Pain and Substance Use Disorder ECHO Principles of Pain Management - PowerPoint PPT Presentation

Pain and Substance Use Disorder ECHO Principles of Pain Management and Substance Use Disorders Dr. Ken Zoucha MD Dr. Tina Chasek LIMHP, LADC

About BHECN The Behavioral Health Education Center of Nebraska (BHECN), pronounced “beacon”, was established in 2009 by a legislative bill to address the shortage of behavioral health professionals in rural and underserved areas of the state. unmc.edu/bhecn MISSION: BHECN is dedicated to improving access to behavioral health care across the state of Nebraska by developing a skilled and passionate workforce.

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Pain and Substance Use Disorder ECHO This webinar is part of a larger Project ECHO that addresses Pain and Substance Use Disorders provided by the Nebraska Department of Behavioral Health and UNMC Psychiatry Department What is an ECHO?

• The Pain and Substance Use Disorder EHCO provides pain and substance use specialist knowledge in a virtual learning network with experts from across the State • The EHCO sessions provide a mixture of didactic knowledge and case based application • All sessions are free of charge and open to any provider working with patients and clients on pain or substance use disorders

Pain and Substance Use Disorder ECHO Expert Team Dr. Todd Stull M.D. Dr. Ken Zoucha M.D. Dr. John Massey M.D. Dr. Tina Chasek LIMHP, LADC Dr. Sandy Cook-Fong MSW Aaron Barnes Nationally Certified Recovery Coach *Also pictured Vince Brandts, LPN

ECHO Topics and Dates Presenter Topic Date February 2 nd 12-1:15 pm CST Dr. Todd Stull Promoting Provider Team Care February 16 th 12-1:15 pm CST Dr. Tina Chasek Screening, Assessment, and Diagnosis of Substance Use Disorders and Data Trends March 2 nd 12-1:15 pm CST Dr. John Massey Pain Management: Non- Pharmacological Interventions March 16 th 12-1:15 pm CST Dr. John Massey Pain Management: Pharmacological Interventions March 30 th 12-1:15 pm CST Dr. Ken Zoucha Substance Use Disorder Treatment: Pharmacological Interventions April 6 th 12-1:15 pm CST Dr. Sandy Cook-Fong Substance Use Disorder Treatment: Non-Pharmacological Interventions April 20 th 12-1:15 pm CST Aaron Barnes Relapse, Peer Support and Primary Support

Substance Use Disorder What We Know Kenneth Zoucha, MD DHHS-Division of Behavioral Health Medical Director-Hastings Juvenile Chemical Dependency Program

ALARMING STATISTICS Total U.S. Drug Deaths* - More than 64,000 Americans died from drug overdoses in 2016, including illicit drugs and prescription opioids-- nearly double in a decade. Source: CDC WONDER

Drugs Involved in U.S. Overdose Deaths* - Among the more than 64,000 drug overdose deaths estimated in 2016, the sharpest increase occurred among deaths related to fentanyl and fentanyl analogs (synthetic opioids) with over 20,000 overdose deaths. Source: CDC WONDER

Opioid-related overdose fatalities by year and region , Nebraska 2005-2015* 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Total Region Central 4 3 0 0 6 2 1 3 1 3 4 27 5 6 6 5 5 6 4 7 7 6 12 69 Eastern Metro 29 22 31 20 48 45 44 41 30 34 32 376 Omaha/ Lincoln 2 0 0 0 1 2 1 1 2 0 4 13 Panhandle Western 0 0 0 1 0 3 0 0 0 4 0 8 Total 40 31 37 26 60 58 50 52 40 47 52 493 Frequency Missing = 62 Missing resident county for the decedent or the resident county is outside Nebraska Data Source: Nebraska Vital Records

Overdose Deaths by Substance 13

Nebraska Overdose Deaths

Addiction Definition Primary, chronic disease Brain reward, motivation, memory & related circuitry Dysfunction leads to characteristic manifestations: • Biological, psychological, social & spiritual Pathological pursuit of reward &/or relief by substance use or Other Behaviors Public Policy Statement: Definition of Addiction American Society of Addiction Mediicne

Addiction Symptoms Inability to consistently abstain Behavioral control impairment Craving Diminished recognition of problems with one’s behaviors and interpersonal relationships Emotional response that is dysfunctional Public Policy Statement: Definition of Addiction American Society of Addiction Medicine

Substance Use Disorder Diagnosis DSM-5 1. Larger amounts or over longer periods of time than intended 2. Persistent desire or unsuccessful efforts to cut down or control use 3. Great deal of time obtaining, using and recovering from effects of use 4. Craving, or strong desire or urge to use substances 5. Failure to fulfill major role obligations at work, school or home 6. Persistent or recurrent social/interpersonal problems caused by use 7. Important social, occupational, or recreational activities are given up 8. Recurrent use in situations that are physically hazardous 9. Continued use despite physical or psychological problems due to use 10. Tolerance 1. Need for markedly increased amounts of substances 2. Diminished effect from same amount of substances 11. Withdrawal 1. Characteristic withdrawal syndrome for a given substance 2. Substances are used to relieve or avoid withdrawal symptoms (2-3 Symptoms-Mild; 4-5 Symptoms-Moderate; 6 or more Symptoms- Severe) Diagnostic Criteria from DSM-5

Progression of Addiction Substance Use Substance Use Disorder Substance Addiction Misuse

ADDICTION The most severe stage of Substance Use Disorder! Loss of Self Control Compulsive Drug Taking Despite Desire to Stop! NOT  Moral Failing  Character Defect  Bad Behavior  Poor Decision Making  Voluntary Choice

Addiction: Three Recurring Stages Binge Intoxication Preoccupation Withdrawal Anticipation Negative Affect

Initiation of Misuse of Substance To fit in with peers Experimentation Treatment of mental illness Pain management

Drug (Opioid) Withdrawal Range of symptoms/Varying lengths of time:  Gastrointestinal distress  Thermoregulation disturbances  Insomnia  Muscle and joint pain  Marked anxiety and dysphoria  Yawning/Sneezing  Intense Craving  ---------------------------------------------  Causes marked discomfort; SUFFERING  Prompting continuation of opioid use

TREATMENT Pharmacological interventions Behavioral interventions • Cognitive-behavioral interventions • Decrease the reinforcing properties of drugs • Enhance the rewarding properties of natural reinforcers • Inhibit conditioned-learned associations • Enhance motivation for non-drug-related activities • Strengthen inhibitory control Treat comorbid conditions

RECOVERY  BEHAVIORAL HEALTH IS ESSENTIAL TO OVERALL HEALTH  PREVENTION WORKS  TREATMENT IS EFFECTIVE  PEOPLE CAN AND DO RECOVER! 28

Pain and Substance Use Disorder ECHO Principles of Pain Management and Substance Use Disorders Questions?