Clinical Track

To view PPTicon-web  PowerPoint presentations click here.

To learn more about individual breakout sessions click on the title name (updated 3-25-16):

Tuesday
Development of the Centers for Disease Control and Prevention (CDC) Opioid Prescribing Guidelines for Chronic Pain in Primary Care
What to Do After an Overdose Reversal: Engaging Patients in Addiction Treatment
Preventing Rx Opioid Abuse: The Role of Dentists
 
Wednesday
Co-Prescribing Opioids and Benzodiazepines: Risks and Recommendations
Chronic Pain and Alternative Therapies
Neonatal Abstinence Syndrome (NAS) and Universal Maternal Drug Testing

Overview
The Centers for Disease Control and Prevention (CDC) reports that U.S. healthcare providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills, and higher prescribing is associated with more overdose deaths. Clinicians are looking for ways to prescribe opioids appropriately so that they manage patients’ pain successfully and mitigate risks for abuse and harm. At the same time, clinicians are responding to public health crises associated with Rx drug and heroin abuse, such as HIV infections, Hepatitis C infections and neonatal abstinence syndrome (NAS). The Clinical Track will equip physicians, dentists and other healthcare professionals to employ the latest federal prescribing guidelines and coordinated care plans for chronic pain, consider alternative prescribing practices and chronic pain treatments, engage patients in treatment following overdose reversal, and work with special populations. Attendees will hear from clinicians, researchers and public health officials about strategies that are being proven effective or showing great promise.
Development of the Centers for Disease Control and Prevention (CDC) Opioid Prescribing Guidelines for Chronic Pain in Primary Care
Tuesday, March 29, 2016 | 11:15 am to 12:30 pm
CE certified AMA | ANCC | ACPE | ADA | AAFP
Presenters Deborah Dowell, MD, MPH
Senior Medical Advisor, Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention
 
Tamara Haegerich, PhD
Deputy Associate Director for Science, Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention
Moderator Mark D. Birdwhistell, MPA
Vice President for Administration and External Affairs, University of Kentucky HealthCare
Session Description A new CDC guideline addresses the prescribing of opioid pain relievers for chronic pain in primary care settings outside of end-of-life care. The guideline addresses: (1) when to initiate or continue opioids; (2) opioid selection, dosage, duration, follow-up and discontinuation; and (3) assessing risk and addressing harms. This presentation will review the evidence and development process behind the guideline, and summarize the clinical recommendations proposed. Implementation of the recommendations could promote safer use of opioids in clinical practice and improve patient outcomes and public health.
Learning Objectives 1. Outline the new CDC guideline for prescribing opioid pain relievers for chronic pain in primary care settings.
2. Describe the evidence and development process behind the CDC guideline.
3. Explain the potential benefits of implementing CDC’s recommendations to promote safer use of opioids in clinical practice and improve patient outcomes and public health.
4. Provide accurate and appropriate counsel as part of the treatment team.
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What to Do After an Overdose Reversal: Engaging Patients in Addiction Treatment
Tuesday, March 29, 2016 | 4:15 pm to 5:30 pm
CE certified AMA | ANCC | AAFP | GA POST
Presenters Harry Earle, MA
Chief of Police, Gloucester Township (NJ) Police Department
 
William J. Lynch, Jr., RPh
Clinical Staff Pharmacist, Kennedy Health System, and Member, Camden County Addiction Awareness Task Force
 
Elizabeth Samuels, MD, MPH
Chief Resident, Emergency Medicine Residency Program, Brown University
 
R. Corey Waller, MD, MS
Medical Director, Center for Integrative Medicine, Spectrum Health Medical Group
Moderator John J. Dreyzehner, MD, MPH, FACOEM
Commissioner, Tennessee Department of Health, and Member, Rx & Heroin Summit National Advisory Board
Session Description Recent increases in the use of naloxone to reverse the potentially fatal respiratory depression caused by heroin and other opioids have led to a reported 26,463 overdose reversals between 1996 and June 2014, according to a survey by the Harm Reduction Coalition. Given the success of community-based naloxone overdose prevention programs, many jurisdictions are equipping first responders with naloxone. While every overdose reversal is a success, some first responders have reported difficulty in motivating recipients to engage in further treatment. Without engaging in treatment, people with opioid addiction are at risk for another overdose. This session will give an overview of best practices and strategies for first responders and emergency personnel to engage persons who have experienced an opioid overdose reversal in addiction treatment. It will help you answer the question: “We administered the naloxone … now what?”

The session will examine one community’s program. In New Jersey, the Camden County Addiction Awareness Task Force has implemented a successful nasal and injection naloxone program with more than 300 saves from these administrations. However, each save has brought with it the problems of where the patients go from here, especially when seeking treatment. With increasing delays in treatment availability and patients signing out against medical advice from hospitals and first responders, the task force quickly realized the community was winning the battle but losing the war. In response, the task force developed Operation SAL (Save a Life!). This presentation will explain the program’s creation and how it is saving lives.

Learning Objectives 1. Define the need to engage persons who experience an opioid overdose reversal in addiction treatment.
2. Identify best practices and strategies for first responders and emergency personnel to engage naloxone recipients in addiction treatment.
3. Describe one community’s program for engaging naloxone recipients in addiction treatment.
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Preventing Rx Opioid Abuse: The Role of Dentists
Tuesday, March 29, 2016 | 5:45 pm to 7:00 pm
CE certified ADA
Presenters John Lindroth, DDS
Associate Professor and Director, Urgent Care Clinic, University of Kentucky College of Dentistry
 
Jeffrey P. Okeson, DMD
Professor and Director, Orofacial Pain Center, University of Kentucky College of Dentistry
Moderator J. Kevin Massey, MS
Business and Program Development Specialist, Weitzman Institute, Community Health Center, Inc., and Member, Rx & Heroin Summit National Advisory Board
Session Description This session will examine how dentists can prevent Rx opioid abuse. The American Dental Association (ADA) states that dentists have a role to play in preventing the diversion, misuse and abuse of painkilling medications, such as hydrocodone and oxycodone. The ADA plans to offer free continuing education on opioid prescribing in 2016. Dentists prescribe 12 percent of immediate-release opioids in the United States, according to an article published in JADA in July 2011. The article’s authors — a team of experts representing such organizations as the National Institute on Drug Abuse and top universities — suggested that dentists “take steps to identify problems and minimize Rx opioid abuse through greater prescriber and patient education; use of peer-reviewed recommendations for analgesia; and, when indicated, the tailoring of the appropriate and legitimate prescribing of opioids to adequately treat pain.”
Learning Objectives 1. Explain dentists’ role in preventing the diversion, misuse and abuse of Rx opioids.
2. Describe efforts to engage dentists in Rx drug abuse prevention.
3. Identify best practice guidelines for managing acute dental pains.
4. Understand best practice guidelines for managing chronic orofacial pains.
5. Provide accurate and appropriate counsel as part of the treatment team.
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Co-Prescribing Opioids and Benzodiazepines: Risks and Recommendations
Wednesday, March 30, 2016 | 12:30 pm to 1:45 pm
CE certified AMA | ANCC | ACPE | AAFP
Presenters Hooshang Shanehsaz, RPh
Director of Pharmacy, Cardinal Health, and Vice President, Delaware Board of Pharmacy
 
R. Corey Waller, MD, MS
Medical Director, Center for Integrative Medicine, Spectrum Health Medical Group
Moderator Kelly J. Clark, MD, MBA, FASAM, DFAPA
President-elect, American Society of Addiction Medicine, and Member, Rx & Heroin Summit National Advisory Board
Session Description Opioids and benzodiazepines are among the top psychoactive medication classes misused, and physicians commonly prescribe them. In 2012, more than 80 prescriptions per 100 persons in the United States were dispensed for opioids, and 35 prescriptions per 100 people are dispensed for benzodiazepines, according to the Centers for Disease Control and Prevention (CDC). When patients are prescribed medications from both classes together, the risk increases for adverse events such as respiratory depression and death. In 2010, for example, benzodiazepines were involved in one-third of the 16,651 known deaths associated with opioid overdose in the United States, based on research reported in JAMA. Combining benzodiazepines with opioid pain relievers increases the risk of a more serious emergency department visit (leading to hospitalizations and deaths), according to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA).

This session will review the risks associated with co-prescribing opioids and benzodiazepines and recommend solutions. Based on a Delaware report that incorporated data from the Delaware Prescription Drug Monitoring Program (PDMP), the first presenter will give an overview of the issues and explain how PDMPs can be used to identify patients who are at high risk to receive co-prescriptions. The second presenter will explain how to reduce the risks of co-prescribing and how to decrease or eliminate the use of benzodiazepines in high-risk populations.

Learning Objectives 1. Describe the risks associated with co-prescribing opioids and benzodiazepines.
2. Identify strategies for prescribers to reduce the harmful effects of co-prescribing opioids and benzodiazepines.
3. Explain how PDMPs can be used to detect patients who are at high risk to receive both prescriptions and identify troublesome prescribing patterns.
4. Identify strategies for prescribers to decrease and/or eliminate utilization of benzodiazepines in high-risk populations.
5. Provide accurate and appropriate counsel as part of the treatment team.
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Chronic Pain and Alternative Therapies
Wednesday, March 30, 2016 | 2:00 pm to 3:15 pm
CE certified AMA | ANCC | ACPE | APA | AAFP
Presenters Traci Green, PhD, MSC
Deputy Director, Boston Medical Center Injury Prevention Center
 
Robert Hall, MD
Corporate Medical Director, Helios
Moderator Robert L. DuPont, MD
Founding President, Institute for Behavior and Health, Inc., and Member, Rx & Heroin Summit National Advisory Board
Session Description The National Institutes of Health (NIH) reported in 2011 that chronic pain impacted more than 76 million people in the United States and accounted for more than $100 billion in annual economic costs, including healthcare expenses, lost income, and lost productivity at work and at home. Rx opioids were once considered the first-line treatment for pain. Now, with opioid use and abuse at staggeringly high levels, physicians are seeking alternative, non-narcotic pain-management methods. This session will delve deeper into concerns related to chronic pain and opioid analgesics and identify alternative therapies.

A case study will reveal that nearly all body systems can be affected by chronic pain and opioid analgesics, leading to more complications, longer recovery, prolonged pain medication usage and a higher risk of Rx drug misuse or abuse. Following the case of “Tom,” the presenter will describe these impacts, which occur even when cases are managed properly. The presenter will discuss strategies necessary to mitigate these adverse effects while focusing on the physical, psychological and functional recovery of the patient.

Next, research will be presented regarding complementary and alternative therapies for a Medicaid population with chronic pain. The presenter will show that rigorous systematic reviews provide preliminary support for the use of complementary and alternative medical (CAM) therapies for the treatment of cancer pain, and non-cancer related pain including neck/low-back pain, fibromyalgia, chronic knee pain and pediatric pain. Within a program designed to reduce emergency department (ED) overutilization, Rhode Island Medicaid introduced a focused chronic pain management pilot program in June 2012. The program targets 1,500 members with chronic pain who are high ED utilizers and offers them the opportunity to take part in an integrated evaluation and treatment approach, an interdisciplinary care team, patient self-help, behavioral health care, and traditional and complementary therapies (massage, chiropractic, acupuncture). Employing alternative therapies at this scale and with this size of a population is unprecedented. This presentation will present data from 48 qualitative interview with patients (n=24) and providers and administrators (n=24). Findings convey barriers and facilitators to participation, and attitudes toward CAM for this population, from multiple perspectives.

Learning Objectives 1. Explain the impacts of chronic pain and opioid analgesics on body systems.
2. Identify strategies to mitigate the adverse effects of chronic pain and opioid analgesics.
3. Describe findings of a chronic pain management pilot program for high emergency-department utilizers.
4. Outlines barriers and facilitators to participation in complementary and alternative therapies for chronic pain.
5. Provide accurate and appropriate counsel as part of the treatment team.
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Neonatal Abstinence Syndrome (NAS) and Universal Maternal Drug Testing
Wednesday, March 30, 2016 | 3:30 pm to 4:45 pm
CE certified AMA | ANCC | APA | NASW | AAFP
Presenters Carla S. Saunders, NNP-BC
Advance Practice Coordinator, Pediatrix Medical Group, Neonatal Nurse Practitioner, East Tennessee Children’s Hospital, and Member, Rx & Heroin Summit National Advisory Board
 
Scott L. Wexelblatt, MD
Regional Medical Director for Newborn Services, Cincinnati Children’s Hospital Medical Center
Moderator Jinhee J. Lee, PharmD
Public Health Advisor, Division of Pharmocologic Therapies, Substance Abuse and Mental Health Services Administration, and Member, Rx & Heroin Summit National Advisory Board
Session Description The National Institute on Drug Abuse reported a five-fold increase from 2000 to 2012 in the proportion of babies born with NAS. This group of problems occurs in newborns who are exposed to addictive opiate drugs while in the mother’s womb. This session will inform clinicians of how to achieve improved outcomes for these infants through early identification and intervention of at-risk infants.

From East Tennessee Children’s Hospital, a representative will identify changing trends in the presentation of babies that are born with NAS. Topics will include: recent legislative issues that impact the prevention and treatment of NAS, the role that medication replacement therapy (MRT) in the presentation of NAS, and the role of family planning and contraception for women in MRT.

From the Cincinnati Children’s Hospital, a presenter will show that universal maternal drug testing improves the identification of infants at risk for the development of NAS. Traditional screening methods underestimate in utero opioid exposure. Early identification allows physicians to observe those infants that are opioid-exposed longer in the hospital, and not discharge infants until NAS has been ruled out. With the implementation of universal maternal drug testing, the hospital identified opioid-exposed infants who would have been missed with its previous risk-based screening approach. The hospital’s standard of care of observing opioid-exposed infants for 72 to 96 hours prevented infants from premature discharge and possibly poor outcomes. The proliferation of narcotic use and abuse warrants careful evaluation of a universal testing strategy.

Learning Objectives 1. Explain a hospital program that uses universal maternal drug testing to improve identification of infants at risk for development of NAS.
2. Outline the justifications for universal maternal drug testing.
3. Describe a study that used direct clinical review to determine if early identification and intervention of pregnant mothers with addiction issues had a positive impact on outcomes of babies born with NAS.
4. Outline best practices to decrease the length of stay and medication intervention performed on infants presenting with NAS symptoms.
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The content and scheduled time of these breakout sessions are subject to change.