Doctor, Our New Hospice Admission is in Pain! Should I Continue that 32 mg of Buprenorphine or Not?
Substance use disorders (SUD), and especially opioid abuse disorder (OUD) with resulting overdose-related deaths, constitute one of the most significant health crises of modern times. The use of illicit synthetic opioids, heroin and misuse of prescription pain medication are reaching epidemic proportions without respect to race, ethnicity or age. These disorders are altering medicine’s practice forever and modern hospice and palliative medicine (HPM) practice. Substance use and OUD occur among seriously ill patients who receive palliative care or hospice services and may be higher than the general population. Surveys of palliative care practitioners suggest it is common to encounter or manage behaviors concerning opioid misuse. Palliative care clinicians find themselves caring for more patients with OUD, given that this patient population is at high risk for life-limiting illnesses. Palliative care clinicians must balance using controlled substances for symptom control and potentially triggering harmful outcomes using controlled substances in a susceptible population. Managing the patient with OUD in the hospice setting is now considered a core skill for palliative care physicians, but there is a lack of guidance to help clinicians in this area to enhance the skill set, a panel of pain management experts and addiction specialists will, by way of case presentation, didactics, and audience participation, enable attendees to
1. Define the current role of methadone, buprenorphine, buprenorphine-naloxone, and intramuscular naltrexone in OUD;
2. Formulate strategies for managing acute pain in the hospice setting, while minimizing risks for harm, misuse or diversion.
3. Integrate multimodal analgesia into the overall treatment plan
4. Formulate analgesic strategies based on the patient’s overall prognosis.
5. Recognize how the interdisciplinary team can address psychosocial challenges frequently encountered in patients with OUD.
Target Audience
Hospice Medical Directors
HPM Physicians
Nurses
Nurse Practitioners
Pharmacists
PAs
Professionals in Training
Learning Outcomes
Desired Outcomes:
1. Define the current role of methadone, buprenorphine, buprenorphine-naloxone, and intramuscular naltrexone in OUD;
2. Formulate strategies for managing acute pain in the hospice setting, while minimizing risks for harm, misuse or diversion.
3. Integrate multimodal analgesia into the overall treatment plan
4. Formulate analgesic strategies based on the patient’s overall prognosis.
5. Recognize how the interdisciplinary team can address psychosocial challenges frequently encountered in patients with OUD.
Disclosures
AAHPM endorses the Accreditation Council for Continuing Medical Education (ACCME) Standards for disclosure and commercial support and endeavors to ensure balance, independence, objectivity, and scientific rigor for all accredited products or programs. All who are in a position to control or influence the content of an educational activity must disclose any relevant financial relationships with ineligible companies.*Disclosure documents were reviewed for potential conflicts of interest and, if identified, were resolved prior to confirmation of participation. Only those who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this activity.
All editors, faculty and staff have disclosed no relevant financial relationships.
*An ineligible company is defined as any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by, or used on, patients.
Faculty
Eric Prommer, MD HMDC FAAHPM
Amy L Davis, DO MS FACP FAAHPM FASAM
Mary Lynn McPherson, PharmD MA MDE BCPS
Kathleen Broglio, DNP ANP-BC ACHPN CPE FPCN FAANP
Jeremy M Hurst, MD
Content Editors
Julie Bruno, MSW LCSW
Julie Tanner, BSN RN-BC CHPN
Staff
Stephanie Adams
Leah Farfan
Theresa Nissen
Julie Tanner, BSN RN-BC CHPN
Angie Tryfonopoulos
This recorded activity is a non-accredited learning resource. No CME or MOC is offered with this activity.