Pain Pod

Academia & Addiction | Pain Pod

Earl Simmons (DMX) gonna give it to ya, a new definition of pain that is!
 
Back in 2009, a prominent study showed that U.S. Schools of Medicine were barely covering the topic of pain management in respective curricula (weighing in at a mere 9 hours on average), which paled in comparison to numerous other medical conditions. Obviously, the rest of healthcare professional schools, that’s us in pharmacy too, had a reconning to take action and amp up the education on pain management, and of course substance use disorder (SUD), commonly referred to as addiction.
 
It's been a wild ride, and in this episode of the Pain Pod, Mark “Pain Guy” Garofoli sits down for a chat with Dr. Lucas Hill, PharmD on the intersection of Academia (the Ivory Tower) and SUD.
 
Come one, come all, to the Pain Pod!!!
 
Episode References
 
·     June 10th, 2022 Time Magazine article “Fewer Than Half of U.S. Pharmacies Carry One of the Most Effective Drugs for Opioid Abuse”: https://time.com/6186319/buprenorphine-overdoses-pharmacy-drug-treatment/
·     AACP Opioid Efforts Database Submission: https://www.aacp.org/opioid
·     APhA Institute on SUD: https://aphainstitute.pharmacist.com/
·     Chronicle of Higher Education Article: https://www.chronicle.com/article/one-university-takes-on-the-opioid-crisis/
2011 Article on U.S. Schools of Medicine 9 hours of Pain Education: https://pubmed.ncbi.nlm.nih.gov/21945594/
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To MME or Not to MME, Is There a Question? | PAIN POD

Let’s face it, when it comes to pain management, one of the most painful efforts of the last few years has involved, in one way, shape, form, or fashion: Morphine Milligram Equivalents (MMEs). As we discussed with the PharmD author of the 2022 CDC Opioid Guideline Update , there are no MME factor changes on the horizon, so just when will we have our minds wrapped around the concept?!?
 
Join the Mark “Pain Guy” Garofoli on the Pain Pod for a dynamic discussion on wrestling (yes, you read that right!), pain management, our healthcare system, and the “street” version of MMEs. Wait, there’s a street version of MMEs? Yes, yes there is, so tune in now to the Pain Pod as you’ll only utilize the edge of your seat even though ya paid for the whole seat!
 
Come one, come all, to the Pain Pod!!!
 
Episode Notes
 
Pre-2016 MME Charts Review
· Nielson S. et. al. A synthesis of oral morphine equivalents (OME) for opioid utilization studies. Pharmacoepidemiology and drug safety 2016; 25: 733–737
 2016 CDC Chronic Pain Opioid Guideline MME Chart
·      CDC Chronic Pain Opioid Guidelines: MMWR March 2016. Updated 2017.
o   Tramadol: 0.1
o   Codeine: 0.15
o   Tapentadol: 0.4
o   Morphine: 1
o   Hydrocodone: 1
o   Oxycodone: 1.5
o   Oxymorphone: 3
o   Hydromorphone: 4
o   Methadone (Up to: 20mg, 40mg, 60mg, >60mg): 4, 8, 10, 12
o   Transdermal Fentanyl: 7.2 (Divided by the # of Days Applied)
o   Transdermal Buprenorphine: 12.6 (Divided by the # of Days Applied)
o   Buprenorphine (SL or Buccal): 0.03 (for mcg calculations) or 30 (for mg calculations)
 
2015 Cat and Dog MME Article
· https://burrardvet.com/2015/04/08/pain-control-in-dogs-cats
 
2016 CDC Chronic Pain Opioid Guideline MME Chart
· CDC Chronic Pain Opioid Guidelines: MMWR March 2016. Updated 2017.
 
2022 CDC Opioid Guideline Revision Resources
· https://www.federalregister.gov/documents/2022/02/10/2022-02802/proposed-2022-cdc-clinical-practice-guideline-for-prescribing-opioids
 
2010 to 2014 MME Relative Risk of Overdose/Death
· https://i1.wp.com/face-facts.org/wp-content/uploads/2017/04/Opioid-dose-vs-overdose-risk.jpg
 
Missouri Marijuana Equivalents (MMEs)
· https://north.life/demystifying-missouri-medical-marijuana-equivalency-units-mmes/
 
 
Audio Add-in’s
Let’s Get Ready to Rumble (Michael Buffer)
· https://www.youtube.com/watch?v=jgopHWACUXs
 
Cash sound
· https://www.youtube.com/watch?v=ZeET7Z1ZGlw
 
Ron Burgundy “That Escalated Quickly”
· https://www.youtube.com/watch?v=FONN-0uoTHI
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RxSummit 2022 Conference Summary | PAIN POD

https://www.rx-summit.com/
Dr. Mark Garofoli was live and in person at the 2022 RxSummit Conference which hosted anyone and everyone affiliated with and touched by our country's Drug Crisis. The "Pain Guy" spoke with many federal and state leaders (including our U.S. Drug Czar Dr. Gupta, our NIDA Director Dr. Volkow, DEA leadership, and so on), along with fellow conference presenters and attendees alike. Many of those conversations were recorded and contained within this dynamic conference summary episode of the Pain Pod!
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The Conversation with the CDC (2022 Opioid Guideline Revision) | PAIN POD

MAJOR ANNOUNCEMENT (in Pain Management)!!!
The 2022 CDC Opioid Guideline Revision (from 2016)!!!
Join the Mark “Pain Guy” Garofoli on the Pain Pod with special guest Dr. Christopher Jones, PharmD, DrPH, MPH from the CDC for a dynamic discussion on the 2022 CDC Opioid Guideline Revision. No questions avoided, no topic left behind, as Mark and Chris review all aspects of this incredibly important advancement in pain management.
You may want to listen to this episode twice, if not ten times!!!
Come one, come all, to the Pain Pod!!!
2022 CDC Opioid Guideline Revision Resources
• https://www.federalregister.gov/documents/2022/02/10/2022-02802/proposed-2022-cdc-clinical-practice-guideline-for-prescribing-opioids
• Email: opioids@cdc.gov
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Thug Drugs: Stimulants | 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)! Grab your Cup of Joe and sit back, or better yet, work out, go for a jog, as this episode will pump, you, UP!
From Caffeine to Cocaine with a jolt of Meth, the PAIN GUY on the PAIN POD will discuss legal and illicit stimulants 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 Breaking Bad, The Wire, and maybe even Scarface for the 222nd time (only pharmacists will get the pun there!). 
Come one, come all, to the Pain Pod!!!
FreeCE Substances of Abuse Specialty Pharmacist (SASP) Certificate
https://www.freece.com/Programs/SeriesCertification/ab66a419-b5e5-458b-9494-0acb6af1be92
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
2005 Combat Meth Act & State Pseudoephedrine Restrictions
https://www.deadiversion.usdoj.gov/meth/cma2005_general_info.pdf
https://odcp.ky.gov/Pages/Cold-Allergy-Medication-Restrictions.aspx
Wasping
https://amp-livescience-com.cdn.ampproject.org/c/s/amp.livescience.com/65954-wasp-spray-overdose-meth.html
https://abcnews.go.com/Health/dangerous-drug-trend-called-wasping-combines-meth/story?id=54068422
Methgators!!!
https://time.com/5627237/tennessee-flush-drugs-meth-gators/
Illicit Substances Resources
Erowid
DEA Reports
Drugs of Abuse
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
Blue Light
Drug Forum
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The Least of Us in Dreamland | PAIN POD

What do Mexico, drugs, society, the Bible, and whiskey have in common? Join us on this episode of the PAIN POD, as Mark “Pain Guy” Garofoli chats with Sam Quinones, author of “Dreamland” and “The Least of Us”, with the later having just released in October 2021. It’s often hard to see the forest within the trees, but Sam clears the fog for all of us to whittle it down on how to provide patient care for those in pain and/or with addiction. Come one, come all, to the Pain Pod!!!
Sam Quinones
https://samquinones.com/
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
FreeCE Substances of Abuse Specialty Pharmacist (SASP) Certificate
https://www.freece.com/Programs/SeriesCertification/ab66a419-b5e5-458b-9494-0acb6af1be92
CDC Opioid Guideline Updated Draft for Public Comment
https://www.regulations.gov/docket/CDC-2022-0024/document
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Painful Poly Pharmacy | PAIN POD

On this episode of the PAIN POD, Mark “Pain Guy” Garofoli will chat with Dr. Eric Christianson, a nationally recognized pharmacology expert, about drug interactions with particular attention in the pain management realm. CYP-450, of course, Serotonin Syndrome, we’ll give the down and dirty on explain what all the hub bub is about, and might even have a conversation for our snowbirds out there and everyone else who enjoys grapefruit juice! Considering drug interaction database flag every medication known to mankind, and yet with completely different recommendations, it’s best to hear it from the source as to how in the world to best help our patients in pain. Listen in, right here, right now, on the Pain Pod. Come one, come all, to the Pain Pod!!!
MedEd101
https://www.meded101.com/
Real Life Pharmacology (Grapefruit Juice Interaction Podcast Episode)
https://www.reallifepharmacology.com/grapefruit-juice-interactions/
AGS Beers List (2019)
https://geriatricscareonline.org/toc/american-geriatrics-society-updated-beers-criteria/CL001
Chicago Tribune Drug Interaction Secret Patient Article (2016)
https://www.chicagotribune.com/investigations/ct-drug-interactions-pharmacy-met-20161214-story.html
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OTC Pain Meds | PAIN POD

On this episode of the PAIN POD, Mark Pain Guy Garofoli chats with Dr. Laura Meyer-Junco, PharmD, BCPS, CPE, an international expert on Over-the-Counter (OTC) self-care pain management, about the complexities of pain medications that are readily available for anyone and everyone in our society in dollar stores, gas stations, grocery stores, hotel gift shops, and pharmacies alike. Just how much info can be crammed into one analgesic pharmacy aisle? Tons! Laura provides some pearls and pointers to help us all help others with OTC pain medications. Join the discussion right here, right now, on the Pain Pod. Come one, come all, to the Pain Pod!!!
Resources
Pediatric OTC Pain Medication Dosing
https://medlineplus.gov/ency/patientinstructions/000783.htm
Dr. Laura Meyer-Junco Bio
https://www.painweek.org/media/read/laura-meyer-junco
Pain News Network (Pain Guy’s Recent PAINWeek Poster Video Interview)
https://www.painnewsnetwork.org/
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Red Flags in the Pharmacy Law Jungle | PAIN POD

On this episode of the PAIN POD, Mark Pain Guy Garofoli will chat with Dr. David Brushwood, a world-renowned pharmacy law expert, about all things pain management, controlled substances, drug diversion, and pharmacy law. You may be sitting down listening, but it turns out you’ll only be using the edge of the seat! Corresponding legal responsibility, check. Professional conversations between prescribers and dispensers alike, check. DEA Red Flags, check. An attempted prescription from a zoo, check, wait, what? Yes, check. You name it, if it’s pharmacy law and pain management related, it’s discussed, right here, right now, on the Pain Pod. Come one, come all, to the Pain Pod!!!
DEA Red Flags Info
Prescribers
Cash only patients and/or no acceptance of worker’s compensation or insurance
Prescribing of the same combination of highly-abused medications
Prescribing the same (high) quantities of pain drugs to most/every patient
High number of prescriptions issued per day
Geographically out-of-area patient population
Dispensers
High percentage controlled to non-controlled medications
High volumes of controlled substances generally
Same Medication(s)/Quantities prescribed by the same prescriber for many patients
Large geographical distances between pharmacy, prescriber(s), and patient
Multiple patients with the same last name or address
Sequential prescription #s for highly diverted drugs from the same prescriber
Patients receiving controlled substances from multiple prescribers
Patients seeking early prescription refills paying out-of-pocket
NABP ”Red Flags” Video
https://nabp.pharmacy/initiatives/awarxe/pharmacist-resources/
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PAINWeek 21 Summary Show | Pain Pod

PAINWeek remains the US pain conference with the most expansive curriculum and is the favorite destination for frontline practitioners to enhance their competence in pain management. 
Dr. Mark Garofoli, PharmD, the host of the Pain Pod, is joined by the Public Health Pharmacist, Dr. Christina Madison, PharmD interviewing participants of the event September 7—11 at The Cosmopolitan in Las Vegas.
See omnystudio.com/listener for privacy information.
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