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

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

• f Nebraska by developing a skilled and

passionate workforce.

About BHECN

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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 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

• 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

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

• Dr. Todd Stull

Promoting Provider Team Care February 2nd 12-1:15 pm CST

• Dr. Tina Chasek

Screening, Assessment, and Diagnosis of Substance Use Disorders and Data Trends February 16th 12-1:15 pm CST

• Dr. John Massey

Pain Management: Non- Pharmacological Interventions March 2nd 12-1:15 pm CST

• Dr. John Massey

Pain Management: Pharmacological Interventions March 16th 12-1:15 pm CST

• Dr. Ken Zoucha

Substance Use Disorder Treatment: Pharmacological Interventions March 30th 12-1:15 pm CST

• Dr. Sandy Cook-Fong

Substance Use Disorder Treatment: Non-Pharmacological Interventions April 6th 12-1:15 pm CST Aaron Barnes Relapse, Peer Support and Primary Support April 20th 12-1:15 pm CST

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

• verdoses 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

• pioids) with over 20,000 overdose deaths. Source: CDC WONDER

Opioid-related overdose fatalities by year and region,

Nebraska 2005-2015*

Region

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Total

Central

4 3 6 2 1 3 1 3 4 27

Eastern

5 6 6 5 5 6 4 7 7 6 12 69

Metro

Omaha/ Lincoln

29 22 31 20 48 45 44 41 30 34 32 376

Panhandle

2 1 2 1 1 2 4 13

Western

1 3 4 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 Misuse

Substance Use Disorder

Addiction

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 Withdrawal Negative Affect Preoccupation Anticipation

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!

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Pain and Substance Use Disorder ECHO

Principles of Pain Management and Substance Use Disorders

Questions?