Headlines run rampant across our country’s newspapers, on the internet, and television news feeds detailing human heartbeats lost to the “opioid crisis.” The sensationalization of healthcare professionals’ roles, indirect or direct, in the overall epidemic continues to ravage our country. Tens of thousands of Americans die of illicit or diverted opioid overdoses. We as healthcare professionals must, simply must, navigate through the hysteria, review the opioid related history, and find a way to continue to improve and save the lives of our patients, for all of society. Guideline after guideline is released, but how does one make tangible changes to their actual patient care? Join our discussion for a voyage well beyond, yet including, controversial opioid related topic after topic, ranging from morphine milligram equivalents to opioid overdose risk to opioid interactions to dealing with a “wine bottle opener in every suitcase.” The sensationalized clinician baggage of the opioid crisis has never been heavier, yet healthcare professionals do have a corresponding responsibility to navigate these choppy waters like never before to provide the patient care that everyone and anyone deserves.

Headline after headline reads “The Opiate Crisis” or “The Opiate Epidemic.” Yet the headlines are dead wrong every single time. “Opioid Pandemic”? Now there we go! Prescription opioids are commonly utilized and scrutinized by every force of nature in our society. It is imperative that healthcare professionals, researchers, and even the lay public fine tune and enhance their understanding of the pharmacology behind the classification of prescription opioids as a foundational starting point. Progressing beyond classifications, one can truly respect the important pharmacodynamic and pharmacokinetic properties of prescription opioids to provide the highest quality patient care with respect to medication selection, dosage, side effects, and drug interactions. Patients deserve this and more!

“It’s only a partial agonist” they say. “How can an opioid overdose medication treat pain?” they ask. “There are multiple parts of the typical mu opioid receptor?” they also wonder. It’s the best of times, and the worst of times, as Dickens said, yet perhaps not in reference to methadone utilization. It takes 2, baby! Or even more. Mixed action opioid medications pack a 1-2 punch, or sometimes even a Buy 1 Get 4! Join us for a discussion of these “atypical opioids” including low dose naltrexone, levorphanol, tramadol, tapentadol, methadone, oliceridine, and of course buprenorphine, which may be the most misunderstood medication in the history of mankind.

Practitioners are often faced with the need to switch a patient from one opioid regimen to a different opioid regimen. This could be a change in dosage formulation, a change in route of administration, or switching to a different opioid altogether. The ability to calculate a new

opioid regimen that provides equivalent analgesic is referred to as equianalgesia. This session will review new and emerging data on opioid conversion calculations to guide these calculations. The ability to perform opioid conversion calculations safely and effectively is a critically important skill in pain management.

Pain is a common symptom in patients with serious illness or at end of life. Oftentimes, pain is severe and requires opioids to manage it. Prescribing opioids in the current landscape presents dynamic challenges in the setting of the opioid crisis and the related social and regulatory changes regarding opioid use. Palliative care patients at any stage in their disease trajectory

deserve adequate pain management as well as optimal safety when it comes to opioid prescribing. In this course, we will discuss the impact and consideration of the opioid crisis on opioid prescribing for patients receiving palliative care. Patient cases will be used to highlight best practices in opioid prescribing for patients at different points along the palliative care trajectory and with different risk factors for opioid misuse.

Opioids are a cornerstone in the management of many painful conditions. These medications are far from benign and recognition of potential safety considerations must be taken into consideration when prescribing, dispensing, administering and monitoring. This course will provide the attendee with information on side effects, adverse events, and drug interactions. There will be discussion over the mechanism or action for each of these to provide the attendee with the science answering the ‘why’ complications occur.

Challenge accepted! Our country has made numerous strides in advancing patient care and more, particularly attempting to ensure that lives within our national opioid crisis are saved and/or improved. One of those positive strides involves the FDA approval of abuse-deterrent formulation (ADF) prescription opioid medications, with the aim of preventing the transition from the misuse and/or abuse of prescription opioid medications to illicit (and possibly laced) diacetylmorphine (aka heroin). How do these formulations work, one might ask? What ADF opioid medications are not only available on the US market, but also specifically approved as an ADF opioid medication? Are these ADFs really foolproof? Well, the street chemists of our country have already accepted the challenge to be knowledgeable on all the above, now it’s our turn as healthcare professionals to get up to speed on these risk reduction entities. Put the potato batteries, M&M’s, and baking yeast aside: it’s time to get down and dirty to understand just how these ADF opioids work, and where their respective place in pain management treatment lies.

In the wake of the national prescription opioid crisis, many providers have expressed a lack of comfort in prescribing and monitoring opioid therapy. However, there is nothing mystical about

providing opioid therapy and monitoring appropriate use. A practical approach implementing systems and safeguards allows clinicians to create a funnel decreasing risk through structured monitoring. In this course, specific strategies will be discussed, including comprehensive evaluation and transfer of care, pain care agreements, state prescription drug monitoring systems, drug testing, pill counts, and naloxone. We will discuss proven strategies with broad applicability to practice and emphasize clinical pearls to successful implementation. Opioid therapy remains a reality for some patients with severe persistent pain and few alternative options; implementing these practices will allow us to focus on providing individualized care.

On average in the United States, a person dies every 7 minutes from a drug overdose; also, a baby is born dependent (not addicted) on opioids every 30 minutes. These staggering statistics involving human heartbeats silenced involve illicit substances of abuse rather than legally prescribed and dispensed opioid medications. Headlines in the US and globally decry the “Opioid Crisis,” “Opioid Epidemic,” or what may perhaps be better termed the “Opioid Pandemic,” but do we as healthcare professionals have a firm understanding of what is going on? One may ask, “Just how did we get this far in the opioid crisis?” or “What pain management treatment options do my patients have besides prescription opioid medications?” or even “How do I help patients I have inherited from other healthcare professionals?” Healthcare professionals are part of the overall supply chain of each and every prescription medication, even if the concerning risks arise once the products are transferred to another person outside of any healthcare relationship. Amongst all this opioid madness, healthcare professionals, and the rest of society, need to progress by utilizing best practices in pain management to ensure safe and

efficacious pain treatment to the highest degree possible. Sounds like the perfect time to review best practices in pain management. When? Now. And always.

It is difficult to comprehensively discuss risk management in clinical care without touching on the topic of urine drug testing. The history of drug testing in America has been largely one directed toward the goal of a “Drug-Free America” through workplace testing. By design, this testing paradigm is without clinical intent. In fact, in many ways, it is a legalistic, adversarial program designed to identify the few, amongst the many, who misuse use drugs. In this session, we will examine drug testing in a patient-centered fashion. By framing drug testing as something you do for your patients, rather than to them, participants will be able to demonstrate a basic understanding of clinical drug testing, explore current presumptive and definitive testing technologies, understand the term “medical necessity” in the context of choosing wisely when ordering UDT, and examine several clinical scenarios related to drug testing through case-based learning.

Buprenorphine is a Schedule III opioid analgesic approved in 1981 by the FDA for use by injection for acute pain. A sublingual dosage form was later developed and approved for opioid

use disorder, followed by the development of transdermal and buccal formulations specifically indicated for chronic pain severe enough to require daily, around-the-clock, long-term opioid treatment for which alternative treatment options are inadequate. As the formulations were developed, there has been increased confusion and misunderstandings of its pharmacology and clinical utility. This lecture focuses on buprenorphine as a partial μ-opioid receptor agonist and how that has been misinterpreted to imply low efficacy. Discussions will include how a partial agonist does not necessarily translate to partial or inadequate clinical efficacy compared to a traditional full μ-opioid receptor agonist, and the specific pharmacokinetics and pharmacology for the parent compound and each metabolite. Misconceptions regarding conversion to or from buprenorphine will be discussed, including various considerations for elective and emergent surgery in patients receiving buprenorphine chronically as an outpatient for a chronic pain syndrome vs those requiring it for opioid use disorder. Buprenorphine formulation transitions and variable dosage adjustments between formulations will be reviewed with a case-based example and regulatory considerations specific to the false impression that an “X” waiver is required to prescribe or dispense buprenorphine for chronic pain.

In some way, shape, form, or fashion, our world has dealt with opioids for centuries. In other words, the “War on Drugs” has been raging for centuries. Heroin was developed and intended to deal with morphine addiction. Methadone, buprenorphine, and naltrexone aim to address heroin (or really any opioid) addiction. Yet each pharmacological entity certainly comes with its own pitfalls. The first wave of the current opioid crisis observationally involved prescription opioids—whether attained via prescription or illicitly—while the second wave involved heroin, and the third wave involves fentanyl analogs and other “laced” products with heroin. Healthcare professionals need to know all opioid substances, and take them into consideration during clinical conversations reviewing for side effects and drug interactions. It’s time to roll up our sleeves and discuss opioid substances well outside the typical clinical realms yet right in front of our faces every day, as our patients and the lay public continually choose to utilize regardless of any situation.

During this session we will review the epidemiology of drug overdoses in the US caused by opioids, with specific attention to data as a result of the COVID pandemic and the rise of the use of synthetic substances, specifically fentanyl. We will define terms involved with substance use including abuse, misuse, diversion, and addiction and will review interventions for substance use disorders in an attempt to reduce harm, thus reducing overdose deaths. Finally we will discuss Recovery-Oriented Systems of Care and the concept of Recovery Capital involved in the process of patients engaging in the recovery process.

The opioid epidemic gave rise to an unprecedented number of overdose deaths. Just as some of these figures started to plateau or decline, the COVID-19 pandemic halted this progress and overdose deaths began to rise again. As many individuals who go on to abuse opioids were first prescribed these medications for pain, it is important to understand the links between pain

management and opioid use disorder. This presentation will provide an overview of the diagnostic criteria for opioid use disorder and screening tools to aid with identifying its presence in clinical settings. The interrelationships between pain management and opioid use disorder will be reviewed and evidenced-based behavioral interventions that are used to treat both pain and opioid use disorder will be presented.

Opioid use disorder is on the rise, despite the reduction of opioid prescriptions across the nation. Recent legislation has opened the door for NPs and PAs to prescribe lifesaving medications and provide access to this patient population. This session will look at the history of opioid use treatment—where we have been and where we are going. We will also look at each medication appropriate for the treatment of opioid use disorder, how to prescribe, safety information, and who each medication is appropriate for.