Monday, November 27, 2017

Lunchtime Listen: The Opioid Epidemic

key words:  medication review, opioid crisis, pain management, non-pharm options, the Surgeon General's Call to Action about the Opioid Epidemic, public health crisis, lunchtime listen audiovisual



Today's Lunchtime Listen recommendation, "Opioid Overdose Epidemic:  A Call to Action" is an audiovisual presentation, supported by the federal Joint Pain Education Project (JPEP), has several statistics about the opioid prescription increase, what the opioid epidemic is, side effects of opioids (pain sensitization, poor sleep) etc.  It mentions the 2016 U.S. Surgeon General's Call to Action about the Opioid Epidemic.    length of video:  about 26 minutes.

While the video is a module intended for prescribing practitioners, it has good information for non-prescribing practitioners to understand when talking with your prescribing colleagues about what you offer as non-pharm pain management therapy options for patients.

"1/4 of patients on long-term use opioids for chronic pain struggle with opioid use disorder"
"In 2014, accidental deaths from opioids exceeded accidental deaths from motor vehicle accidents"

After minute 25, the summary:
"#1.  DO NOT PRESCRIBE OPIOIDS as a FIRST LINE TREATMENT" 
Instead, it is recommended primary care providers consider which non-opioid and non-pharm therapies are appropriate.  
Here's a quick guide about what non-pharm therapies are commonly used in pain programs and how to refer created by several integrative medicine national organizations:  Moving Beyond Medications


Blogposts related to opioid medications and non-pharm options
Calculating Morphine Equivalent Dose
Medication Review and ROS:  Opioid Medication Side Effects
The Autumn 2017 White Paper:  Acupuncture's Role in Solving the Opioid Epidemic
Metrics and Pain Management:  Using the DVPRS as your Pain Scale



More Lunchtime Learning Recommendations
Launching an Integrative Health Program in a Medical Center 
Integrative Medicine Leadership:  Lori Knutson's "Leading Simply in a Complex System" 
The Complexity of Acupuncture Research in just 10 minutes
Samueli Institute's On Human Flourishing series
Research Review:  Key Studies to Understand when Discussing Pain Management with a Physician


If you have found this blog and its posts useful, contribute $5 or $25 today to support this resource (blog and website).  Thank you.  If you or your business/program want to sponsor or co-sponsor a specific project, like the Webinar Series, contact me.  


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Tuesday, November 21, 2017

In November, the Chum Salmon Run: Update on the HH Project Work

key words:  project update, fundraising, opioid crisis, online courses

Here in the Pacific Northwest, we have several "runs" of salmon.  Last week I chaperoned a school field trip for my daughter's class where we travelled to Twanoh State Park, where the Olympic mountains meet the southern portion of the Hood Canal. See quick video of it here.

Time for the monthly progress update.   I continue to learn more about the Teachable platform for hosting online courses as we finish up the beta-testing phase of the Workers’ Comp Documentation Toolkit:  (East Asian Medicine) Practitioner’s Perspective.  I designed this course for the WA L&I Acupuncture Pilot Participants to be successful in transitioning to this style of clinical work and the state workers’ comp system of documentation and reimbursement.

I have continued to post short clips of my Hospital Handbook Project work in the blog.  (The book manuscript has more comprehensive information.)   Recently have posted a series of posts related to the current opioid crisis.  The following posts are useful for the patient or patient advocate: 
And these posts are intended for the practitioner:
If you missed it, you can still listen (or watch, when there is video), a recommended Lunchtime Learning series from the related blogposts or from the YouTube playlist.

Our Facebook Page is growing.  Please “like” our page and rate it (if you like the information).  You can also send me messages/email through the Hospital Handbook Project Facebook page.
Book progress--I am going through edits of the manuscript and learning more about self-publishing process every month.



“Gratitude makes sense of our past, brings peace for today, and creates a vision for tomorrow.” –Melody Beattie

Tuesday, November 14, 2017

The White Paper, Acupuncture's Role in Solving the Opioid Epidemic

key words:  research literacy, acupuncture for pain relief, acupuncture for pain management, non-pharm pain management options, opioid epidemic, cost-effectiveness of acupuncture, the acupuncture analgesic mechanism, acupuncture and neuroplasticity

"The United States is facing a national opioid epidemic, and medical systems are in need of non-pharmacological strategies that can be employed to decrease the public’s opioid dependence." 

"Acupuncture is an effective, safe, and cost-effective treatment for numerous types of acute and chronic pain. Acupuncture should be recommended as a first line treatment for pain before opiates are prescribed, and may reduce opioid use."

In September 2017, the white paper, Acupuncture's Role in Solving the Opioid Epidemic:  Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management, was published by The Joint Acupuncture Opioid Task Force, chaired by Bonnie Bolash, MAc.

This white paper is just 15 pages long and incredibly well-referenced (21 pages long when including references section).  You can look at a copy on Evidenced-based Acupuncture's website.

This work was a collaboration of the following national and international organizations:  The American Society of Acupuncturists (ASA), The American Alliance for Professional Acupuncture Safety (AAPAS), The Acupuncture Now Foundation (ANF), The American TCM Association (ATCMA), The American TCM Society (ATCMS), and the National Federation of TCM Organizations (NFTCMO).

All the topics in the paper are supported by research in the end notes/reference section.
I highlighted some topics with a related quote below.  Check out the full paper here.


For anyone asking, how does acupuncture work?  The paper states,
 "mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives." 

Is acupuncture cost-effective?
"...acupuncture’s cost-effectiveness could dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding the development of opioid addiction that requires costly care, destroys quality of life, and can lead to fatal overdose."

Who recommends it?
"Acupuncture has been recommended as a first line non-pharmacologic therapy by the FDA, as well as the National Academies of Sciences, Engineering, and Medicine in coping with the opioid crisis. The Joint Commission has also mandated that hospitals provide non-pharmacologic pain treatment modalities." [section 4]
"Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacological treatment options, and acupuncture stands as the most evidence-based, immediately available choice to fulfill these calls.  Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, and neonatal intensive care units to treat a variety of pain seen commonly in hospitals." 

Acupuncture and neuroplasticity

"Acupuncture is effective for the treatment of chronic pain involving maladaptive neuroplasticity" and "acupuncture has the capacity to reverse adverse neuroplastic changes" [section 3]

Source:  The September 2017 white paper, Acupuncture's Role in Solving the Opioid Epidemic:  Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management
scientific journal citation:
Fan AY, Miller DW, Bolash B, Bauer M, Faggert S, He H, Li YM, Matecki A, Camardell L, Koppelman MH, Stone J, McDonald J, Meade L, Pang J.  Acupuncture's Role in Solving the Opioid Epidemic:  Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management --White Paper 2017. J Integr Med. 2017; 15(6): 411-425.  http://dx.doi.org/10.1016/S2095-4964(17)60378-9

Simultaneously published in Meridians:  Journal of Acupuncture and Oriental Medicine, winter 2018.  www.meridiansjaom.com

Related blogposts
Calculating Morphine Equivalent Dose
Medication Review:  Discerning Side Effects of Opioid Medications
37 Attorney Generals Push Incentive Programs for Non-Pharm Pain Management Therapies
Sept 2017 update on Joint Commission's Pain Management Standard
The Field of Acupuncture Research in 10 Minutes
FDA Pain Management Guideline Recommends Acupuncture
Lunchtime Listen:  the Opioid Epidemic
Metrics and Pain Management, using a Validated Pain Scale

Useful Infographic on Non-Pharm Pain Relief Options for a PCM
Moving Beyond Medications:  Non-Pharm Approaches to Pain Management and Well-Being, a one-page infographic for PCMs.  This is a collaborative work by several national integrative medicine groups.



Thursday, November 2, 2017

Professional Practice: Discerning Medication Side Effects from Symptoms and Signs


Medication Review and Review of Systems:  Side Effects of Opioid Medications
10.28.2017
Key words:  medication review, documentation standards, professional practice (OPPE), opioids, MEQ, medication side effects, workers’ comp, pain management

Why do you need to know?
It is important and useful for an EAMP to consider the side effects of a patient’s medications.  This helps, when going through the assessment, including the Review of Systems (ROS), to discern what is a side effect from a medication (branch or twig) vs. what is endemic to constitution or specific condition (root and/or earlier branch). 

What is the source of the following information?
The August 2017 CDC online training based on the January 2016 CDC Guidelines on Safe Opioid Prescribing, “Applying CDC’s Guideline for Prescribing Opioids” https://www.cdc.gov/drugoverdose/training/overview/index.html

Common side Effects of Opioid use
Constipation
Dry mouth
Drowsiness
Nausea
Confusion
Vomiting
Tolerance/loss of medication effectiveness
Physical dependence
Decreases ability to safely operate equipment
Sexual dysfunction

Red Flags—Be Wary of Opioid Medication + Nervous System Depressants
Benzodiazepines
Drinking alcohol
Why is this a red flag? 
These combinations [opioid + benzodiazepine or opioid + drinking alcohol] can quickly lead to respiratory depression (slowed and stopped breathing)

Serious Risks Associated with Opioid Use
Death
Opioid use disorder
Respiratory depression
Decreased ability to safely operate a vehicle
Unintentional ingestion by household members/others (children)
Overdose

What Conditions Make People at Extra High Risk for Adverse Events or Death d/t Overdose when taking Opioids, according to the 2016 CDC Guideline?
If they have a history of:
Overdose
Any sleep disorders
Renal or hepatic (liver) problem
Alcohol or substance use problem
Age:  65+
Pregnancy (pregnant women)
If they currently have one of the following:
Depression
Alcohol or substance use
Prescribed over 50 MME/day
Taking benzodiazepines
Treated with methadone

Reference for the above information:
Source:  The 2016 CDC Guidelines on Safe Opioid Prescribing.  For the related CEU training, go to the CDC course, Applying CDC’s Guideline for Prescribing Opioids  

Useful Infographic when Communicating with PCM Colleagues about Non-Pharm Pain Relief Options
Moving Beyond Medications: Non-Pharm Approaches to Pain Management and Well-Being, a one-page infographic for PCMs, a collaborative work by several national Integrative Medicine groups.

Related Blogposts
Calculating Morphine Equivalent Dose (MEQ)
Metrics and Pain Management, using a Validated Pain Scale

More about sleep disturbance as a side effect of opioid medications, see Sleep disturbance in patients taking opioid medication for chronic back pain, published 2016 in the journal Anaesthesia by Robertson and Purple et al.

If you found this information useful, please consider contributing to this resource at our website.  Thank you.

copyright Megan Kingsley Gale
Do not reproduce without the author's written permission

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