Education in Long-term Use of Controlled Release Opioids

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Education in Long-term Use of Controlled Release
Opioids

• Barry Eliot Cole, MD, MPA
• Director of Education,
• American Academy of Pain Management
• Sonora, CA 95370

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Todays Situation

• Millions of Americans suffer from significantly
  painful disorders that disrupt their lives
• Tens of millions of Americans lack adequate
  healthcare insurance, live in rural or
  underserved areas, have co-existing substances
  abuse disorders or other psychosocial issues that
  deny them access to available pain relieving
  therapies

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Why We Are Here

• Something must be done to keep substance abusers
  from dying
• Controlled release opioids are not the problem
  (there are no defective products per se)
• Self-destructive thinking is far more dangerous
  this cannot be regulated by any agency or body
• Drug abuse policy must occur at end user level
• Practitioner knowledge deficits contribute to
  poor patient selection for opioid therapy
• Education is the preferred remedy

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Public Policy Implications from Fixing
Prescription Drug Abuse

• Restrictive options likely lead to reduced
  numbers of willing providers for long-term opioid
  therapy
• More barriers will prevent patients in pain from
  receiving effective pain relieving strategies
• Increased costs will be associated with managing
  chronic pain and they will be passed along
• More burdensome administrative duties will be
  associated with monitoring screening programs
• No improvement in current problem of
  under-treated pain in USA will occur

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Public Policy Implications (2)

• None of these options can
• Absolutely prevent criminal diversion
• Prevent misuse of lawful medication by ill
  informed patients
• Stop further deaths by overdose when abusers
  tamper with products or use them by routes of
  administration never intended

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Educational Recommendation

• Education is the preferred remedy
• Create a Federal pain management educational
  requirement that addresses the proper assessment
  and evaluation of pain and its potential
  management with long-term opioid therapy
• Consider making this a requirement for continued
  DEA registration

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Educational Recommendation (2)

• Education would focus on proper patient selection
  for opioid therapy based upon
• medical history
• substance abuse risk potential and screening
• thorough physical examination
• development of a plan of care with behaviorally
  measurable goals

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Educational Recommendation (3)

• obtaining informed consent
• establishing ongoing monitoring procedures
• establishing success of treatment by realizing
  behavioral goals and measuring outcome
  objectively to determine therapeutic efficacy
• complying with federal and state laws governing
  prescribing of controlled substances

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Role for Simulation Based Opioid Prescribing
Training

• Create an environment immersing practitioners
  into decisions-making experiences that mimic real
  life
• Safely allow for the consequences of their right
  and wrong decisions
• Provide detailed assessments of identified gaps
  in knowledge

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Importance of Simulation for Opioid Prescribing
Education

• When the application of principles or concepts is
  critical (life and death decisions)
• When many variables are involved in making good
  decisions
• When the consequences of making poor decisions
  has a high cost
• The US Military is the greatest proponent of
  simulation testing based on these principles!

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Justification for Simulations

• Traditional Testing
• Doesnt show the consequences of decision-making
• Knowledge being tested may not seem relevant to
  physician. What does this have to do with me?
• Passing tests doesnt necessarily lead to
  behavioral changes

• Simulation Testing
• Shows consequences of bad decisions or lack of
  knowledge.
• Directs student to specific areas of need.
• Knowledge is relevant because the lack of it
  leads to failure.
• Most likely to change behavior on the job.

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Summary

• Working together is our only hope now
• Credentialing groups and organizations
• Federal and state law enforcement
• Professional societies
• Addiction community
• Pain sufferers
• Legislatures