In November 2022, the CDC published an updated Clinical Practice Guidelines for Prescribing Opioids for Pain. The new CDC material contains 12 recommendations and associated implementation considerations focusing on four main topics: (1) whether to initiate opioid therapy, (2) drug and dose selection, (3) duration of initial opioid therapy and conducting follow-up, and (4) risk mitigation strategies. The CDC materials ARE voluntary and ARE NOT legally mandated.

Nevertheless, main street practitioners need to understand how the CDC materials relate to their professional licensing board rules and guidelines, and how to incorporate CDC implementation considerations into patient encounters and medical record documentation. Using sample patient encounters, attendees will examine all 12 CDC recommendations, evaluate how to relate them to their state licensing board material, and use them to individualize patient care and improve medical record documentation. As part of this course, attendees will be provided a quick reference guide to support the review of their charting practices with the goal of improving their documentation of opioid prescribing considerations to actively demonstrate quality patient pain care.

Will I lose my license? Just how far is too far? No one ever enjoys answers to difficult patient care scenarios being the cookie cutter answers of “differs patient to patient”. Yet, just how does one prescriber and dispense medications while adhering to the Controlled Substance Act “corresponding responsibility” while accounting for reasonable patient variations?

Join us for a dynamic discussion on how to provide patient care while staying within the parameters of law described by many yet clarified in black and white as the “DEA Red Flags."

Learning Objectives:

• Recall the “DEA Red Flags” for prescribers and dispensers.
• Explain how to respectfully proceed when medication misuse, abuse, or diversion is suspected and/or confirmed.
• Recognize appropriate actions for prescribers and dispensers related to the federal mandated corresponding responsibility to ensure the legitimate medical purpose and usual course of practice for any given prescription.

Reductions in opioid prescribing has been a key component to improving opioid safety with tremendous progress over the past decade.  This has not always been carried out in a person-centered compassionate way, however, leading to serious and potentially catastrophic outcomes.  

This session will discuss how to taper appropriately and engage in shared decision-making with patients and the ethics of nonconsensual or forced opioid tapers/discontinuations and emerging data on harms.  This will be an interactive session with specific examples of complicated cases often seen by frontline providers to make the course more applicable for attendees.

Who amongst us, as clinicians, have managed patients with chronic, long-term pain resistant to any and all treatment modalities tried? What do we do in those situations? Refer out to a different pain management group, again? Try the same medication already tried and failed by the patient to see if, by some miracle, it will work? Or, do we just give up and counsel the patient that their pain is too difficult to treat? That there isn’t anything else we can do?

This seminar intends to set up the discussion of how we handle these types of complicated cases when there appears to be no end in sight. We will review assessment strategies to verify what exact modalities have failed in the past, as not all failures are created equally. We will also delineate between ‘last line’ treatment modalities that may be used when all others fail. Some specific treatments of interest include IV lidocaine infusions, last line anticonvulsants, pain pumps, and NMDA antagonists.

This lecture will empower clinicians of all types to do as Rocky; continue fighting and refuse to go down.

Learning Objectives:

• Demonstrate assessment strategies when a patient with chronic pain thinks there is no other treatment options left.
• Describe differences, mechanisms, and clinical evidence of last line anticonvulsants as they relate to pain management.
• Define the mechanisms, clinical evidence, and dosing strategies of intravenous lidocaine infusions as it relates to specific neurologic pain conditions.

Drug diversion has been a longstanding issue in the healthcare realm with up to 15% of healthcare workers engaged in illicit drug use, but there are now additional factors to consider like the worsening opioid epidemic, the impact of the COVID-19 pandemic, staff burnout, and staffing shortages. For over half of diversion cases, incidents occur for a year or more before detection. Advances have been made over the last few years in available surveillance tools to identify diversion sooner, with some providing real-time feedback to leaders.

This session will review best practices on preventing diversion of controlled substances, share lessons learned from the creation of a robust diversion surveillance program leveraging artificial intelligence, corresponding metric development and reporting for stewardship efforts, and introduction of a standardized corrective action plan focused on appropriate controlled substance handling.

Learning Objectives:

• Outline best practice recommendations around diversion and available tools for controlled substance surveillance
• Design a diversion surveillance team and corresponding metrics with limited resources
• Develop a standardized corrective action algorithm and associated policy for controlled substance mishandling, diversion, and poor practices

Is there value to providing medications at low doses when the analgesic benefit may not be realized but the patient is still exposed to the risks of the medications? Are high doses of alternatives safer than low doses of opioids? Should opioids be avoided all together? Two experienced clinicians from different practice settings (palliative care and acute inpatient care) will embrace the controversies and involve the audience in an interactive game of Family Feud where the presenters will use case-based vignettes to present the evidence behind the "top answers on the board" as it relates to pertinent analgesic-related questions.

The purpose is to provide some clarity to analgesic doses in areas where it might not be so clear and prepare those in attendance with the knowledge to tackle come of these problems at their practice sites.

Are you putting it all on red or all on black? Prescribing and managing opioids does not have to be a game of roulette. Join Jess, Jeff and Tim as we discuss choosing the right patient, the right medication and the right plan for opioid therapy.

In addition to identifying clinical scenarios for opioid use, we will describe strategies and assessment for patient selection, monitoring for side effects and compliance based on accepted guidelines.

Main street practitioners face typical business and workflow challenges as they try to incorporate telemedicine into daily medical practice. These challenges increase when controlled substances are part of a patient's treatment plan.

This course will address the current legal-regulatory landscape - federal and state - involving controlled substance prescribing and telemedicine. Attendees will actively work through several case examples to evaluate the prescriber's conduct and to illustrate critical documentation requirements for demonstrating proper use of telemedicine if controlled substances are prescribed through telemedicine visits.