The management of chronic noncancer pain with opioid medications is controversial. The negative consequences have been described as a public health emergency and the efficacy of chronic opioid therapy remains a subject of significant debate. Despite recommendations that chronic opioid therapy not be utilized until other methods fail, there remains a large population of patients for whom no other therapy has been effective and a large cohort of people who have been treated for years with opioids. Many new patients are still started and maintained on chronic opioid therapy. This course describes one system’s use of clinical pharmacists incorporated into the pain management team to reduce risks. Participants will learn how the pharmacists are utilized in this team-based model. Topics covered will include the nuts and bolts about how to incorporate pharmacists into clinical management, outcomes of the model of care, DEA certification for pharmacists, billing for services, and lessons learned.

Buprenorphine was developed by UK based Reckitt & Colman Products and released in the United Kingdom in 1978. That same year, a clinical study determined that buprenorphine could be helpful in reducing cravings of pure opioids in patients with an opioid abuse disorder. Then, a separate study published in 1982 demonstrated that buprenorphine offered excellent analgesia with a blunted abuse liability. Buprenorphine is a partial agonist at the mu-opioid receptors and an antagonist at the kappa receptors. Mu-opioid receptor activity produces the analgesic effects of buprenorphine, while a strong affinity for the kappa receptors render them inactive. While initially buprenorphine was used as an anesthetic, currently it has been prescribed for the induction and maintenance in patients with an opioid use disorder. However, buprenorphine is a unique molecule with multiple applications. This presentation will provide an in-depth discussion of the history of buprenorphine and its application for pain control, opioid use disorders, and antisuicide properties in patients with chronic pain

The use of opioids to treat chronic pain has become quite contentious in recent years. Things get even more confusing when we consider adding an adjuvant analgesic in the mix. Does this reduce or heighten risk? The audience can decide where to throw spitballs when 2 practitioners debate 2 separate topics. First, is the use of cannabis plus an opioid likely to provide an enhanced clinical effect (eg, allow for opioid dose reduction and by extension, harm), make no difference, or possibly cause more harm. The second debate will evaluate the use of gabapentin plus an opioid. On one hand, we have data showing the gabapentinoids may be habituating and result in addiction. Combining gabapentin with an opioid may also increase the risk of mortality. On the other hand, rational polypharmacy, using an opioid and gabapentin, has been shown to result in superior clinical outcomes compared to either analgesic alone. So perplexing. What’s a practitioner to do? Listen to the debate and decide for yourself!