things that the acupuncture helped with, but you had to keep
going back and keep having it done, and I just couldn’t do that
with the needles.
50. Even with the additional services, addressing complex health
care needs are a challenge:
We had some intense patients in Florida, but up in Rhode Island, the percentage of
patients with intense behavioral health needs was far greater. We’ve actually had
extra training on behavioral health needs because we were being hit with stuff that
we had not been exposed to, to such a degree.
Staff, Providers insufficiently prepared to deal with complex
needs ; training indicated:
I think if anything, that if the COC had to be overlooked again, and someone were
gonna begin it somewhere else, provide adequate, proper training to the employees
that are going to be going into this- home visit training. Safety training. Mental
health training. Behavior training. Even clinical training helps too.
System Adjustments for CAM:
Provider/ Administrator
51. Appropriate CAM candidates: Admins
Unanswered questions remain over whether the program
adequately serves patients with the greatest needs
It works especially well for people who have been socially
disenfranchised, patients who haven’t been treated well by
the system. They are used to less than respectful care. They
respond well to the caring and concern extended…at the
holistic care provider level….You cannot discount the spiritual
enlightenment that comes from a different approach, one
that’s not cut-and-dry, and quick (as they’ve become
accustomed to receiving)….We have to do something with
THESE patients! We can’t keep doing the same thing because
it is not working!
52. Barriers Facilitators
Pain Improved communication on
cancelations/rescheduling (including
texting)
Transportation Mobile CAM options, clear instructions for
transportation assistance
Childcare/dependent care CAM provider flexibility
Motivation Daily interaction*
Uncertainty of CAM
Skepticism, extended distrust of medical
system, lack of information on CAM, Fear
CAM-knowledgeable case managers
Memory challenges, recall, lack of reminder
system
Simple reminders for appointments,
transportation assistance
Low self-efficacy, health/literacy Holistic, patient-centered case
management; patient education to nurture
health literacy; CAM providers
“reintroduces” patient to their body
Low priority of self-care, health MI-based case management
Insufficient number of visits/”dose” Billing/visit # flexibility
53. • Already using it
– Most people [27 out of 32 total patients interviewed] had ‘smart phones’ but some
share phones with family members because of eligibility restrictions for government
phones
– All text. 13 currently receive texts from health providers or pharmacies; mostly
appointment/refill reminders. All expressed contentment with interacting with the
healthcare system in this way.
– Some skepticism about texting technology in general from a minority of patients
• Messages should be relevant to health needs & supportive
– Participants interested in appointment reminders, motivational support messages, self-
care, prep for appointments, hearing peer “voice”
• No major concerns about privacy or safety
– One concern: receiving texts while driving
Is Text Messaging the Right Mode of
Communication?
54. Living Well Topics OPENtext Self Management Topics
Being an active self manager Orientation (in person + via SMS)
Problem solving & action plans CAM 101
Understanding the pain and
symptom cycle
Goal setting
Physical activity and exercise Exercise/physical activity
Balancing activity and rest Mood*
Medications Safe Medication Use (storage, disposal,
addiction)*
Nutrition Food as medicine
Communications – with family and
care providers
Sleep
Relaxation and meditation Mindfulness
Dealing with difficult emotions Social Support
Health Literacy*
Stress & Stress Management*
*Explicit relapse, recovery supports
55. CAM P1 P2 Topic
Message
Type
content
There are traditional and alternative
treatments for chronic pain. Common
alternative treatments are Chiropractic,
Acupuncture and Massage (or CAM for
short).
I will be texting you a lot about CAM -
Chiropractic, Acupuncture and Massage.
These are common alternative treatments
for chronic pain.
Alternative
Treatments
Knowledge
content
Besides CAM, there are lots of alternative
treatments. Some are 1000s of years old.
We STILL don't understand how they work,
but they do!
Besides CAM, there are lots of alternative
treatments. Some are 1000s of years old.
Scientists aren’t sure what makes them
work, but they do!
Alternative
Treatments
Knowledge
content
Remember, in figuring out how to be most
useful to you, CAM providers consider the
whole person, not just the symptoms.
Remember, in figuring out how to be most
useful to you, CAM providers consider the
whole person, not just the symptoms.
Alternative
Treatments
Knowledge
content
No treatment works right away. Whatever
CAM you try will need time before your
body feels any different. Give it a few visits
to see if it works.
I have to remind myself that every
treatment takes time—even CAM. The body
needs at least a few visits before it feels the
difference. Keep that in mind.
Alternative
Treatments
Motivation
keyword/
Quick
page
For tips on things you should do to prepare
for your CAM visit, text PREPARE or go to
XXXXXXXXXXXXXXXXXXXXX
For tips on things you should do to prepare
for your CAM visit, text PREPARE or go to
XXXXXXXXXXXXXXXXXXXXX
Massage
Therapy
ACTION
PEER
story
KV’s story: One surprise from getting acupuncture has been learning to relax my mind. My first visit, she put the
needles in & said she’d be back in 15 minutes.
I panicked a little, wondering how I could lie there not moving with a bunch of needles in me. But then I decided
to try meditating.
I closed my eyes and breathed deeply. It really relaxed me, even after the needles were out and I’d gotten up
and left.
Fortune
cookie
Fortune says: Life does not get better by chance. It gets better by change.
Fortune says: He who laughs at himself never runs out of things to laugh at.
56. OPEN Comparative Effectiveness Trial
Patients with
chronic pain, ED
overutilization
lower ED
utilization,
costs
•Pain
•Quality of
life
•Medication
use/misuse
•Primary
care visits
Basic needs support
OPENnav
Esteem, social
support, tailored
motivation
OPENtext
CAM engage-
ment increased
•# visits,
retention
•Self efficacy to
self manage
chronic pain
•Readiness to
self manage
chronic pain
57. OPENnav
Peer Navigator,
n=150
Eligible for or enrolled in
Chronic Pain Initiative (CPI), referral to OPEN
•AMI case manager
•Health plan case manager
OPENtext,
n=150
Complementary & Alternative Medicine (CAM) services:
Acupuncture, Chiropractor, Massage Therapy
N=79 enrolled (as of 2/29/16)
1 drop out
98% retention
80% female, 47% Non-White, 15% Hispanic/Latino
59. Chronic Pain and
Alternative Therapies
Presenters:
• Robert Hall, MD, Corporate Medical Director, Helios
• Traci Green, PhD, MSC, Deputy Director, Boston Medical
Center Injury Prevention Center, and Associate Professor of
Emergency Medicine, Boston University
Clinical Track
Moderator: Robert L. DuPont, MD, Founding President, Institute
for Behavior and Health, Inc., and Member, Rx and Heroin Summit
National Advisory Board
Editor's Notes
Alternative Medicine Integration
Hsu C, Bluespruce J, Sherman K, Cherkin D. Unanticipated benefits of CAM therapies for back pain: an
exploration of patient experiences. J Altern Complement Med 2010;16(2):157-63.
Maslows hierarchy of needs. Recognizing the arms have overlap though….PNs may incorporate more sophisticated support, and the text program has some basic needs content