opioid prescribing for cnp speakers notes
TRANSCRIPT
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http://tinyurl.com/6d9yxgz
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2. http://www.cdc.gov/homeandrecreationalsafety/rxbrief/
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3. http://www.ncbi.nlm.nih.gov/pubmed/23031398
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http://tinyurl.com/lrkcdql
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http://tinyurl.com/lrkcdql
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129653/
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8. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm
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http://www.ncbi.nlm.nih.gov/pubmed/21751058
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http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf
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http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf
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http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf
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http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf
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http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf
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6. http://www.samhsa.gov/data/2k12/NSDUH115/sr115-nonmedical-use-pain-
relievers.htm
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http://www.cdc.gov/nchs/data/databriefs/db22.pdf
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http://tinyurl.com/mr9dttb
Y axis = Opioid Prescriptions/1000 Residents
15. Tillamook
23. Marion
36 Total Counties
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http://preview.tinyurl.com/mza7766
Approximately 150/yr in OR.
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Opioids are not the final common pathway for all chronic non-malignant pain.
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http://tinyurl.com/lr9hwhh
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DIRE: Diagnosis, Intractability, Risk, Efficacy
COMM: Current opioid misuse measure
SOAPP-R: Screener and Opioid Assessment for Patients with Pain
Naïve = < 60MED
Tolerant = > 60MED
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DIRE: Diagnosis, Intractability, Risk, Efficacy
http://tinyurl.com/lks94bf
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http://preview.tinyurl.com/lhxtoju
http://www.ncbi.nlm.nih.gov/pubmed/21467284
http://www.ncbi.nlm.nih.gov/pubmed/21482846
http://www.ncbi.nlm.nih.gov/pubmed/22026451
http://www.fda.gov/downloads/Drugs/N.../UCM307844.pdf
Dosages in excess of 100MED/day warrant a pain management consultation.
MED = Milligrams Equivalent Dose (Morphine)
University of Washington Opioid Dose Calculator:
http://agencymeddirectors.wa.gov/mobile.html
Practical Pain Management Opioid Dose Calculator:
http://opioidcalculator.practicalpainmanagement.com/
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Opioid dose conversion calculators:
http://agencymeddirectors.wa.gov/mobile.html
http://opioidcalculator.practicalpainmanagement.com/
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http://tinyurl.com/mmazr8y
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http://www.ncbi.nlm.nih.gov/pubmed/22213274
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http://tinyurl.com/kzvs443
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http://gov.oregonlive.com/bill/2013/SB384/
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http://tinyurl.com/mb2lj6r
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http://tinyurl.com/kpuh547
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http://tinyurl.com/abnywac
The CDC estimates that 30% of all prescription painkillers deaths in 2010 involved
benzodiazepines.
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http://tinyurl.com/ly6o6vj
The CDC estimates that 20% of all prescription painkillers deaths in 2010 involved alcohol.
(http://www.pbs.org/newshour/rundown/prescription-drug-abuse-cdc-answers-your-
questions/)
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18. http://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=5
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http://www.oregon.gov/omb/pdfforms/materialrisknotice.pdf
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20. http://www.oregon.gov/omb/newsletter/winter2011.pdf
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Safety surveillance measures.
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http://www.fda.gov/ohrms/dockets/ac/02/slides/3820s2_05_passik.ppt
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http://www.ncbi.nlm.nih.gov/pubmed/14635824
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http://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=3
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http://www.ncbi.nlm.nih.gov/pubmed/19663620
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http://www.ncbi.nlm.nih.gov/pubmed/23070654
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Doctor shopping is an aberrant behavior and grounds for discharge.
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Thanks to Dr. David Russo, Columbia Pain Management
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http://tinyurl.com/klx8vn5
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http://tinyurl.com/modae4l
The CDC estimates that less than 1% of all prescription painkillers deaths in 2010 involved
marijuana.
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NSDUH: National Survey on Drug Use and Health
The CDC estimates that less than 1% of all prescription painkillers deaths in 2010 involved
marijuana.
70% of heavy users are white males under the age of 35.
For an impartial analysis of marijuana use/legalization:
http://www.amazon.com/Marijuana-Legalization-Everyone-Needs-
Know%C2%AE/dp/0199913730/ref=sr_1_1?ie=UTF8&qid=1393092023&sr=8-
1&keywords=marijuana+and+kilmer
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30% of heavy users co-utilize other illicit drugs.
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40% of heavy users use alcohol heavily.
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The 20% of all users consume 80% of the marijuana sold.
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http://www.martin.uky.edu/centers_research/Capstones_2012/Farley.pdf
Study included the 16 states with both MM & PDMP’s in 2011. Look back was 1996 – 2006.
…”I conclude that the implementation of Medical Marijuana Programs does not cause a
decline in prescription controlled substance
utilization.”
James Farley, Martin School of Public Policy
“
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http://preview.tinyurl.com/lweycl7
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http://www.ncbi.nlm.nih.gov/pubmed/24076302
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http://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=6
2x compared to alcohol’s 9x
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http://www.ncbi.nlm.nih.gov/pubmed/19793342
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http://tinyurl.com/lr9hwhh
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24. http://www.deadiversion.usdoj.gov/fed_regs/rules/2006/fr0906.htm
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Special thanks to my reviewers for their critical input.
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Special thanks to my reviewers for their critical input.
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Physicians for responsible opioid prescribing. An excellent resource for responsible opioid
prescribing.
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