Disclosure 2018 2019: Co chair, Task Force on Protecting the - - PDF document

SLIDE 1

In Intervenin ing in in the the Opioid ioid Epidem Epidemic ic in in the the US: US: Educ ducating ing Heal Health th Pr Professionals – Challenges, Successes and Unintended Consequences

Norman Kahn MD CPE Convener, Conjoint Committee on Continuing Education (CCCE)

nkahn@cmss.org

Disclosure

• 2012‐2019: Convener, Conjoint Committee on

Continuing Education (CCCE)

• Coalition of 27 organizations in medicine, nursing,

dentistry, pharmacy, PAs, addressing the opioid epidemic through the continuing education of health professionals

• 2018‐2019: Co‐chair, Task Force on Protecting the

Integrity of Continuing Education (ACCME)

• 2018‐2021: Member, Advisory Board, Center for

Professionalism and Value in Health Care (ABFM Foundation)

• 2017: Co‐chair, Planning Committee, Vision Initiative for

the Future of Ongoing Certification (ABMS)

• 2008‐2017: EVP/CEO, Council of Medical Specialty

Societies (CMSS)

SLIDE 2

Conjoint Committee on Continuing Education (CCCE): Member Organizations

(n=25)

Accreditation Council for Continuing Medical Education Accreditation Council for Graduate Medical Education Accreditation Council for Pharmacy Education Alliance for Continuing Education in the Health Professions American Academy of Family Physicians American Association of Colleges of Nursing American Association of Colleges of Osteopathic Medicine American Academy of Physician Assistants American Association of State Boards of Pharmacy American Board of Medical Specialties American Dental Association Commission for Continuing Education Provider Recognition American Dental Education Association American Hospital Association American Medical Association American Nurses Credentialing Center American Osteopathic Association Association for Hospital Medical Education Association of American Medical Colleges Council of Medical Specialty Societies Federation of State Medical Boards Medbiquitous Consortium National Association of Boards of Pharmacy National Board of Medical Examiners National Council of State Boards of Nursing Society for Academic Continuing Medical Education

Conjoint Committee on Continuing Education: Objectives

The CCCE’s goal … to use accredited continuing education to improve the performance of the U.S. health care system The CCCE’s strategic focus… to facilitate the education of prescribers of opioid analgesics, and their practice teams, in Risk Evaluation and Mitigation Strategies (REMS)

SLIDE 3

Conjoint Committee on Continuing Education (CCCE): FDA and RPC

• FDA
• Opioid Analgesic REMS Education Blueprint

for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain (9‐18‐18)

• REMS Program Companies (RPC)
• Since 2012, FDA requires opioid

manufacturers to collaborate to address FDA Opioid Risk Evaluation and Mitigation Strategies (REMS) through supporting (through pooled funds managed by a neutral third party) accredited continuing education for clinicians

REMS Program Companies:

December 2018

(n = 59)

• 3M Company
• Abhai LLC
• Akon, Inc.
• Allergan Sales, LLC
• Alvogen
• Amneal Pharmaceuticals, LLC
• ANI Pharmaceuticals, Inc.
• Apotex Inc.
• Ascent Pharmaceuticals, Inc.
• Aurolife Pharma LLC
• Avanthi, Inc.
• BioDelivery Sciences

International, Inc.

• Cipher Pharmaceutical, Inc.
• Colllegium Pharmaceuticals Inc.
• Daiichi Sankyo, Inc.
• Depomed, Inc.
• Egalet Corporation
• Elite Laboratories Inc.
• Endo Pharmaceuticals Inc.
• Epic Pharma, LLC
• Fosun Pharma USA Inc.
• Genus Lifesciences Inc.
• Hikma Pharmaceuticals USA Inc.
• Ingenus Pharmaceuticals NJ, LLC
• Ipca Laboratories Limited
• Janssen Pharmaceuticals Inc.
• Jerome Stevens Pharmaceuticals,

Inc.

• Ken Lifescience
• Lannett Company, Inc.
• Larken Laboratories, Inc.

SLIDE 4

REMS Program Companies

(continued)

• 31.

Lupin Pharmaceuticals Inc./Novel Laboratories, Inc.

• 32.

Macleods Pharmaceuticals Limited

• 33.

Mallinckrodt LLC

• 34.

Mayne

• 35.

Megalith Pharmaceuticals Inc.

• 36.

Mikart, Inc.

• 37.

Mylan, Inc.

• 38.

Nesher Pharmaceuticals USA LLC

• 39.

Nexgen Pharma, Inc.

• 40.

Osmotica Pharmaceutical Corp

• 41.

Paddock Laboratories, LLC, subsidiary

• f Perrigo Company PLC
• 42. Pernix (Bankrupt)
• 43.

Pfizer, Inc.

• 44.

Pharmaceutical Associates, Inc.

• 45.

Purdue Pharma LP

• 46.

Rhodes Pharmaceuticals LP

• 47.

Sandoz Inc.

• 48.

Sentynl Therapeutics, Inc.

• 49.

Sun Pharmaceutical Industries, Inc.

• 50.

Teva Pharmaceuticals USA, Inc.

• 51.

ThePharmaNetwork, LLC

• 52.

Tris Pharma, Inc.

• 53.

Upsher‐Smith Laboratories, LLC

• 54.

Valeant Pharmaceuticals North

• 55.

Validus Pharmaceuticals LLC

• 56.

VistaPharm Inc.

• 57.

WESPharm Inc.

• 58.

Wockhardt USA

• 59.

Zydus Pharmaceuticals (USA) Inc.

• 60.

Xiromed/Chemo Research SL

The national landscape has expanded

• FDA
• CDC
• NIDA
• SAMHSA
• HRSA
• HHS
• AHRQ
• ONDCP
• DEA
• Surgeon General’s Office
• President’s Commission
• “Public Health Emergency”
• NGA
• NAM

SLIDE 5

Philosophical Assumptions?

• For the public:
• Is opioid addiction/opioid use

disorder criminal and/or sociopathic behavior?

• For health professionals:
• Is opioid prescribing

unnecessary and therefore inappropriate?

Overdose Deaths in US‐ all types

Source: National Center for Health Statistics

5 10 15 20 25

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

Deaths per 100,000 population

Motor Vehicle Crash Overdose

SLIDE 6

Opioid Epidemic:

19th Century US

• America’s per capita consumption of opiates

tripled (~ 2,000,000 people, 1865‐1880)

• Aggressive marketing and over‐prescribing of

painkillers

• Congress introduced the first law to criminalize

drug use, the Harrison Narcotic Act of 1915

• Taxed narcotics, prohibited using narcotics in the

treatment of addiction

• The Guardian, US Edition, December 2017

SLIDE 7

Drug overdose deaths in the United States: Continued to increase in 2016

New York Times, September 2, 2017

Source: National Center for Health Statistics, Centers for Disease Control and Prevention



Opioid Deaths

SLIDE 8

Heroin Use Climbed then Stabilized

See table 7.2 in the 2017 NSDUH detailed tables for additional information and the 2017 CDC MortalityData.

PAST YEAR, 2002 AND 2015- 2017, 12+ 1 5

Progress on Prescription Pain Reliever Misuse and Heroin initiation

+ Difference between this estimate and the 2017 estimate is statistically significant at the .05 level. P =0.0337 P =0.0008 P =0.0090

PAST YEAR, 2017, 12+

See tables 7.2, 7.28, and 7.34 in the 2017 NSDUH detailed tables for additional information.

1 6

SLIDE 9

78

people die every day from heroin and opioid

• verdoses in the U.S.

The epidemic is national.

Source: National Vital Statistics System, Mortality file

United States 80% of World’s Opioid Painkillers 99% of World’s Vicodin 5% of World’s Population

International Narcotics Control Board Report, 2008 The influence of prescription monitoring programs on chronic pain management, Pain Physician, 2009

SLIDE 10

Opioid Prescribing in the U.S. and other Countries, 2000‐2016

NYT: August 10, 2017

Sources of Rx Opioids Among Past‐year Non‐ Medical Users

Jones, Paulozzi, et al. JAMA Int Med 2014

SLIDE 11

Pain: The 5th Vital Sign

• History
• Introduced by president of

American Pain Society 1995

• Embraced by VA system late 1990s
• Became Joint Commission standard

2001 ‐ 2017

• Because
• Recognition pain undertreated
• Untreated pain leads to chronic

pain

• Chronic pain interferes with quality
• f life, is costly, and common

SLIDE 12

Promotion: Oxycodone (OxyContin)

• Approved 1995
• Sales:
• 1996 $45 million
• 2000 $1.1 billion
• 2010 $3.1 billion (30% of

painkiller market)

• 1996‐2002 funded >20,000

pain‐related educational programs

• Provided financial support

to: American Pain Society, the American Academy of Pain Medicine, the Joint Commission, members of Congress

Increase in Opioid Prescribing Associated with Increase in Death

Slide from and used with permission of CDC Division of Unintentional Injury Prevention

SLIDE 13

25

SLIDE 14

Interventions

• Enforcement
• Closing “pill mills”
• Disciplining prescribers
• Public Health
• Availability of naloxone
• Medication assisted/based treatment (good evidence for Methadone,

Buprenorphine)

• Other…
• Education
• Prescribers
• Health professional team members
• Public?

Enforcement – a few examples

2017 ‐

• Alabama – John Couch MD ‐ 20 years in prison for prescribing large

quantities of opioids, with no legitimate purpose, as part of his pain clinic practice

• Rhode Island ‐ Jerrold Rosenberg MD ‐ convicted of healthcare fraud for

receiving kickbacks from the manufacturer to prescribe sublingual fentanyl spray for cancer pain that patients did not have

• Michigan – Abdul Haq MD – conspiracy conviction for prescribing medically

unnecessary opioids 2019 –

• US DOJ ‐ Appalachian Regional Prescription Opioid Strike Force

SLIDE 15

4D Model (DEA)

• Dated
• Duped
• Disabled
• Dishonest

Prescription Monitoring Programs that Share Patient Data via PMP InterConnect‐ as of August 20, 2018

SLIDE 16

Indications for

• pioids
• End of life care
• Palliative care
• Chronic cancer pain (CDC)
• Acute injury (i.e. battlefield, … post‐

surgery?) or acute severe pain (i.e. renal colic)

• Chronic non‐cancer pain in stable,

reliable patients on high doses long‐ term, if unable to taper or switch to MAT? (FDA)

• (see CDC Guideline for Prescribing Opioids for Chronic

Pain — United States, 2016)

SLIDE 17

CDC Guideline for Prescribing Opioids for Chronic Pain ‐ 2016

• Determining When to Initiate or Continue Opioids for

Chronic Pain (CDC)

• Opioid Selection, Dosage, Duration, Follow‐Up, and

Discontinuation (CDC)

• Assessing Risk and Addressing Harms of Opioid Use (CDC)
• (apply to all patients outside of active cancer treatment, palliative care, and end‐
• f‐life care)
• www.cdc.gov/drugoverdose/prescribing/guideline.html

Chronic Pain Management:

Me Medi dical Ma Management

34

• Nonopioid analgesics
• Acetaminophen
• NSAIDs
• Adjuvant medications
• Antidepressants, such as SNRI’s, TCAs (JAMA article on effectiveness of

amitriptyline – October 1 2018)

• Anticonvulsants, such as gabapentin, pregabalin, topiramate,

carbamazepine, etc.

SLIDE 18

Chronic Pain Management

35

• Medical management
• Interventional pain management procedures
• Cognitive‐behavioral therapy
• Self directed home exercise program
• Complimentary medicine
• Acupuncture
• Nutritional consult
• Life style changes

Approaches to Opioid Crisis: Public Health

• Primary prevention school education

programs

• Safe opioid prescribing & disposal
• Prescription Drug Monitoring

Programs

• Drug take‐back initiatives
• Regulation and legal action around

“pill mills”

• Opioid prescribing limits
• Abuse‐deterrent opioid formulations
• Provider education
• Screening, Brief Intervention and Referral

to Treatment (SBIRT)

SLIDE 19

Approaches to Opioid Crisis: Public Health

• Opioid Use Disorder (OUD) treatment

with agonist therapy

• Overdose response education and

naloxone distribution

• Good Samaritan Laws
• Laws to allow access without a

prescription

• Safe Injection/Consumption Facilities
• 1. Would you

consider implementing an intervention that could be shown to…

• Increase retention in treatment
• Reduce illicit opioid use
• Reduce risk of overdose
• Reduce risk of HIV, HBC, HCV infections
• Increase rates of employment
• Decrease crime
• Increase length of life

Benefits Of Agonist (Methadone and Buprenorphine) Treatment

SLIDE 20

Opioid Use Disorder: Treatment

• Medication assisted/based treatment

(MAT):

• Methadone
• Only available in Opioid Treatment

Programs (“methadone clinics”)

• Buprenorphine
• Prescriber must have “waiver” to

be able to prescribe and there are limits on size of patient population

• Injectable extended release

naltrexone

Medication Assisted Treatment (MAT)

Source: National Institute on Drug Abuse, Pew Charitable Trusts Credit: Rebecca Hersher and Alyson Hurt/NPR

Methadone (Full Agonist); Activates opioid receptors in the brain, fully replacing the effect of whichever opioid the person is addicted to Buprenorphine (Partial Agonist): Activates opioid receptors in the brain, partially replacing the effect of whichever opioid the person is addicted to Naltrexone (Antagonist): Binds to the opioid receptors in the brain, blocking the effects of opioids.

SLIDE 21

Hospitals:

Wi Withdr thdraw awal al vs vs Trea eatm tmen ent

41

• Medication Assisted/Based Treatment
• No special waver to start MAT in hospital
• Methadone (full agonist)
• Buprenorphine (partial agonist)
• Naltrexone (antagonist)
• Must be done with proper link to outpatient MAT program and counseling

While waiting for EMS to arrive…

• At least try to get breathing

restarted by giving the antidote via nasal spray

• Administer rescue breathing
• (if pulse)
• Administer chest compressions
• (if no pulse)

SLIDE 22

Important notes about naloxone (Narcan)

• If the first dose does not work, you can

administer a 2nd dose

• It takes approximately 2-5 minutes to take effect
• Narcan stays in the system ~ one hour
• Narcan has a shorter half-life than heroin
• Someone can go back into overdose after

Narcan wears off

• 40% of overdoses are witnessed, but rarely

is Narcan available (MMWR)

• Someone who overdosed should NOT use

any type of depressant following the

• verdose
• 2. Would you

consider implementing an intervention that could be shown to result in…

• Overdose death reduction
• Milloy et al, PLOS One, 2008
• Marshall et al, Lancet 2011
• Kerr et al., International Journal of Drug Policy, 2006
• Reductions in syringe sharing
• Kerr et al., The Lancet, 2005
• Wood et al. American Journal of Infectious Diseases, 2005
• Increases in safer injection behaviors
• Stoltz et al, Journal of Public Health, 2007
• Small et al., Drug and Alcohol Dependence, 2008
• Increased use of (referral to and retention in)

addiction treatment

• Wood et al., New England Journal of Medicine, 2006
• Wood et al., Addiction, 2007
• DeBeck et al., Drug and Alcohol Dependence, 2010
• Reductions in violence against women
• Fairbairn et al, Social Science and Medicine, 2008
• Slide credit: Sharon Stancliff, MD

SLIDE 23

• 2. Would you

consider implementing an intervention that could be shown to result in…

• Reductions in public disorder
• Wood et al., Canadian Medical Association Journal, 2004
• Petrar et al., Addictive Behaviors,
• Stoltz et al., Journal of Public Health, 2007
• No negative changes in community drug use

patterns

• Kerr et al., British Medical Journal, 2006
• No increases in initiation into injection drug use
• Kerr et al., American Journal of Public Health, 2007
• No increases in drug‐related crime
• Wood et al., Substance Abuse Treatment. Prevention, and

Policy, 2006

• Promotes effective police‐public health

partnerships

• DeBeck et al, Substance Abuse Treatment. Prevention, and

Policy, 2008

• Cost‐effective
• Bayoumi & Zaric, CMAJ, 2009
• Andersen & Boyd, IJDP, 2010
• Pinkerton, et al, Addiction, 2010

Findings from Insite Vancouver BC Slide credit: Sharon Stancliff, MD

Supervised Injection Facilities

• Facilities where people may go to

consume drugs (obtained elsewhere) in a hygienic environment with appropriate equipment without fear

• f arrest, under trained supervision
• Hedrich, D., T. Kerr & F. Dubois‐Arber (2010) 'Chapter 11;

Drug consumption facilities in Europe and beyond. European Monitoring Centre for Drugs and Drug Addiction

• The Conjoint Committee on Continuing Education

(CCCE) does not have a position on supervised injection facilities.

• Slide credit: Sharon Stancliff, MD

SLIDE 24

Insite, Vancouver British Columbia

Internationally: 97 facilities 66 cities 11 countries; illegal in the US1

Photo Credit: Sharon Stancliff, MD 1‐ http://www.abell.org/sites/default/files/files/Safe%20Drug%20Consumption%20Spaces%20final.pdf

American Journal of Preventive Medicine

• Aug. 8, 2017

SLIDE 25

Successful Strategies: Clinician Education

• Quality educational activities
• On‐line (more participants)
• Live (more completers)
• Incorporate the FDA Blueprint:

FDA’s Opioid Analgesic REMS Education Blueprint for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain (September 2018)

• Tailored to audience (rural NP vs
• ncologist vs dentist)
• Increases knowledge, changes

practice behaviors in ways linked to improved patient outcomes

Successful Strategies: Clinician Education

• Quantity educated
• Medicine – > 418,442 (REMS‐compliant CE completers)
• ACCME PARS ‐ 892 activities, 395,663 successfully completing
• ~194,328 registered to prescribe schedule 2/3 (n =~ 1.2 million)
• ~93,192 prescribed in the past year (n =~ 320,000)
• In addition to the majority of family physicians who are included in

ACCME PARS data, an additional 3098 were educated through providers accredited by AAFP but not by ACCME

• In addition to DO’s who are included in the PARS system, 19,681 were

educated through providers accredited by AOA but not by ACCME

• Nursing ‐ > 18,422 (REMS‐compliant CE completers)
• ANCC
• (2628 nursing prescribers)
• Pharmacy – > 2023 (REMS‐compliant CE completers)
• six ACPE accredited providers, 18 REMS‐compliant activities, 2023

participants

• + 3999 activities in CE on “opioids” and 5486 activities in CE on “pain

management” (may be some duplication of these activities)

• Pharmacy technicians: “opioids” ‐ 87,685; “pain management” – 167,229

(may not represent unique learners)

• Pharmacists: “opioids” – 413,864; “pain management” – 490,589 (may

not represent unique learners)

• Total > 438,887 completers of FDA

Blueprint‐compliant (REMS‐compliant) CE,

plus …

SLIDE 26

Continuing Education: Mandatory or Voluntary?

• Twenty‐six states mandate content‐specific

Continuing Education (CE)

• End of life care
• Domestic violence
• Infection control
• HIV/AIDS
• Bioterrorism
• Pain management (24 states)
• Mandatory CE
• No evidence in the literature of learning or practice

behavior change

• Diverts education from prioritized clinician needs
• Voluntary CE
• Self‐identified need or practice gap
• Accreditation Council for Continuing Medical

Education (ACCME) Program and Activity Review System (PARS) measures learning and practice behavior change

And those choosing not to educate themselves? Challenges…

• Rarely prescribing ‐ therefore not recognizing

such education as a priority

• The prescriber is the expert ‐ therefore not

sensing a need to take advantage of the education

• Lack of awareness
• Trusting enforcement to manage the problem
• Requiring 2‐3 hours of education discourages

some from participating

• Mandated state CE other than pain

management or opioid prescribing ‐ results in clinicians forgoing opioid education to fulfill

• ther requirements
• Overwhelmed by the many demands on

practice

SLIDE 27

Future Considerations: 2019

• Adaptive learning
• Tests knowledge first
• Results in immediate needs

assessment/gap analysis

• Followed by learning specifically

targeted to identified gaps

• Personalized learning design

What else can we do?

SLIDE 28

Role of CE in Public Health: The Opioid Epidemic

MJ Kanaczet, M.Ed.

Director, Office of Continuing Professional Development University of Rhode Island College of Pharmacy Kingston, RI mj @ uri.edu

CE Pearls: ACPE Spring Education Conference May 14‐15, 2019

Disclosure

 The speaker has no relevant financial relationships with

any entity producing, marketing, reselling or distributing health care goods or services consumed by, or used on, patients within the last twelve months.

SLIDE 29

Learning Obj ectives

 Summarize the scope of the US Opioid public health crisis.  Describe recent developments of FDA

’s Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) including education for healthcare providers involved in the treatment and monitoring of patients with pain.  Discuss the impact of continuing education (CE) in addressing

the nation’s opioid crisis.

 Identify strategies to collaborate with educational colleagues,

experts, and patients/families to address the epidemic.

 Upon conclusion of the conference, reflect on ways to foster continued

development and dissemination of one’s CPE practices and experiences.

Prescribe to Prevent: Prescribe Naloxone Save a Life

SLIDE 30

59

ASAM Board of Directors April 2010

“Naloxone has been proven to be an effective, fast‐acting, inexpensive and non‐addictive

• pioid antagonist with minimal

side effects... Naloxone can be administered quickly and effectively by trained professional and lay individuals who observe the initial signs of an opioid

• verdose reaction.”

www.asam.org/ docs/ publicy-policy-statements/ 1naloxone-1- 10.pdf



Primary Care Provider Concerns about Management of Chronic Pain in Communit y Clinic Populat ions Carole C Upshur, EdD, Roger S Luckmann, MD, MPH, and Judit h A S avageau, MPH

“The AMA has been a longtime supporter of increasing the availability of Naloxone for patients, first responders and bystanders who can help save lives and has provided resources to bolster legislative efforts to increase access to this medication in several states.”

www.ama-assn.org/ ama/ pub/ news/ news/ 2014/ 2014-04-07- naxolene-product-approval.page

“APhA supports the pharmacist’s role in selecting appropriate therapy and dosing and initiating and providing education about the proper use

• f opioid reversal agents to

prevent opioid-related deaths due to overdose”

www.pharmacist.com/ policy/ controlled-substances-and-

• ther-medications-potential-abuse-and-use-opioid-reversal-

agents-2

Prescribe to Prevent

SLIDE 31

Prescribe to Prevent: Core Topics

 Risk factors for opioid overdose  How to recognize and respond to an

• pioid overdose

 How to incorporate naloxone into that

• verdose response

 Medico-legal issues surrounding the

distribution of naloxone, including third party prescribing and Good S amaritan laws

SLIDE 32

Prescribe to Prevent: Impact on Pharmacists prescribing and confidence

10 20 30 40 50 60 Prescribing Naloxone S afety Plan Referral t o agonist t reat ment Identify Risk Factors Before P2P AfterP2P Walley Alexander Y, Xuan Ziming, Hackman H Holly, Quinn Emily, Doe-Simkins Maya, Sorensen- Alawad Amy et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis BMJ 2013; 346 :f174

SLIDE 33

Interprofessional Collaboration

Image credit: University of Waterloo S chool of Pharmacy, IPE

SLIDE 34

Resources



Upshur CC, Luckmann RS, Savageau, JA. Primary care provider concerns about management of chronic pain in communit y clinic populations. J Gen Int ern Med 2006 Jun;21(6):652-5.



Walley Alexander Y , Xuan Ziming, Hackman H Holly, Quinn Emily, Doe-S imkins Maya, S

• rensen-Alawad Amy et
• al. Opioid overdose rat es and implement at ion of overdose educat ion and nasal naloxone dist ribut ion in

Massachuset t s: int errupt ed t ime series analysis BMJ 2013; 346 :f174



S hane R. Mueller MS W, Alexander Y . Walley MD, MS c, S usan L. Calcat erra MD, MPH, Jason M. Glanz PhD & Ingrid A. Binswanger MD, MPH, MS (2015): A Review of Opioid Overdose Prevent ion and Naloxone Prescribing: Implicat ions for Translat ing Communit y Programming Int o Clinical Pract ice, S ubst ance Abuse, DOI: 10.1080/ 08897077.2015.1010032



Coffin PO, Behar E, Rowe C, Sant os GM, Coffa D, Bald M, Vit t inghoff E.Nonrandomized Int ervent ion S t udy of Naloxone Coprescript ion for Primary Care Pat ient s Receiving Long-Term Opioid Therapy for Pain. Ann Int ern Med. 2016 Aug 16;165(4):245-52. doi: 10.7326/ M15-2771. Epub 2016 Jun 28.



European Monit oring Cent re for Drugs and Drug Addict ion (2015), Prevent ing fat al overdoses: a syst emat ic review of t he effect iveness of t ake-home naloxone, EMCDDA Papers, Publicat ions Office of t he European Union, Luxembourg.



Lessons from t he Field: Promising Int erprofessional Collaborat ion Pract ices. 2015. Whit e Paper, The Robert Wood Johnson Foundat ion, rwj f.org.



www.prescribet oprevent .org

SLIDE 35

Point & Counter‐Point The Patient’s Perspective

Barbara Jolly, RPh, MPA, LDE Professor and Director Office of Lifelong Professional Development Sullivan Univ. College of Pharmacy & Health Sciences BLJolly@Sullivan.edu

Thoughts from the perspective of a former

• pioid half-way house

counselor who is also a chronic pain patient

I have no relevant financial relationships to disclose

Learning Obj ectives



Summarize the scope of the US Opioid public health crisis.



Describe recent developments of FDA ’s Opioid Analgesic Risk Evaluation and Mitigation S trategy (REMS ) including education for healthcare providers involved in the treatment and monitoring of patients with pain.



Discuss the impact of continuing educat ion (CE) in addressing the nation’s

• pioid crisis.



Identify strategies to collaborate with educational colleagues (academia, CPE, interprofessional), experts, and patients/families to address the epidemic.



Upon conclusion of the conference, reflect on ways to foster continued development and dissemination of one’s CPE practices and experiences.

SLIDE 36

How prevalent is OUD among patients with serious, legitimate pain? It depends whom you ask and how you count

What my state is doing

Kentucky Board-approved pharmacist-initiated protocols

https:/ / pharmacy.ky.gov/ Board% 20Authorized% 20Protocols/ Opioid% 20Use% 20Disord er% 20Protocol% 20v2% 20Approved% 20December% 2012,% 202018.pdf

SLIDE 37

Being a patient with serious persistent debilitating pain.

Considering the patient’s perspective How does is feel to be a patient that is denied needed opioids?

https:/ / video.search.yahoo.com/ search/ video? fr=mcsaoffblock&p=countd

• wn+timer#id=1&vid=017283a288d15eaa1962b9daf61d1544&action=click

Let’s try a short exercise Imagine that . . .

SLIDE 38

The take home-message . . .

We MUS T prevent diversion & misuse of

• pioids while not treating every patient as an

addict or criminal. It turns out we actually have to get to know

• ur patients. Reserve “ the look” for those

situations warranting its use. Get treatment for those who need it Make a difference, one patient at a time. It takes many small battles to win a war.