Addiction, Pain, Transplant
Opioid use presents an ongoing medical, social and economic challenge – whether through the mortality associated with opioid overdoses (an estimated 130 people per day, or 47,000 deaths/annually), the economic burden of prescription opioid misuse ($78.5 billion a year), criminal justice system involvement, or the increasing rates of health resource utilization.1,2 Despite efforts to limit opioid use nationwide, the rates of opioid use disorder (OUD) and associated morbidities have been steadily increasing. Accordingly, it is not surprising that the patients with OUD-related complications are presenting more frequently for medical care, often with severe complications including endocarditis, osteomyelitis or blood borne infections.
Several factors contribute to overall complexity of managing patients with OUD in the general hospital setting, and unsurprisingly, Consultation-Liaison (CL) Psychiatrists are often asked to assist in managing this complex population. The CL Psychiatrist needs to be familiar with several concepts related to opioid use disorder in the hospital setting including opioid tolerance, hyperalgesia, safe use of prescription opioids for pain, and management of medications for opioid use disorder including buprenorphine, methadone, and extended-release naltrexone. Furthermore, best treatment of the underlying psychiatric conditions, including mood disorders, anxiety, ADHD, chronic trauma and personality disorders, often arise, as do the concerns regarding safety assessment and discharge prior to completion of medical treatment.
At the end of the workshop, participants will be able to describe the necessary elements of a comprehensive approach that is needed to manage both acute pain and OUD, discuss the rationale for different pain management strategies while ensuring the stability of the patient’s recovery, and be able to identify potential aberrant behaviors associated with opioid use with strategies to best manage these behaviors.