Addiction, Pain, Transplant
Chronic pain is a national public health problem as outlined in the 2011 study by the national academy of medicine. At least 100,000,000 American suffer from some form of chronic pain. Until recently treatment of chronic pain with opioids was increasing at an alarming rate. The increasing prescriptions have been accompanied by an epidemic of opioid related adverse events. In 2012, for every 100 person’s in the United States, 83 opioid prescriptions and 38 benzodiazepine prescriptions were written by healthcare providers. In the emergency department, at least 17% of discharges included prescriptions for opioids. In 2012 drug overdose became the leading cause of injury related deaths in the United States, surpassing death from traffic accidents. Every day more than 115 people in the United States die from opioid overdose. The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis that affects public health as well as social and economic welfare. Roughly 21-29% of patients prescribed opioids for chronic pain misuse them. Between 8-12% develop an opioid use disorder. An estimated 4-6% who misuse prescription opioids transition to heroin. About 80% of people who use heroin first misused prescription opioids. Devastating consequences also include rising incidence of neonatal abstinence syndrome, increase in injection drug use contributing to the spread of infectious diseases including HIV and hepatitis C. This symposium will consider the most current situation with regard to the chronic pain, opioid crisis and use of medical cannabis for chronic pain. Dr. Gentry will describe the biosocial model of chronic pain, treatment options of chronic non-cancer pain, including paradigm shift in its treatment, review risk factors for adverse outcomes of opioid therapy, universal guidelines for opioid prescribing for chronic pain, aberrant drug taking behaviors, clinical effect of buprenorphine on various categories of patients with chronic pain with or without opioid use disorder and will discuss opioid tapering recommendations. Dr. Bostwick will review the use of medical cannabis for chronic pain and explain how -- even if cannabis is rescheduled -- the FDA paradigm for approving medications will hinder its endorsement for use in its botanical form. Dr. Gilliam will discuss psychosocial/rehabilitative treatment approaches for chronic pain. He will also present outcomes data from a large sample of chronic pain sufferers receiving tertiary level pain rehabilitation treatment and explore potential mechanisms of action accounting for patients’ improved outcomes.