Intervening in the Opioid Epidemic in 

the US:Educating Health 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)

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)

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.

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  of 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

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

0

5

10

15

20

25

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

Dea

ths per 100,000 population

Motor Vehicle Crash Overdose

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

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

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+

15

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.

16

78people die every day from heroin and opioid overdoses 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

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

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 of life, is costly, and common

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

25

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

4D Model (DEA)

•Dated•Duped•Disabled•Dishonest

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

Indications for opioids

• 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)

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‐of‐life care)

• www.cdc.gov/drugoverdose/prescribing/guideline.html

Chronic Pain Management: Medical 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.

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)

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

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.

Hospitals:Withdrawal vs Treatment

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)

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 overdose

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

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 of 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

Insite, VancouverBritish Columbia

Internationally: 97 facilities66 cities11 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 MedicineAug. 8, 2017

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 oncologist 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 …

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 other requirements

• Overwhelmed by the many demands on practice

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?

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 PharmacyKingston, RI mj@uri.edu

CE Pearls: ACPE Spring Education ConferenceMay 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.

Learning Objectives 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

59

ASAM Board of DirectorsApril 2010

“Naloxone has been proven to be an effective, fast‐acting, inexpensive and non‐addictive opioid 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 overdose reaction.” 

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

Primary Care Provider Concerns about Management of Chronic Pain in Community Clinic Populations Carole C Upshur, EdD, Roger S Luckmann, MD, MPH, and Judith A Savageau, 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 of opioid reversal agents to prevent opioid-related deaths due to overdose”

www.pharmacist.com/policy/controlled-substances-and-other-medications-potential-abuse-and-use-opioid-reversal-agents-2

Prescribe to Prevent

Prescribe to Prevent: Core Topics

Risk factors for opioid overdose

How to recognize and respond to anopioid overdose

How to incorporate naloxone into thatoverdose response

Medico-legal issues surrounding thedistribution of naloxone, including third partyprescribing and Good Samaritan laws

Prescribe to Prevent: Impact on Pharmacists prescribing and confidence

0

10

20

30

40

50

60

Prescribing Naloxone Safety Plan Referral to agonisttreatment

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

InterprofessionalCollaboration

Image credit: University of WaterlooSchool of Pharmacy, IPE

Resources Upshur CC, Luckmann RS, Savageau, JA. Primary care provider concerns about management of chronic pain in

community clinic populations. J Gen Intern Med 2006 Jun;21(6):652-5.

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

Shane R. Mueller MSW, Alexander Y. Walley MD, MSc, Susan L. Calcaterra MD, MPH, Jason M. Glanz PhD & Ingrid A. Binswanger MD, MPH, MS (2015): A Review of Opioid Overdose Prevention and Naloxone Prescribing: Implications for Translating Community Programming Into Clinical Practice, Substance Abuse, DOI: 10.1080/08897077.2015.1010032

Coffin PO, Behar E, Rowe C, Santos GM, Coffa D, Bald M, Vittinghoff E.Nonrandomized Intervention Study of Naloxone Coprescription for Primary Care Patients Receiving Long-Term Opioid Therapy for Pain. Ann Intern Med. 2016 Aug 16;165(4):245-52. doi: 10.7326/M15-2771. Epub 2016 Jun 28.

European Monitoring Centre for Drugs and Drug Addiction (2015), Preventing fatal overdoses: a systematic review of the effectiveness of take-home naloxone, EMCDDA Papers, Publications Office of the European Union, Luxembourg.

Lessons from the Field: Promising Interprofessional Collaboration Practices. 2015. White Paper, The Robert Wood Johnson Foundation, rwjf.org.

www.prescribetoprevent.org

Point & Counter‐PointThe Patient’s Perspective

Barbara Jolly, RPh, MPA, LDEProfessor and Director

Office of Lifelong Professional DevelopmentSullivan Univ. College of Pharmacy & Health Sciences

BLJolly@Sullivan.edu

Thoughts from the perspective of a former opioid half-way house counselor who is also a chronic pain patient

I have no relevant financial relationships to disclose

Learning Objectives

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 (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.

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%20Disorder%20Protocol%20v2%20Approved%20December%2012,%202018.pdf

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

Let’s try a short exercise

Imagine that . . .

The take home-message . . .

We MUST prevent diversion & misuse of opioids while not treating every patient as an addict or criminal.

It turns out we actually have to get to know our 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.