Schedule (subject to change)
7:00a - 7:30a - Registration and Exhibits
Coffee will be served.
7:30a - 8:30a - Falling Down the Rabbit Hole: A Primer for Chronic Pain Management and Substance Abuse Disorders
UAN 0530-0000-18-038-L01-P
AANP Rx Hours 0.0
Course Description
The field of pain management has undergone a circuitous adventure, much like a rabbit hole. As the economic, mental health, and medical consequences of prescribing opioid medications have mounted, the prevailing logic regarding the usefulness of prescribing opioids for chronic pain has shifted. The widespread dissemination of opiates and the lax safety measures placed on their storage has also led to an increase in nonmedical use. Given the high level of comorbidity between opioid use disorders and chronic pain, providers' decisions about how to address treatment with patients who may have or who have been diagnosed with substance use disorders are often complex. The new CDC guidelines will require providers to assess for risk of overdose or development of a substance use disorder, and to be keenly aware of their patients' pain levels and pain management strategies when working as part of a system where opioid medications may be prescribed. Participants will learn how patient and provider education programs and communication interventions may improve outcomes in pain management. Participants will also learn how to select candidates for opioid trials, assess for risk, and initiate opioid therapy, but only after exploring nonopioid and nonpharmacological strategies.
David Cosio, PhD
8:30a - 9:30a - Product, Disease Awareness, Medical Information Program*
Breakfast will be served.
Sponsored by AstraZeneca and Daiichi Sankyo, Inc., Srinivas Nalamachu, MD
9:30a - 9:40a - Break & Exhibits
9:40a - 10:40a - 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.
Courtney M. Kominek, PharmD
10:40a - 11:40a - The Other Opioid Crisis: Fentanyl and Heroin
UAN 0530-0000-18-055-L01-P
AANP Rx Hours 0.0
Course Description
There is a significant amount of media, political, and public attention paid to the opioid crisis/opioid epidemic in the United States today. With the seemingly ever-increasing number of opioid-related overdoses and fatalities, there has been a feverish push by stakeholders to diminish the amount of opioids prescribed in order to help stem these worrisome trends. Unfortunately, there may be a lack of focus regarding the true definition and characterization of the opioid epidemic. There may also be a rush to judgment about the role of appropriately prescribed opioid analgesics in the addiction crisis we face today as well. This presentation will discuss the roles and statistics of both prescription and illicit opioids (namely heroin and fentanyl) in today's "opioid overdose epidemic" with the intention of clarifying important differences and similarities between these competing epidemics including concerns and clinical considerations specific to each of them. Additionally, this program will examine and identify how these medications and drugs share potentially tragic adverse effect profiles in many cases. However, it is important for clinicians to make sure that appropriate chronic pain patients that may be candidates for opioid analgesic therapy aren't penalized, and still get the treatment that they deserve.
Kevin L. Zacharoff, MD, FACIP, FACPE, FAAP
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 Collegium Pharmaceuticals, Jeffrey Rosenberg, MD, PhD
1:10p - 2:00p - The Gentle Art of Saying No: How to Establish Appropriate Boundaries With Chronic Pain Patients
UAN 0530-0000-18-054-L01-P
AANP Rx Hours 0.0
Course Description
Effective pain management has been deemed a human right, but some chronic pain patients perceive that to mean they are entitled to opioid analgesics for prolonged pain control. In response to these expectations, providers may feel pressured to say "Yes" and continue prescribing opioids, thereby reinforcing the patient's beliefs and reliance on medication. This has contributed to a dramatic rise in opioid analgesic misuse and deaths from prescription drug overdose. In fact, the CDC has identified opioid misuse as a "public health epidemic" and released new guidelines in March 2016. While a collaborative relationship is optimal for pain management, there may be times when a practitioner saying "No" is the best treatment. Many providers feel uncomfortable setting boundaries; however, boundary setting is important work because rights as a provider are also important. When reasonable limits are placed on a patient and the patient continues to step beyond those limits, it is imperative that providers maintain boundaries and be consistent in their message. Participants will learn about the gentle art of saying "No" and how to use a decision tree when making pain management decisions. Sample cases will be presented along with recommended treatment strategies.
David Cosio, PhD
2:00p - 2:10p - Break & Exhibits
2:10p - 3:00p - 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.
Courtney M. Kominek, PharmD
3:00p - 3:50p - The Regulatory Agency Will See You Now
UAN 0530-0000-18-056-L01-P
AANP Rx Hours 0.4
Course Description
Despite high prevalence and seemingly continuous attention, the clinical challenges associated with assessing, treating, and managing patients with chronic pain continue to persist. Many different forces are at play and responsible for this frequently frustrating situation and, as is often the case, the person with the most at risk is the patient with chronic pain. There is no deficit of opinions for possible solutions to this problem. In fact, the number of potential solutions seems to increase each year, all with the intent of helping pain care be more safe and effective, and most trying to stem the negative consequences of abuse, misuse, and diversion of prescription pain medications. Clinicians have had to juggle these good intentions along with the fear of regulatory scrutiny. This course will present and detail the variety of current regulatory forces that need to be considered in clinical practice; how they can potentially impact clinical decisions regarding chronic pain; and how they can be negotiated. A number of regulatory agencies are now "sitting at the pain management table" for the foreseeable future and it is critical to navigate the waters without sacrificing that most important stakeholder: the patient.
Kevin L. Zacharoff, MD, FACIP, FACPE, FAAP
*Not certified for credit.
