1

2

http://tinyurl.com/6d9yxgz

3

2. http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

4

3. http://www.ncbi.nlm.nih.gov/pubmed/23031398

5

http://tinyurl.com/lrkcdql

6

http://tinyurl.com/lrkcdql

7

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129653/

8

8. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm

9

http://www.ncbi.nlm.nih.gov/pubmed/21751058

10

http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf

11

http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf

12

http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf

13

14

http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf

15

http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf

16

6. http://www.samhsa.gov/data/2k12/NSDUH115/sr115-nonmedical-use-pain-

relievers.htm

17

http://www.cdc.gov/nchs/data/databriefs/db22.pdf

18

http://tinyurl.com/mr9dttb

Y axis = Opioid Prescriptions/1000 Residents

15. Tillamook

23. Marion

36 Total Counties

19

http://preview.tinyurl.com/mza7766

Approximately 150/yr in OR.

20

21

Opioids are not the final common pathway for all chronic non-malignant pain.

22

http://tinyurl.com/lr9hwhh

23

24

DIRE: Diagnosis, Intractability, Risk, Efficacy

COMM: Current opioid misuse measure

SOAPP-R: Screener and Opioid Assessment for Patients with Pain

Naïve = < 60MED

Tolerant = > 60MED

25

DIRE: Diagnosis, Intractability, Risk, Efficacy

http://tinyurl.com/lks94bf

26

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/

27

Opioid dose conversion calculators:

http://agencymeddirectors.wa.gov/mobile.html

http://opioidcalculator.practicalpainmanagement.com/

28

http://tinyurl.com/mmazr8y

29

http://www.ncbi.nlm.nih.gov/pubmed/22213274

30

http://tinyurl.com/kzvs443

31

http://gov.oregonlive.com/bill/2013/SB384/

32

http://tinyurl.com/mb2lj6r

33

http://tinyurl.com/kpuh547

34

http://tinyurl.com/abnywac

The CDC estimates that 30% of all prescription painkillers deaths in 2010 involved

benzodiazepines.

35

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/)

36

18. http://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=5

37

http://www.oregon.gov/omb/pdfforms/materialrisknotice.pdf

38

20. http://www.oregon.gov/omb/newsletter/winter2011.pdf

39

Safety surveillance measures.

40

http://www.fda.gov/ohrms/dockets/ac/02/slides/3820s2_05_passik.ppt

41

42

43

44

http://www.ncbi.nlm.nih.gov/pubmed/14635824

45

http://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=3

46

http://www.ncbi.nlm.nih.gov/pubmed/19663620

47

http://www.ncbi.nlm.nih.gov/pubmed/23070654

48

Doctor shopping is an aberrant behavior and grounds for discharge.

49

Thanks to Dr. David Russo, Columbia Pain Management

50

http://tinyurl.com/klx8vn5

51

http://tinyurl.com/modae4l

The CDC estimates that less than 1% of all prescription painkillers deaths in 2010 involved

marijuana.

52

http://preview.tinyurl.com/k48rkys

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

53

http://preview.tinyurl.com/k48rkys

30% of heavy users co-utilize other illicit drugs.

54

http://preview.tinyurl.com/k48rkys

40% of heavy users use alcohol heavily.

55

http://preview.tinyurl.com/k48rkys

The 20% of all users consume 80% of the marijuana sold.

56

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

“

57

http://preview.tinyurl.com/lweycl7

58

http://www.ncbi.nlm.nih.gov/pubmed/24076302

59

http://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=6

2x compared to alcohol’s 9x

60

http://www.ncbi.nlm.nih.gov/pubmed/19793342

61

http://tinyurl.com/lr9hwhh

62

24. http://www.deadiversion.usdoj.gov/fed_regs/rules/2006/fr0906.htm

63

Special thanks to my reviewers for their critical input.

64

Special thanks to my reviewers for their critical input.

65

Physicians for responsible opioid prescribing. An excellent resource for responsible opioid

prescribing.

66