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Delivery Problems in the Old System • Providers: Addiction providers uncomfortable treating pain Pain Management providers uncomfortable treating addiction PCPs uncomfortable treating both and PCPs prescribe the opioids Lack of training of providers in addiction Regulations surrounding opioids Perceive patients as difficult and time-consuming. • Patients Stigmatization to addiction Believe pain is primary problem not addiction Fear their pain will not be addressed Denial SUD programmatic treatment is overwhelming Not ready for treatment Many will agree to treatment in Primary Care but are reluctant to go to “Bldg. 1.”
Improvement Change: Creation of Co-occurring Disorders Clinic (CODC) • Establishment of unique clinic within Ambulatory Care Service to evaluate, treat, manage and monitor comorbid pain and addiction: High risk opioid patients • history of substance use disorder • family history of substance use disorder • younger age • psychiatric illness Noncompliant patients Complex pain regimens Prescribed high dose opioids
Page 1 and 2: Patricia Pade, MD University of Col
Page 3 and 4: Objectives • To provide a brief o
Page 5 and 6: Chronic Pain • 116 million people
Page 7 and 8: Opioid Use • Use of opioids has i
Page 9 and 10: Fatal Drug Poisoning • Between 19
Page 11 and 12: Opioid Pharmacology: How do these M
Page 13 and 14: • Tolerance: Repeated Dosing: Opi
Page 15 and 16: Brief pharmacology overview: full o
Page 17 and 18: Brief pharmacology overview: opioid
Page 19 and 20: The Use of Buprenorphine/Naloxone t
Page 21: The Problem for Veterans
Page 25 and 26: Patient population • Referrals fr
Page 27 and 28: Initial Evaluation A. PAIN Detailed
Page 29 and 30: Buprenorphine induction process •
Page 31 and 32: Study participants Participant Data
Page 33 and 34: Months Average duration of opioid u
Page 35 and 36: Number Number Number 60 40 Co-morbi
Page 37 and 38: Adjuvant Medications Na and Interve
Page 39 and 40: Ongoing monitoring for compliance
Page 41 and 42: 93/143 patients remained in treatme
Page 43 and 44: Conclusions 11. Patients with co-oc
Page 45 and 46: Office Based Opioid Treatment: Bupr
Page 47: References 1. Institute of Medicine

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