# Presentation: 690093

## Education in Long-term Use of Controlled Release Opioids

- Barry Eliot Cole, MD, MPA
- Director of Education,
- American Academy of Pain Management
- Sonora, CA 95370

- American Academy of Pain Management, 2003

## Today’s Situation

- Millions of Americans suffer from significantly painful disorders that disrupt their lives
- Tens of millions of Americans lack adequate healthcare insurance, live in rural or underserved areas, have co-existing substances abuse disorders or other psychosocial issues that deny them access to available pain relieving therapies

- American Academy of Pain Management, 2003

## Why We Are Here

- Something must be done to keep substance abusers from dying
- Controlled release opioids are not *the* problem (there are no defective products per se);
- Self-destructive thinking is far more dangerous; this cannot be regulated by any agency or body
- Drug abuse policy must occur at “end user” level
- Practitioner knowledge deficits contribute to poor patient selection for opioid therapy
- Education is the preferred remedy

- American Academy of Pain Management, 2003

## Public Policy Implications from “Fixing” Prescription Drug Abuse

- Restrictive options likely lead to reduced numbers of willing providers for long-term opioid therapy
- More barriers will prevent patients in pain from receiving effective pain relieving strategies
- Increased costs will be associated with managing chronic pain and they will be passed along
- More burdensome administrative duties will be associated with monitoring & screening programs
- No improvement in current problem of under-treated pain in USA will occur

- American Academy of Pain Management, 2003

## Public Policy Implications (2)

- None of these options can
- Absolutely prevent criminal diversion
- Prevent misuse of lawful medication by ill informed patients
- Stop further deaths by overdose when abusers tamper with products or use them by routes of administration never intended

- American Academy of Pain Management, 2003

## Educational Recommendation 

*Education* is the preferred remedy
- Create a Federal pain management educational requirement that addresses the proper assessment and evaluation of pain and its potential management with long-term opioid therapy
- Consider making this a requirement for continued DEA registration

- American Academy of Pain Management, 2003

## Educational Recommendation (2)

- Education would focus on proper patient selection for opioid therapy based upon
- medical history
- substance abuse risk potential and screening
- thorough physical examination
- development of a plan of care with behaviorally measurable goals

- American Academy of Pain Management, 2003

## Educational Recommendation (3)

- obtaining informed consent
- establishing ongoing monitoring procedures
- establishing success of treatment by realizing behavioral goals and measuring outcome objectively to determine therapeutic efficacy
- complying with federal and state laws governing prescribing of controlled substances

- American Academy of Pain Management, 2003

## Role for Simulation Based Opioid Prescribing Training

- Create an environment immersing practitioners into decisions-making experiences that mimic real life
- Safely allow for the consequences of their right and wrong decisions
- Provide detailed assessments of identified gaps in knowledge

- American Academy of Pain Management, 2003

## Importance of Simulation for Opioid Prescribing Education

- When the application of principles or concepts is critical (life and death decisions)
- When many variables are involved in making good decisions
- When the consequences of making poor decisions has a high cost
*The US Military is the greatest proponent of simulation testing based on these principles!*

- American Academy of Pain Management, 2003

## Justification for Simulations

- Traditional Testing
- Doesn’t show the consequences of decision-making
- Knowledge being tested may not seem relevant to physician. “What does this have to do with me?”
- Passing tests doesn’t necessarily lead to behavioral changes

- Simulation Testing
- Shows consequences of bad decisions or lack of knowledge.
- Directs student to specific areas of need.
- Knowledge is relevant because the lack of it leads to failure.
- Most likely to change behavior on the job.

- American Academy of Pain Management, 2003

## Summary

- Working together is our only hope now
- Credentialing groups and organizations
- Federal and state law enforcement
- Professional societies
- Addiction community
- Pain sufferers
- Legislatures

- American Academy of Pain Management, 2003