Learning objectives:

1. Review US CDC guidelines for managing chronic pain as well as those underlying substance use disorders.
2. Review best practices in managing chronic pain utilizing pharmacological and non-pharmacological approaches.
3. Define options for treatment with long acting opioids for chronic pain as well as substance use.
4.  

Abstract:

As opioid related deaths reached new heights, those with chronic non-cancerous pain have been required to comply with ever tightening state and federal policies that make getting refills on medication difficult. Some pharmacies have stopped filling any narcotics adding to the burden of individuals living in chronic pain and dependent on opioids to function. Patients on chronic opioid treatment for pain are able to maintain their quality of life as medication allows them to participate in daily activities and carry on with daily life. When the last opioid guidelines were issued in 2016, the opioid epidemic was partially fueled by prescription opioids misuse. Today, more than half the opioid related deaths are fentanyl related and prescriptions for opioid have dropped. Many providers will not prescribing opioids to manage pain. Patients on chronic opioid treatment may have difficulty finding a provider who will prescribe their medication. Others are accused of being addicts and are turned away. This year, the CDC is preparing for a new guideline, which hopes to clarify issues raised with the 2016 version. Chronic non-cancerous pain treatment goals have evolved into get the patient off opioids” and begin a taper with consent or not. The patient may feel powerless and unheard when their provider plans an opioid taper without their consent. Despite the patients desire, the system is deaf to patient choice and quality of life issues. While opioids are not the first choice for therapy, many patient are currently stable on opioids for years. Their quality of life is productive yet many dealing with the uncertainty of providers determined to get them off an opioid. It is possible the risk will be worse as the concept of having their opioids withdrawn is terrifying. In the past few years, the number of patients who would rather choose suicide rather than live in unrelieved pain has been increasing.