Concurrent Management of

Chronic Pain and Addiction

Larry C. Driver, MDUniversity of Texas Distinguished Teaching Professor,Professor, Department of Pain Medicine,Professor, Section of Integrated Ethics,The University of Texas M.D. Anderson Cancer Center,Houston, Texas

Lynn R. Webster, MDVice President of Scientific Affairs,PRA Health Sciences,Salt Lake City, Utah

September 27, 2016

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Accreditation

• The American Academy of Pain Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

• Credit Designation:The American Academy of Pain Medicine designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Speaker and Planning Committee,

Disclosures

• Jennifer Westlund, MSWDirector of Education,AAPMo No relevant financial

relationships

• Angela CaseyVP, Medical Director,PharmaCom Groupo No relevant financial

relationships

• Lynn R. Webster, MDVice President of Scientific Affairs,PRA Health Sciences

o AstraZeneca (consultant)

o Cara Therapeutics (consultant)

o Charleston Labs (advisory board)

o Egalet (advisory board)

o Depomed (travel expenses)

o Insys Therapeutics (consultant)

o Jazz Pharmaceuticals (advisory board)

o Kaleo Pharmaceuticals (advisory board)

o Marathon Pharmaceuticals (consultant)

o Merck (consultant)

o Orexo Pharmaceuticals (advisory board)

o Pfizer (advisory board)

o Proove Biosciences(advisory board)

o Trevena (advisory board)

o Shionogi (advisory board)

o Zogenix (consultant)

Speakers & Planners Planners

The contents of this activity may include discussion of off label or investigative drug uses. The faculty is aware that is their

responsibility to disclose this information.

• Larry C. Driver, MDChair, AAPM Professional Education and CME Oversight Committeeo No relevant financial

relationships

4

Target Audience

• The overarching goal of PCSS-O is to offer evidence-based trainings on the safe and effective prescribing of opioid medications in the treatment of pain and/or opioid addiction

• Our focus is to reach providers and/or providers-in-training from diverse healthcare professions including physicians, nurses, dentists, physician assistants, pharmacists, and program administrators

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Educational Objectives

• At the conclusion of this activity participants should be able to:

1. Devise a plan to incorporate risk assessment tools into clinical practice when managing patients with chronic pain.

2. Utilize information from risk assessment tools in order to stratify patients’ risk for abuse and addiction and develop a differential diagnosis.

3. Implement an individualized pain management plan for patients with addiction that addresses risk and integrates the perspectives of patients, their social support systems, and health care providers in the context of available resources.

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The recently released National Pain Strategy envisions an environment in which:

People experiencing pain would have timely access to

patient-centered care that meets their biopsychosocial needs and takes into account individual preferences, risks,

and social contexts, including dependence and addiction.

The Interagency Pain Research Coordinating Committee. National Pain Strategy. A Comprehensive Population Health-Level Strategy for Pain. 2016.

National Pain Strategy

A Comprehensive Population Health-Level Strategy for Pain

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Definition of Terms

Abuse

Use of a medication (for a medical

purpose) other than as directed or as

indicated, whether willful or

unintentional, & whether harm results or not

Any use of an illegal drug

The intentional self-administration of a

medication for a non-medical purpose,

such as altering one’s state of

consciousness, eg, getting high

A primary, chronic, neurobiological disease,

with genetic, psychosocial, & environmental factors

influencing its development & manifestations

Behavioral characteristics include one or more of the following: Impaired control over drug use,

compulsive use, continued use despite

harm, craving

Misuse Addiction

Katz NP, et al. Clin J Pain 2007;23:648-60.

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DSM-5 Opioid Use Disorder

• Severity of the disorder is based on the number of criteria endorsed:

Mild: 2 to 3 criteria

Moderate: 4-5 criteria

Severe: ≥6 criteria

• These 3 DSM-5 categories broadly correlate with:

Misuse (mild)

Abuse (moderate)

Addiction (severe)

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: APA, 2013.

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Problem

Webster LR, Webster RM. Pain Med. 2005;6:432-42.

ADRB=aberrant drug-related behavior

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Who Misuses/Abuses Opioids

& Why?

Patients with the disease of addiction

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Spectrum of Behaviors

Nonmedical users Pain patients(nonpatients)

Passik SD, Kirsh KL. Exp Clin Psychopharmacol 2008;16:400-4.

SUD=substance-use disorder

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ADDICTION

Risk Factors for Addiction

Adapted from: NIH. National Institute on Drug Abuse. Drugs, Brains, and Behavior: The Science of Addiction. NIH Pub No. 14-5605. Rev 2014.

Biology/genes Environment

Brain mechanisms

DRUG

• Genetics

• Gender

• Mental disorders

• Route of administration

• Effect of drug itself

• Tmax and Cmax

• Early use

• Availability

• Cost

• Chaotic home and abuse

• Parent’s use and attitudes

• Peer influences

• Community attitudes

• Poor school achievement

Prescriber behavior:

Improper patient selection, counseling,

& management

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Patient Risk Factors

for Opioid Abuse

Biological Psychiatric Social

• Age ≤45 years

• Gender

• Family history of drug or alcohol abuse

• Cigarette smoking

• Physical Illness

• Pain severity/duration

• Nonfunctional status due to pain

• Exaggeration of pain

• Unclear pain etiology

• Sleep disorder

• Substance use disorder

• Polysubstance use

• Preadolescent sexual abuse (in women)

• Major psychiatric disorder (eg, personality disorder, anxiety, depression, bipolar disorder)

• Psychological stress

• Prior legal problems

• History of motor vehicle accidents

• Poor family/social support

• Isolation

• Involvement in a problematic subculture

• Unemployed

• Focus on opioids

Katz NP, et al. Clin J Pain 2007;23:103-18. Manchikanti L, et al. J Opioid Manag2007;3:89-100. Webster LR, Webster RM. Pain Med 2005;6:432-42. Cheatle MD. Pain Med 2011;12:S43-8. Savage SR. Clin J Pain 2002;18:S28-38. Alturi S, Sudarshan G. Pain Physician 2002;5:447-8. Dunbar SA, Katz NP. J Pain Symptom Manage 1996;11:163-71.

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Reason Providers Fail to

Assess Risk

• Pessimism regarding treatment effectiveness

• Fears about patient sensitivity

• Perceived time constraints

Friedmann PD, et al. Arch Intern Med 2001;161:248-51.

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Assessments for Opioid

Abuse and Addiction

• Predictive tools

• Diagnostic tools

• Urine drug testing

• Prescription-monitoring programs

• Pill counts

• Include patient’s support system (eg, family and friends)

Webster LR, Dove B. Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners. North Branch, MD: Sunrise River Press. 2007.

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Limitations of

Familiar Screening Tools

• Designed to identify patients who already have problems managing substance intake

• Not to predict who may develop problems

• Not designed to screen specifically for opioid abuse

• Often take a long time to administer and require unique skills to interpret

Smith HS, Passik SD. Screening for the risk of substance abuse in pain management. In: Pain and Chemical Dependency. 1st ed. New York, NY: Oxford University Press; 2008. Webster LR, Dove B. Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners. North Branch, MD: Sunrise River Press. 2007.

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Assessment Tool Criteria

• Predictive

• Brief

• Easy to administer and interpret

• Geared to opioid abuse rather than alcohol or other substances

• Validated in patients with pain

• Applicable to a variety of clinical settings

• Self-administered

Tsuang MT, et al. Arch Gen Psych 1998;55:967-72. Smith HS, Passik SD. Screening for the risk of substance abuse in pain management. Pain and Chemical Dependency. 1st ed. New York, NY: Oxford University Press; 2008.

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Validated Risk Stratification Tools

for Opioid Misuse

Tool Description Time Diagnostic accuracy Notes

Opioid Risk Tool (ORT)

10-item patient self-report that assesses risk of ADRBs

1 min

At cutoff of >4 or unspecified, sensitivity was 0.20-0.99 & specificity was 0.16-0.88 to detect opioid overdose, addiction, abuse, or misuse (5 studies)

-

Screener and Opioid Assessment for People with Pain–Revised (SOAPP®-R)

24-item patient self-report: assesses risk of drug-related behaviors

<10 min

At cutoff of >3 or unspecified, sensitivity was 0.25 & 0.53 & specificity was 0.62 & 0.73 for detection of opioid overdose, addiction, abuse, or misuse for likelihood ratios close to 1(2 studies)

Designed to prevent patient deceptionRequire licensing agreement but no fee for clinical use

Current Opioid Misuse Measure (COMM)

17-item patient self-report: identify patients on long-term opioid therapy exhibiting ADRBs

<10 min

At cutoff of ≥10, sensitivity was 0.74 & specificity was 0.73 for detection of ADRB(1 study)

Require licensing agreement but no fee for clinical use

Diagnosis, Intractability, Risk, Efficacy (DIRE)

7-item clinician interview: predict analgesic efficacy & patient adherence with long-term analgesic therapy

<2 min

At cutoff of 13, sensitivity was 94% & specificity was 87% with poor vs good/fair adherence (1 study)

-

Chou R, et al. J Pain 2009;10:131-46. Chou R, et al. J Pain 2009;10:147-59. Washington State Agency Medical Directors' Group Interagency Guideline on Prescribing Opioids for Pain (3rd ed), 2015. CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016. Fabian LA, et al. J Addict Res Ther 2014;5:182. Belgrade MJ, et al. J Pain 2006;7:671-81.

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Validated Risk Stratification Tools

for Opioid Misuse

Tool Description Time Diagnostic accuracy Notes

Pain Assessment & Documentation Tool (PADT)

Clinician-directed interview: 4 domains to document potential ADRB during pain treatment

Few minutes

Not yet evaluated

Only small component addresses abuse risk

Cut down/Annoyed/Guilty/Eye-Opener Adapted to Include Drugs (CAGE-AID)

4-question clinician-administered tool: screen for substance abuse disorders

<5 min

Cutoff of 2: 91% sensitivity & 98% specificity in adolescents Cutoff of 1: 88% sensitivity & 55% specificity in adults Cutoff of 1 or 2: sensitivity of 0.79 & 0.70 & specificity of 0.77 & 0.85 (1 study each)

-

Addiction Behaviors Checklist (ABC)

20-item clinician-administered tool: track behaviors characteristic of opioid addiction in chronic pain patients

Described as “brief”

At cutoff of 3 or greater (using ABC data from initial visit only), sensitivity was 87.50% & specificity was 86.14% (1 study)

-

Single-item form of the Coping Strategies Questionnaire

1 question to predict opioid misuse: “It’s terrible and I feel it is never going to get better”

Very brief Highly predictive vs SOAPP-RStudy published as abstract

Chou R, et al. J Pain 2009;10:147-59. Passik SD, et al. Clin Ther 2004;26:552-61. Manchikanti L, et al. Pain Physician 2012;15:S1-65, S67-116. Couwenbergh C, et al. Subst Use Misuse 2009;44:823-34. SAMHSA. www.integration.samhsa.gov/images/res/CAGEAID.pdf. Wu SM, et al. J Pain Symptom Manage 2006;32:342-51. Gross R, et al. J Pain 2016;17:S25.

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Agreement Between Clinical

Interview & Measures of ADRB

Clinical

interview

DIRE

ORT

SOAPP

Adapted from: Moore TM, et al. Pain Med 2009;10:1426-33.

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Opioid Risk Tool (ORT)

Mark each box that applies Female Male

1. Family history of substance abuse

Alcohol

Illegal drugs

Prescription drugs

1

2

4

3

3

4

2. Personal history of substance abuse

Alcohol

Illegal drugs

Prescription drugs

3

4

5

3

4

5

3. Age (mark box if 16-45 years) 1 1

4. History of preadolescent sexual abuse 3 0

5. Psychological disease

ADD, OCD, bipolar, schizophrenia

Depression

2

1

2

1

ADD = attention deficit disorder; OCD = obsessive-compulsive disorder

• Exhibits high degree of

sensitivity and specificity

• 94% of low-risk patients

did not display an

aberrant behavior

• 91% of high-risk patients

did display an aberrant

behavior

Total score

Risk% with

aberrant behavior

0-3 Low 6%

4-7 Moderate 28%

≥8 High 91%

Webster LR, Webster RM. Pain Med 2005;6:432-42.

N=185

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Screener and Opioid Assessment for

Patients with Pain (SOAPP): V.1.0-SF (5Q)

The following are some questions given to all patients at the Pain Management Center who are on or being considered for opioids for their pain. Please answer each question as honestly as possible. This information is for our records and will remain confidential. Your answers alone will not determine your treatment. Thank you.

Please answer the questions below using the following scale:

0 = Never 1 = Seldom 2 = Sometimes 3 = Often 4 = Very Often

1. How often do you have mood swings? 0 1 2 3 4

2. How often do you smoke a cigarette within an hour after you wake up?

0 1 2 3 4

3. How often have you taken medication other than the way that it was prescribed?

0 1 2 3 4

4. How often have you used illegal drugs (for example, marijuana, cocaine, etc.) in the past five years?

0 1 2 3 4

5. How often, in your lifetime, have you had legal problems or been arrested?

0 1 2 3 4

Please include any additional information you wish about the above answers. Thank you.

To score the SOAPP V.1.0-SF, add ratings of

all questions:

A score of ≥4 is considered positive

Sum of questions

SOAPP indication

4 +

<4 -

SOAPP is available in 3 formats: 5Q, 14Q, & 24Q

PainEDU. Screener and Opioid Assessment for Patients with Pain (SOAPP)® Version 1.0-SF. www.painedu.org/load_doc.asp?file=SOAPP_5.pdf

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Risk Stratification

Lower Risk Moderate Risk Higher Risk

Primary care patientsPrimary care patients with

specialist support Pain specialist patients

ORT Score 0-3 ORT Score 4-7 ORT Score ≥8

No past or current history of substance use disorders

No family history of past or current substance use disorders

No major or untreated psychopathology

Consistent UDT results

Consistent PDMP results

Mild to moderate pain

May be a past history of substance use disorders

May be a family history of problematic drug use

May have past or concurrent psychopathology

Not actively addicted

Usually consistent UDT results

Consistent PDMP results

Mild to severe pain

Active substance use disorders

Major, untreated psychopathology

Poor social support

Actively addicted

Inconsistent UDT results

PDMP multiple prescribers

Moderate to severe pain

Gourlay DL, et al. Pain Med 2005;6:107-12. Webster LR Webster RM. Pain Med 2005;6:432-42.

ORT=Opioid Risk Tool; PDMP=Prescription Drug Monitoring Program; UDT=urine drug testing

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Behaviors Concerning for Addiction:

Spectrum of Yellow to Red Flags

Portenoy RK. J Pain Symptom Manage 1996;11:203-14.Passik SD, et al. Oncology (Williston Park) 1998;12:517-24.

○ Requests for increased opioid dose

○ Requests for specific opioid by name, “brand name only”

○ Unsanctioned dose escalation or other noncompliance with therapy on 1 or 2 occasions

○ Nonadherence with other recommended therapies (eg, physical therapy)

○ Resistance to change therapy despite adverse effects (eg, over-sedation)

○ Deterioration in function at home and work

○ Multiple dose escalations or other noncompliance with therapy despite warnings

○ Nonadherence with monitoring (eg, pill counts, urine drug testing)

○ Multiple “lost” or “stolen” opioid prescriptions

○ Illegal activities (eg, forging prescriptions, selling prescription opioids)

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Organic mental syndrome Personality disorder Chemical coping Depression/anxiety/

situational stressors

Differential Diagnosis:

Aberrant Drug-Taking Behavior

Addiction

Pain-relief seeking & substance-use

disorder

Criminal intent (diversion)

Pain-relief seeking

Other psychiatric diagnosis

Webster LR, Dove B. Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners. North Branch, MD: Sunrise River Press. 2007.Passik SD, Kirsh KL. Curr Pain Headache Rep 2004;8:289-94.

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Discussing Possible Addiction

• Give specific and timely feedback why patient’s behaviors raise your concern for possible addiction, eg, loss of control, compulsive use, continued use despite harm

• Remember patients may suffer from both chronic pain and addiction

• May need to “agree to disagree” with the patient

• Benefits no longer outweighing risks

“I cannot responsibly continue prescribing opioids as I feel it would cause you more harm than good”

• Always offer referral to addiction treatment

• Stay 100% in “Benefit/Risk” mindset

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When to Refer to an

Addiction Medicine Specialist

• When a patient:

Is using illicit drugs

Is experiencing problems with other prescription drugs

− eg, benzodiazepines

Has an addiction or abuse to alcohol

Agrees they have an opioid addiction and wants help

Has a dual or a trio diagnosis of pain, addiction, and psychiatric disease

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Chronic Pain Patient

with Addiction

• BMI 32

• History of substance use Drinks 5-6 shots liquor daily

Frequent cannabis use

Occasional cocaine or crack use when available

Past use of heroin and methamphetamine on 2-3 occasions

• Acute lumbar disc herniation age 40 Epidural steroid injection, no surgery

• Progressively worsening low back pain over last 4-5 years Pain now radiating into lower extremities, R>L

Imaging: diffuse lumbar spondylosis and degenerative disc disease

• Management No indications for surgery, occasional procedural interventions

Chronic pharmacotherapy (non-opioid)

Occasional prescription of opioid analgesic

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Chronic Pain Patient

with Addiction

• Discussion points

Strategies for chronic pain management in face of worsening pain and extensive substance use history

− Will occasional opioid use evolve to possible chronic opioid therapy?

o Risk management for opioid therapy?

− Non-opioid alternatives?

30

Patient with Cancer Pain &

Concurrent Drug Addiction

• History of substance use

50 pack-years smoker

4-5 glasses wine daily

Frequent cannabis use

• Laryngeal cancer, treated with:

Chemoradiation therapy

Surgical resection

• Discussion points

Cancer pain management during:

− Active cancer treatment?

− Survivorship?

Risk management and ongoing monitoring?

31

Opioid Addicted Patient

with Acute Pain

• History of substance abuse and addiction

Nicotine

Alcohol

THC

Cocaine

Prescription opioids

• Motorcycle accident

Bilateral femur fractures

2⁰ / 3⁰ burns on legs

• Treatment

Underwent ORIF fracture repair

Requires daily burn dressing changes

ORIF=open reduction and internal fixation

32

Opioid Addicted Patient

with Acute Pain

• Discussion points

Pain management:

− Following postoperative ORIF fracture repair

− For daily burn dressing changes

As patient recovers over time, what are considerations for ongoing pain management balanced with addiction management?

33

Interdisciplinary Multimodal Approach

is Key to Successful Pain Management

The NPS and IOM recommend a

multimodal, integrated, interdisciplinary, biopsychosocial

approach to pain that is tailored to individual

patients’ needs

The Interagency Pain Research Coordinating Committee. National Pain Strategy. A Comprehensive Population Health-Level Strategy for Pain. 2016. Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press; 2011.

34

Disincentives to spend sufficient time evaluating and managing the medically and behaviorally complex condition of chronic pain, due to poor reimbursement

Barriers to Comprehensive

Treatment

Insufficient education and training of primary care and specialist physicians who commonly care for patients with chronic pain

Insufficient numbers of interdisciplinary pain treatment centers, due to inadequate reimbursement by third-party payers for these services

Leaves pain

patients out

in the cold

35

Barriers Driven By

Reimbursement Policies

•Lack of reimbursement for:o Time to conduct comprehensive

patient interviews, assessment, and education

o Time spent planning and coordinating care

o Specialty care services

o Interdisciplinary practice

o Psychosocial and rehabilitative services

oComplementary and integrative medicine

oMedication management and monitoring

o Pain self-management programs

•Lack of access to medicationsoRationing and medication

shortages

oHigh cost of abuse-deterrent formulations

o Prior authorization

o Fail first protocols

Current payment practices tied to the fee-for-service system tend to

cover mono-therapy and interventional procedures instead of integrated, interdisciplinary, patient-

centered programs and services that conform to the biopsychosocial

model of careInstitute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press; 2011. The Interagency Pain Research Coordinating Committee. National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain. 2016. A position statement from the American Academy of Pain Medicine. Minimum Insurance Benefits for Patients with Chronic Pain. 2014. Schatman ME, Webster LR. J Pain Research 2015;8:153-8.

36

• Expand pain and addiction education in medical and dental schools and CME programs

• More expansive insurance coverage and provider reimbursement for non-opioid evidence-based treatments, including:

Behavioral health (eg, CBT, mindfulness)

Physical and occupational therapy

Interventional procedures

Complimentary approaches

• Payment reform to foster interdisciplinary care

At least 3-months coverage for an interdisciplinary evaluation and treatment program for people with severe pain that has failed or is not expected to respond to first-line therapies, and is not expected to resolve in the foreseeable future

• NIH funding to discover safer, more effective alternatives to opioids

Advocacy: Affecting Health Care

on Behalf of Our Pain Patients

Overcoming

obstacles

American Academy of Pain Medicine Letter to President Obama. July 18, 2016. A position statement from the American Academy of Pain Medicine. Minimum Insurance Benefits for Patients with Chronic Pain. 2014.

37

Conclusions

• Risk of ADRBs, misuse, abuse, and addiction must be assessed when managing patients with chronic pain

• Risk assessment can be implemented into clinical practices

• Utilize information from risk assessment tools to stratify patients’ risk for abuse and addiction and develop a differential diagnosis

• Implement an individualized pain management plan for patients with addiction that addresses their risk and integrates the perspectives of patients, their social support systems, and providers in the context of available resources

• A position statement from the American Academy of Pain Medicine. Minimum Insurance Benefits for Patients with Chronic Pain. 2014.

• Alturi S, Sudarshan G. Pain Physician 2002;5:447-8. • AAPM Letter to President Obama. July 18, 2016. • American Psychiatric Association. Diagnostic and

Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: APA, 2013.

• Belgrade MJ, et al. J Pain 2006;7:671-81.• Cheatle MD. Pain Med 2011;12:S43-8. • Chou R et al. J Pain 2009;10:131-46, 147-59. • Couwenbergh C, et al. Sub Use Misuse 2009;44:823-34.• Dowell D et al. MMWR Recomm Rep 2016;65:1-49.• Dunbar SA, Katz NP. J Pain Symptom Manage

1996;11:163-71.• Fabian LA et al. J Addict Res Ther 2014;5:182. • Friedmann PD et al. Arch Intern Med 2001;161:248-51.• Gourlay DL et al. Pain Med 2005;6:107-12. • Gross R et al. J Pain 2016;17:S25.• Institute of Medicine. Relieving Pain in America: A

Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: NAP; 2011.

• Katz NP et al. Clin J Pain 2007;23:103-18. • Katz NP et al. Clin J Pain 2007;23:648-60.• Manchikanti L et al. J Opioid Manag 2007;3:89-100. • Manchikanti L et al. Pain Physician 2012;15:S1-65. • Manchikanti L et al. Pain Physician 2012;15:S67-116. • Moore TM et al. Pain Med 2009;10:1426-33.• NIDA. Drugs, Brains, and Behavior: The Science of

Addiction. NIH Pub No. 14-5605. Rev 2014.

• PainEDU. Screener and Opioid Assessment for Patients with Pain (SOAPP)® Version 1.0-SF.

• Passik SD et al. Clin Ther 2004;26:552-61. • Passik SD et al. Oncology 1998;12:517-24. • Passik SD, Kirsh KL. Curr Pain Headache Rep

2004;8:289-94.• Passik SD, Kirsh KL. Exp Clin Psychopharmacol

2008;16:400-4.• Portenoy RK. J Pain Symptom Manage 1996;11:203-14.• SAMHSA.

www.integration.samhsa.gov/images/res/CAGEAID.pdf• Savage SR. Clin J Pain 2002;18:S28-38. • Schatman ME, Webster LR. J Pain Research

2015;8:153-8.• Smith HS, Passik SD. Screening for the risk of

substance abuse in pain management. In: Pain and Chemical Dependency. 1st ed. New York, NY: Oxford University Press; 2008.

• The Interagency Pain Research Coordinating Committee. National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain. U.S. Department of Health and Human Services; 2016.

• Tsuang MT et al. Arch Gen Psych 1998;55:967-72. • Washington State Agency Medical Directors' Group

Interagency Guideline on Prescribing Opioids for Pain 3rd ed, 2015.

• Webster LR, Dove B. Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners. North Branch, MD: Sunrise River Press. 2007.

• Webster LR, Webster RM. Pain Med. 2005;6:432-42.• Wu SM et al. J Pain Symptom Manage 2006;32:342-51.

References

39

PCSS-O Colleague Support

Program and Listserv

• PCSS-O Colleague Support Program is designed to offer general information to health professionals seeking guidance in their clinical practice in prescribing opioid medications.

• PCSS-O Mentors comprise a national network of trained providers with expertise in addiction medicine/psychiatry and pain management.

• Our mentoring approach allows every mentor/mentee relationship to be unique and catered to the specific needs of both parties.

• The mentoring program is available at no cost to providers.

• Listserv: A resource that provides an “Expert of the Month” who will answer questions about educational content that has been presented through PCSS-O project. To join email: pcss-o@aaap.org.

For more information on requesting or becoming a mentor visit:

www.pcss-o.org/colleague-support

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PCSS-O is a collaborative effort led by American Academy of Addiction Psychiatry (AAAP) in

partnership with: Addiction Technology Transfer Center (ATTC), American Academy of Neurology

(AAN), American Academy of Pain Medicine (AAPM), American Academy of Pediatrics (AAP),

American College of Physicians (ACP), American Dental Association (ADA), American Medical

Association (AMA), American Osteopathic Academy of Addiction Medicine (AOAAM), American

Psychiatric Association (APA), American Society for Pain Management Nursing (ASPMN),

International Nurses Society on Addictions (IntNSA), and Southeast Consortium for Substance

Abuse Training (SECSAT).

For more information visit: www.pcss-o.org

For questions email: pcss-o@aaap.org

Twitter: @PCSSProjects

Funding for this initiative was made possible (in part) by Providers’ Clinical Support System for Opioid Therapies (grant no.

5H79TI025595) from SAMHSA. The views expressed in written conference materials or publications and by speakers and

moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade

names, commercial practices, or organizations imply endorsement by the U.S. Government.

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