Pain Pod

DEA Red Flags: Part 1 | Pain Pod

Mark "Pain Guy" Garofoli, PharmD, MBA, BCGP, CPE, CTTSRed Light, Green Light, GO! On this episode of the Pain Pod, we discuss the infamous DEA Red Flags, their respective color, where to find them documented, and the multitude of other general controlled substance concerns.We all have our stories, so this episode is right up everyone’s alley.Come one, come all, to the Pain Pod!!!Pain Guy• www.painguy.usPain Guy’s Practical Pain Management “Controlled Substance Concerns” Article• Garofoli MP, “Prescribing and Dispensing Controlled Substances: When to Pump the Brakes”. Practical Pain Management. 2022; 22(6).• https://www.practicalpainmanagement.com/issue202206/prescribing-and-dispensing-controlled-substances-when-to-pump-the-brakesDrug Topics Chain Pharmacies Red Flags Article• https://www.drugtopics.com/view/national-pharmacy-chain-opioid-settlements-poised-to-affect-independent-pharmacies

Geri Duty 2: Cracking Open the 2023 Beers Criteria | Pain Pod

On this episode of the Pain Pod, we discuss the intersection of pain management, our geriatric patient population, and the 2023 AGS Beers Criteria Update. Let’s face it, if you’re not geriatric (65yo or even more experienced), you hope to be one day! So, this episode is right up everyone’s alley. A discussion of Centenarians (not the Roman soldier Centurions, rather those living to be at least 100yo)! Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us 2023 AGS Beers
Criteria (Article •https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18372
JAGS • https://agsjournals.onlinelibrary.wiley.com/journal/15325415
AGS • https://www.americangeriatrics.org/
 

Geri Duty: A Geriatric Patient Care Discussion with DeLon Canterbury | Pain Pod

Guests:Mark Garofoli, PharmD, MBA, BCGP, CPE, CTTSDeLon Canterbury, PharmD, MBA, BCGPEpisode DescriptionOn this episode of the Pain Pod, we welcome Dr. DeLon Canterbury CEO of GeriatRx to discuss the intersection of pain management, our geriatric patient population, and the 2023 AGS Beers Criteria Update. Let’s face it, if you’re not geriatric (65yo or even more experienced), you hope to be one day! So, this episode is right up everyone’s alley. A discussion of Centurions (not the Roman soldiers, rather those living to be at least 100yo)!Come one, come all, to the Pain Pod!!!2023 AGS Beers Criteria (Article• https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18372 JAGS• https://agsjournals.onlinelibrary.wiley.com/journal/15325415AGS• https://www.americangeriatrics.org/ GeriatRxo https://www.geriatrx.org/ 

Thug Drugs: Opioids | Pain Pod

THUG DRUGS! With a name like that, it has to be good! Even better than Smuckers (Age old ad slogan for jelly/jam)!
From OTC and prescription opioids to controlled substance opioids, Heroin to Oxy, the PAIN GUY on the PAIN POD will discuss legal and illicit opioids in the realms of pain management, substance use disorder (addiction), and our communities, and globe for that matter.
Get ready for some homework, as you’ll definitely end up watching American Pain, Dopesick, Drugs Inc., Hamilton’s Pharmacopeia, and maybe even Lord of the Rings, wait, Lord of the Rings, yup, addiction, the entire time.
Come one, come all, to the Pain Pod!!!
Drug/Overdose Trends
• https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
• https://www.iqvia.com/insights/the-iqvia-institute/reports/prescription-opioid-trends-in-the-united-states
Illicit Substances Resources
• Erowid
• DEA Reports
o Drugs of Abuse
o National Drug Threat Assessment
• INCB (International Narcotics Control Board)
• UNODC (United Nations Office on Drugs and Crime)
• European Monitoring Centre for Drugs and Drug Addiction
• CESAR (Center for Substance Abuse Research)
• NIDA (National Institute on Drug Abuse)
• Online Blogs o Blue Light o Drug Forum

Naloxone: The High Cost of What Price | Pain Pod

Naloxone! Literally everywhere! Naloxone is now OTC, so what now??? The PAIN GUYTM will discuss all things opioid antagonists including naloxone, naltrexone, and even nalmefene in this episode of the PAIN POD! This episode is for all of society, with the usual sprinkle of pharmacology. Come one, come all, to the Pain Pod!!!
 
References
• https://www.medpagetoday.com/neurology/generalneurology/60632
• Moss, R.B., Carlo, D.J. Higher doses of naloxone are needed in the synthetic opioid era. Subst Abuse Treat Prev Policy 14, 6 (2019). • https://www.cnn.com/2018/11/06/health/naloxone-expiration-date-potency-study/index.html • Hossain MF, Rashid M, Mullins R, Davis T, Kimble C, Sarkar S; Charles “CK” Babcock. Chemical stability of naloxone products beyond their labeled expiration dates. J Opioid Manag. 2022 Jan-Feb;18(1):39-46. • Comparison of Relapse Rates Between Drug Addiction and Other Chronic Illnesses JAMA. 284: 1689-1695, 2000. • https://www.vice.com/en/article/qv7jmp/heroin-overdose-parties-are-a-dehumanizing-myth • https://naloxoneautoinjector.com/ • https://www.statnews.com/2023/03/28/opioid-overdose-naloxone-industry-profits/ • Katzman JG, Takeda MY, Bhatt SR, Moya Balasch M, Greenberg N, Yonas H. An Innovative Model for Naloxone Use Within an OTP Setting: A Prospective Cohort Study. J Addict Med. 2018 Mar/Apr;12(2):113-118. • Hatfield E, et. al. Use of low-dose naltrexone in the management of chronic pain conditions. JADA. December 2020. JADA 151(12). • https://www.reuters.com/business/healthcare-pharmaceuticals/addiction-drug-shows-promise-lifting-long-covid-brain-fog-fatigue-2022-10-18/ • https://www.painmedicinenews.com/Online-First/Article/09-21/FDA-Orphan-Drug-Low-Dose-Naltrexone/64707 • https://www.investopedia.com/ask/answers/06/orphandrugstatus.asp • https://www.statnews.com/2023/03/28/opioid-overdose-naloxone-industry-profits/

Unfit for Recovery: A Chat with Jake Nichols | Pain Pod

Remember Pain Guy’s TEDx talk “Mise en Scene: Pain, Addiction, and YOU”? It was all about the cinematic experience, right? Well on this episode of the Pain Pod, we welcome another movie enthusiast known all across our country for his countless efforts to educate and help folks improve and save lives in respect to our opioid epidemic, none other than, Jake Nichols, author of “Unfit for Recover” which released at the beginning of 2023.
 
Pain Guy couldn’t put the book down. Seriously, even Dr. Gretchen Garofoli (Pain Guy’s Wife!) noted that he couldn’t put the darn thing down, although he was done reading it within 24 hours (would’ve been less, but gotta work and have some family time of course)!
 
Come one, come all, to the Pain Pod!!!
 
Drug/Overdose Trends
https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
https://www.iqvia.com/insights/the-iqvia-institute/reports/prescription-opioid-trends-in-the-united-states
 
Jake Nichol’s Book “Unfit for Recover” can be purchased on Amazon at: https://www.amazon.com/Unfit-Recovery-Fighting-Addiction-Unforgiving/dp/B0BPVTVH6G/ref=sr_1_1?crid=SC1I222C7TQ4&keywords=unfit+for+recovery&qid=1677860166&sprefix=unfit+for+%2Caps%2C176&sr=8-1
 

Buprenorphine: The Most Misunderstood Medication of the Century | Pain Pod

Can anyone truly explain the dynamic comprehensive pharmacology of buprenorphine in 30 minutes or less? This isn’t pizza delivery folks, its pharmacology, brought to you by the Pain GuyTM! In this episode of the Pain Pod, we’ll run down the recent MAT/MATE Acts in respect to the elimination of the X-Waiver, and then dive into the pharmacological phun of buprenorphine including its synthesis, mechanisms of action, Mu receptor affinity, metabolism (half-life), max daily dose, induction/micro dosing, MME factor, ceiling effect, side effects, mcg vs mg approvals, misuse, diversion, abuse, costs, and access. Can it be done in less than a half hour? You betcha! Join Mark “Pain Guy” Garofoli on this episode of the Pain Pod. Come one, come all, to the Pain Pod!!!
DEA Letter • https://www.deadiversion.usdoj.gov/pubs/docs/A-23-0020-Dear-Registrant-Letter-Signed.pdf
MAT/MATE Acts (Presidential Ink) • https://www.pewtrusts.org/en/research-and-analysis/articles/2022/12/30/president-signs-bipartisan-measure-to-improve-addiction-treatment
Buprenorphine Pain Management Products Narrative Review • Hale M, Garofoli MP, Raffa R. Benefit-Risk Analysis of Buprenorphine for Pain Management. Journal of Pain Research. 24 May 2021 Volume 2021: 14 Pages 1359-1369.

Urine Luck! A Review of Urine Drug Monitoring | Pain Pod

Paging all urine experts, all urine experts please report to the Pain Pod! Actually, if you believe that you could benefit from a thorough discussion on the complexities of urine drug screening and testing, then “you’re in” luck! Everyone gets a cup! Everyone fills a cup! But then what? Shouldn’t a practitioner know what cross-reactants could create possible false-positives? Are there methods to “beat the system” and outsmart urine drug screenings and testings? Join us for a lively discussion on the most useful strategies for incorporating urine drug screenings, or preferably testings, into your own practice. If “you’re in” over your head, then this episode is for you! In this episode of the Pain Pod, Mark “Pain Guy” Garofoli chats through the multiple nuances of all thing’s urine in respect to patient care. Come one, come all, to the Pain Pod!!!

Breaking News: 2022 CDC Opioid Guideline Update | Pain Pod

BREAKING NEWS: The 2022 CDC Opioid Guideline Update is published!!!
 
Unless you’d like to read all 100 pages of the guideline publication on your own, you may want to start by listening to this episode at least once.
 
Join the Mark “Pain Guy” Garofoli on the Pain Pod for a dynamic dissection of the 2022 CDC Opioid Guideline Update. Not a ton of actual updates compared to the 2016 guideline, but a half dozen that every clinician needs to be aware of, along with a handful a very specific reference checks leading to rather riveting conversations in the near future for you. “Pain Guy” will review all aspects of this incredibly important advancement in pain management so that you can correlate to your own patient care, educational efforts, or whatever setting you’re in NOW.
 
You may want to listen to this episode twice, and share it will everyone (seriously, all clinicians need to listen in, and patients in pain alike)!!!
 
Come one, come all, to the Pain Pod!!!
 
2022 CDC Opioid Guideline Revision Resources
2022 CDC Opioid Guideline Update: CDC Chronic Pain Opioid Guidelines: MMWR March 2016.
http://dx.doi.org/10.15585/mmwr.rr7103a1
CDC Opioid Guideline Update Timeline: https://www.cdc.gov/opioids/guideline-update/index.html
CDC Drug Overdose Deaths Data (Including Prescription Opioids): https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
Initial Rx Opioid Duration compared to Probability of Continued Use: Shah A, et al. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017; 66: 265–269.
Opioid and Benzo Combination tripling overdose death rate: Tae Woo Park, et al. Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study. BMJ 2015;350:h2698.
2016 CDC Chronic Pain Opioid Guideline: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

PAINWeek 2022 Conference Summary | Pain Pod

Vegas Baby!!!
The vibe at PAINWeek 2022 was electric! Electricity flowing through the Cosmo Hotel and
Casino on Las Vegas Boulevard (“the strip”), similar to what’s generated by the Colorado River,
Lake Meade, and a miles and miles of electrical wires! Pain Guy was the beat on the street”
strolling through the PAINWeek presentations, exhibit hall, and Cosmo hallways chatting it up
with fellow faculty, exhibitors, and attendees alike! Dr. A.J. Gupta (an attendee), Barby Ingle
(author, speaker, and overall dynamic iPain exhibitor and attendee), Nicole Hemmenway (CEO
of our U.S. Pain Foundation), and Richard Tuorto (Pain Medicine News) join us for energized
conversations revolving around what their organizations do for healthcare professionals and
patients in pain, pain management in general, and of course, their experiences at PAINWeek
2022. Checkout this mobile mic episode of the Pain Pod as we team up with the folks of
PAINWeek to give you, Pain Pod Nation, the audio vibe of the electricity of being there in
person.
Come one, come all, to the Pain Pod (and PAINWeek 2023)!!!
Episode References
 PAINWeek: https://www.painweek.org/
 iPain (International Pain Foundation): https://internationalpain.org/
 Barby Ingle: https://barbyingle.com/
 US Pain Foundation: https://uspainfoundation.org/about-us/our-team/
 Pain Medicine News: https://www.painmedicinenews.com/
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