Schedule (subject to change)
8:00a - 8:30a - Registration and Exhibits
Coffee will be served.
8:30a - 9:30a - A Comedy of Errors: Methadone and Buprenorphine
UAN 0530-0000-18-032-L01-P
AANP Rx Hours 1.0
Course Description
The most contentious, poorly understood analgesics today are methadone and buprenorphine. This fast paced workshop will equip practitioners with immediately implementable practical tips regarding when and how to use these analgesics, including dosage formulations, routes of delivery, appropriate use in therapy, drug interactions, dosage titration (both up and down), opioid conversion calculations, and more. All discussions will be aimed at enhancing clinical, economic, and humanistic outcomes on the individual patient and health system level.
Douglas L. Gourlay, MD, MSc, FRCPC, FASAM
9:30a - 10:30a - Not for Human Consumption: New Drugs of Abuse and Their Detection
UAN 0530-0000-18-043-L01-P
AANP Rx Hours 1.0
Course Description
Designer drugs are structurally related to illegal psychoactive drugs and include cathinones (bath salts and flakka), synthetic cannabinoids (K2), piperazines (Molly), salvia, kratom, and desomorphine (krokodil). Often designer drugs are readily available on the Internet or in head shops and skirt regulation through the development of novel analogs and labeling the products "not for human consumption." These novel psychoactive substances are consumed typically by younger males via various routes and modes for their desirable effects; however, undesirable and even life-threatening reactions or death may occur. Additionally, designer drugs are often coingested with other psychoactive substances and may be metabolized through cytochrome P450 pathways leading to drug-drug interactions furthering the potential for harm. Management is normally with supportive measures and symptomatic care. Unfortunately, most of these agents are challenging to detect as they are not readily identified by immunoassay urine drug testing, though some may lead to false positives. More advanced testing with liquid or gas chromatography/mass spectroscopy is able to detect designer drugs but is limited due to its availability, cost, delay in results, and the ever-changing designer drug structures.
Abigail T. Brooks, PharmD, BCPS
10:30a - 10:40a - Break & Exhibits
10:40a - 11:40a - Get Your Specimens in Order: The Importance of Individualized Test Orders and Timely Test Utilization
UAN 0530-0000-18-039-L01-P
AANP Rx Hours 0.0
Course Description
The government has ramped up its efforts in 2018 to connect claims of inappropriate opioid prescribing to financial gain, including gain from urine drug testing. While most physicians do not have a financial interest in a clinical laboratory, the government's decision to highlight an opioid prescriber's failure to timely utilize drug test results is significant, and suggests the government is looking at other factors tied to medical decision making. Thus, prescribers should pay attention to licensing board, payer, and professional society guidance on ordering drug tests and how to use drug test results when treatment involves opioid prescribing. Attendees will learn how to identify the core elements of medical necessity and document an individualized testing plan for each patient. This course will cover critical areas of medical record documentation, including the decision to drug test, when and how often; determining which drugs to test and why; and how to coordinate timely review and use of drug test results in connection with the patient's plan of care. Attendees will gain additional insight into these issues through position papers, published late 2017 and early 2018, by the American Academy of Pain Medicine and the American Association for Clinical Chemistry. The overall goal of the course is to assist prescribers in their quest to provide quality pain care to their patients and to document their rationale for drug testing and their treatment decisions.
Jennifer Bolen, JD
11:40a - 12:00p - Faculty Q&A
12:00p - 12:10p - Break & Exhibits
12:10p - 1:10p - Product, Disease Awareness, Medical Information Program*
Lunch will be served.
Sponsored by Salix Pharmaceuticals, Joseph Pergolizzi, Jr., MD
1:10p - 2:00p - Trainwreck: Addressing Complex Pharmacotherapy With the Inherited Pain Patient
UAN 0530-0000-18-057-L01-P
AANP Rx Hours 0.0
Course Description
The prescription drug problem in America has led to many guidelines and, in some cases, regulations aimed at stemming the tide of prescription drug abuse. Some are evidence based, but most are driven by fear and an overwhelming need to do "something." Unfortunately, while these guidelines have offered suggestions of how to apply this information in a clinical context going forward, they provide little information as to the management of those patients who already exceed these current guidelines. This is where the concept of the "inherited patient" comes into play. Some of these patients are doing well while some are doing quite poorly. The undeniable fact is that as these guidelines are being exceeded, risk of a bad outcome increases while likelihood of achieving therapeutic goals decreases. This workshop will, through the use of representative cases, help participants to recognize irrational pharmacotherapy and, when necessary, address it through a combination of pharmacological as well as biopsychosocial frameworks.
Douglas L. Gourlay, MD, MSc, FRCPC, FASAM
2:00p - 2:10p - Break & Exhibits
2:10p - 3:00p - Product, Disease Awareness, Medical Information Program*
Refreshments will be served.
Sponsored by ADAPT® Pharma, George Avetian, DO
3:00p - 3:50p - What's All the "GABA" About? Pregabalin and Gabapentin Abuse
UAN 0530-0000-18-058-L01-P
AANP Rx Hours 0.0
Course Description
The gabapentinoids are a popular class of medications among prescribers for use in chronic pain and various other neurological conditions. In fact, prescription rates for both gabapentin and pregabalin have increased in the United States and other countries in recent years. However, these medications have a street value to a newer niche of users, including patients taking them at megadoses to enhance the effects of other psychotropic drugs, and other patients taking them to manage or mitigate opioid withdrawal symptoms and possibly even opioid cravings. While pregabalin is already classified as a controlled substance, gabapentin does not yet carry this classification. In response to rising abuse, various states and regulatory bodies are considering changes to enhance patient safety and protect the provider's license. Learn what changes you should make to your practice, if any, in light of the growing abuse of gabapentinoids and how to identify patients potentially abusing them.
Abigail T. Brooks, PharmD, BCPS
3:50p - 4:40p - Embrace Changes and Mitigate Legal Risks Associated with Opioid Prescribing and the Issue of Overdose: An Updated Blueprint for the Frontline Pain Practitioner and Medical Directors
UAN 0530-0000-18-045-L01-P
AANP Rx Hours 0.0
Course Description
Overdose--a small word that packs a major punch, and a big reason for many recent legal regulatory changes in controlled substance prescribing and pain management. Too many physicians and allied healthcare practitioners are caught unawares by the legal issues surrounding overdose events, fatal and nonfatal. Often, prescribers are the last to learn about an overdose event and, worse yet, fail to take action once notified. Through a series of case examples, attendees will learn how to develop and implement overdose event policies and protocols. Attendees will receive copies of sample policies and protocols and learn how to tailor them to their respective practices and state licensing board framework. Professional licensing board and criminal cases involving overdose events do not usually end well for the prescriber, but there is much the prescriber can do proactively to signal his/her intent to get things right. While prescribers cannot control what their patients do once they leave the medical office, they are responsible for establishing a safe framework for opioid prescribing, including a proper response when something goes wrong.
Jennifer Bolen, JD
*Not certified for credit.
Schedule (subject to change)
7:00a - 7:30a- Registration and Exhibits
Coffee will be served.
7:30a - 8:30a - Rational Polypharmacy: An Update for Specific Conditions
UAN 0530-0000-18-048-L01-P
AANP Rx Hours 0.0
Course Description
Multidrug therapy, also known as rational polypharmacy, has been a part of treatment approaches for chronic pain for many years. This course will review the concept of rational polypharmacy as it applies to the treatment of migraine, neuropathic pain, and musculoskeletal pain conditions.
Charles E. Argoff, MD, CPE
8:30a - 9:30a - Evidence-Based Approaches to Chronic Pain Management: Time to Reconsider the Benefit of Technophilism?
UAN 0530-0000-18-037-L01-P
AANP Rx Hours 0.0
Course Description
Americans are obsessed with all that is technical, yet technologically-focused approaches to chronic pain management are not necessarily the most effective approaches. Despite their perceived promise, unimodal approaches such as medications, surgery, spinal cord stimulation, intrathecal opioid pumps, and various other interventional approaches are not necessarily the most effective ways to treat chronic pain. Primary care physicians, when overwhelmed by these patients, are apt to refer them either to interventionalists or surgeons prematurely, resulting in myriad unnecessary injections and surgeries--with iatrogenic complications associated with both. This presentation will emphasize the potential benefits of considering referral of patients with chronic pain to physiatrists--who are the pain specialists with the broadest armamentaria for treating the biopsychosocial complexities of these conditions.
Michael E. Schatman, PhD, CPE, DASPE
9:30a - 9:40a - Break & Exhibits
9:40a - 10:40a - Product, Disease Awareness, Medical Information Program*
Breakfast will be served.
Sponsored by Teva, Stephen H. Landy, MD, FAHS, FAAN
10:40a - 11:40a - Recent Advances in Opioid Abuse Deterrent Formulations
UAN 0530-0000-18-201-L01-P
AANP Rx Hours 0.0
Course Description
In 2017 the United States declared the opioid crisis as a public health emergency. The growing awareness of opioid related harms began much earlier and active efforts have been ongoing for over the last 10 years. Although the healthcare system has little impact on the illegal manufacturing, distribution, and abuse of illicit opioids, the healthcare system can positivity take steps to reduce the abuse of legitimate medical opioids. Many misconceptions exist regarding prescription opioid abuse and positive solutions will occur when specific problems are addressed, such as drug diversion and the way people abuse opioids. This course will review abuse mitigation strategies with particular focus on the technological enhancement to reduce abuse, especially the diversion, of prescription opioids, their process for obtaining FDA approval as abuse-deterrent opioids and a review of current and possible future technologies.
This presentation is supported by an unrestricted educational grant from Daiichi-Sankyo, Inc.
Jessica Geiger-Hayes, PharmD, BCPS, CPE
11:40a - 12:00p - Faculty Q&A
12:00p - 12:10p - Break & Exhibits
12:10p - 1:00p - Lost in Translation: Making Sense of Clinical Treatment Guidelines
UAN 0530-0000-18-040-L01-P
AANP Rx Hours 0.0
Multiple clinical treatment guidelines have been published regarding headache and pain management. However, many have questioned the benefit of such clinical guidelines for the treatment of individual patients. This course will review key published treatment guidelines for migraine, interventional pain management, chronic opioid use, neuropathic pain, and chronic low back pain. The faculty will review the relevant guidelines and discuss their strengths and critical weaknesses when using such guidelines to actually treat people.
Charles E. Argoff, MD, CPE
1:00p - 1:50p - Reefer Madness Revisited
UAN 0530-0000-18-398-L01-P
AANP Rx Hours 0.0
Course Description
Medical, and recreational, marijuana serve as sources of great confusion to patients and clinicians alike. A culture of "neuromysticism" around medical marijuana has arisen, leaving patients and clinicians alike confused regarding what constitutes "medical" marijuana. A part of this confusion is related to the poor quality of the available research on safety and efficacy, which are due, in part, to the restrictive scheduling of the drug. This lecture will focus on what we know, and what we don't know, about the efficacy and safety of medical cannabinoids. Specific recommendations regarding the safest and most effective use of medical marijuana as part of a pain management armamentarium will be provided.
Michael E. Schatman, PhD, CPE, DASPE
1:50p - 2:40p - Relax, All Antispasmodics Are the Same....Right?
UAN 0530-0000-18-244-L01-P
AANP Rx Hours 0.8
Course Description
Antispasmodics are commonly used in managing pain from muscle spasms, cramping, and sometimes hiccups, but they aren't a one-size-fits-all medication. Certain antispasmodics are for smooth muscle, others are for skeletal muscle. Some are more sedating. The aim of this session is to provide a high level review of the different classes and types of antispasmodics and their place in therapy. The discussion will include pharmacokinetic profiles, side effects, and dosing pearls for the different muscle relaxers. Participants should leave the presentation with a better understanding of the appropriate place of antispasmodics in therapy and be more "relaxed" when choosing one, knowing that they are customizing their patient's care by matching the symptom to the appropriate medication.
Jessica Geiger-Hayes, PharmD, BCPS, CPE
*Not certified for credit.
