COMMENTARY

Opioids: Proper Prescribing and Treating Addiction

Charles E. Argoff, MD

Disclosures

July 08, 2014

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This is Dr. Charles Argoff, Professor of Neurology at Albany Medical College and Director of the Comprehensive Pain Management Center at Albany Medical Center.

We all know that chronic pain as an entity can be very difficult, very challenging to manage. As a group, individuals with chronic pain may have other comorbidities such as substance abuse and addiction disorders of various types with various substances. We pain management clinicians need help with this; not all of us have been trained in substance abuse management or even substance abuse recognition.

When taking care of people with chronic pain, many of us have found that many of these patients have issues that would be considered substance abusing-type behaviors, substance abuse disorders, even unbeknownst to them. We all need to work together, not only to address the pain but also to support each other as we address the other complications of chronic opioid therapy, for example, and chronic pain treatment itself.

Today, I want to talk about support systems that are available to us. These systems are the Providers' Clinical Support System for Opioid Therapies (PCSS-O) and the Providers' Clinical Support System for Medication Assisted Treatment (PCSS-MAT).

Providers' Clinical Support System for Opioid Therapies

Let me talk first about the PCSS-O. The PCSS-O is a 3-year grant funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT). This is a collaborative project led by the American Academy of Addiction Psychiatry and in concert with the American Dental Association, the American Medical Association, the American Osteopathic Academy of Addiction Medicine, the American Psychiatric Association, the American Society for Pain Management Nursing, and the International Nurses Society on Addictions. These organizations provide free training and educational resources about the safe and effective prescribing of opioid medications and the treatment of pain and/or opioid addiction.

The PCSS-O also provides a colleague support program. In this program, clinical experts are enlisted to provide information to clinicians about evidence-based clinical practice for prescribing opioid medications. The real focus of this project is to reach prescribers, prescribers in training, and other healthcare providers from diverse healthcare professions -- including physicians, nurses, dentists, physician assistants, pharmacists, and program administrators -- to offer free, easily accessible, evidence-based trainings in this area.

The training topics focus on safe and appropriate prescribing of opioids and provide peer support. So, again, there is a clinical support system with peer support to these prescribers. To reach the largest number of prescribers in the most cost-effective and efficient way, the PCSS-O approach provides a variety of education materials dedicated to a variety of topics within this overall area. A national training and mentoring program has been established that has been shown to help improve the health and safety of Americans with chronic pain and/or opioid-related addiction. This support system has been in effect, and the resources are excellent. There are multiple types of available resources, and I urge you to look at this and review the topics that may be of interest to you.

Providers' Clinical Support System for Medication Assisted Treatment

The PCSS-MAT is also a 3-year grant funded by SAMHSA and CSAT. The American Academy of Addiction Psychiatry, as the lead organization, has formed a collaborative effort for this project in partnership with other professional organizations of physicians involved in the care of people who have addictions, including the American Osteopathic Academy of Addiction Medicine, the American Psychiatric Association, and the American Society of Addiction Medicine. The Association for Medical Education and Research in Substance Abuse is an affiliated partner, and this collaboration allows the reach to go to nurses, social workers, and pharmacists as well.

Like PCSS-O, PCSS-MAT is a national training and mentoring project that was developed in response to what we all recognize as a prescription opioid misuse epidemic and, along with the availability of newer pharmacologic, pharmacotherapeutic options, to address opioid dependence. This is very important because, even with the best of intentions, with the best monitoring setup from the beginning, we may find that people for whom we have prescribed an opioid analgesic may develop or already have substance abuse and addiction disorders that need to be managed. These resources are very useful to help us understand what we can do, certainly from a pharmacologic perspective.

The primary goals of the grant are to enhance the prescribers' and other health professionals' knowledge, skills, and attitudes regarding the safe and effective use of medication-assisted treatment of opioid dependence and to improve the flexibility of approaches. In other words, the goals are to increase the flexibility of approaches by providers working in traditional treatment models; to allow implementation of the evidence-based medical model of addiction management; and, recognizing pharmacotherapy as the most effective strategy for pain relief, to prevent relapse to opioid dependence.

The PCSS-MAT mentoring program is available at no cost to providers, and the mentors are part of a national network of trained providers with expertise in medication-assisted treatment and clinical practice. These mentors can provide support by telephone, by email, or in person if logistically possible. Also, the PCSS-MAT provides free evidence-based resources to train clinicians and the public about medications that are used for treating opioid addiction -- including apomorphine, naltrexone, and methadone, for example -- so that we can more effectively address this public health crisis. The educational resources include clinical outline models, case vignettes, online discussions, webinars, live trainings, mentoring programs, and other clinical tools to assist practicing clinicians.

I hope that by learning about these programs and realizing that they are free resources that have been developed with much thought and collaboration, you will avail yourselves of these resources. This is a challenging area of patient management, and these resources may be quite helpful in your care of people with chronic pain who are receiving chronic opioid therapy or when you realize you are taking care of someone who has a substance abuse disorder, specifically an opioid addiction disorder.

Thank you very much for viewing this. I hope this this will be of interest to you. I am Dr. Charles Argoff from Albany Medical College.

PCSS-O: Funding for this initiative was made possible (in part) by Providers' Clinical Support System for Opioid Therapies (grant no. H79TI023439) from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily re?ect the of?cial 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.

PCSS-MAT: Funding for this initiative was made possible (in part) by Providers' Clinical Support System for Medication Assisted Treatment (1U79TI024697) 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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