Curbside Consults Podcast
Published August 16, 2019
In the current era of the opioid epidemic, what role do opioid prescriptions play? With all the scrutiny physicians face when prescribing opioids, what can trainees do to be safe and thoughtful prescribers? Dr. Scott Hadland, Assistant Professor of Pediatrics at Boston University School of Medicine and on the faculty of the Grayken Center for Addiction at Boston Medical Center, helps us understand the changing landscape of opioid use, the physician’s role in the epidemic, and the resources available to help trainees become responsible, informed, and engaged prescribers.
0:17 – Introduction
1:01 – Overview of discussion
1:50 – “Waves” of the opioid crisis
4:05 – Summary of Zhu et al. Initial Opioid Prescriptions among U.S. Commercially Insured Patients, 2012–2017. NEJM March 2019.
7:17 – What does this study tell us?
7:37 – Importance of the decline of first-time opioid prescriptions
8:13 – Questions left unanswered
9:44 – Geographic variations in opioid-prescription patterns
10:26 – Pros and cons of public health measures to change opioid prescribing habits from 2012 to 2017
12:03 – Limited impact of opioid prescription rates on opioid use and overdose
14:18 – Importance of expanding access to treatment and harm reduction
16:00 – Prescribing opioids as a trainee
16:26 – Approach to prescribing pain medication for an opioid-naïve patient in pain
17:01 – What makes a safe and thoughtful opioid prescription?
17:36 – Non-narcotic and nonpharmacologic strategies for mild-to-moderate pain relief
18:17 – Considerations when an opioid is needed
19:53 – What to consider when a patient has a history of opioid use
21:59 – Available opioid prescribing resources and training programs for trainees
23:18 – Importance of addiction education in medical training
24:29 – Challenges of chronic pain treatment and fear around opioid prescribing
26:12 – Summary of discussion and resources, NEJM Knowledge+
Resources and articles discussed in the episode:
1. Zhu et al. Initial Opioid Prescriptions among U.S. Commercially Insured Patients, 2012–2017. N Engl J Med 2019.
2. Schieber et al. Trends and Patterns of Geographic Variation in Opioid Prescribing Practices by State, United States, 2006-2017. JAMA Netw Open 2019.
3. Chen et al. Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States. JAMA Netw Open 2019.
4. Dowell et al. No Shortcut to Safer Opioid Prescribing by Dowell et al. New England Journal of Medicine. N Engl J Med 2019.
5. Boston University School of Medicine. SCOPE of Pain: Safer/Competent Opioid Prescribing Education.
6. NEJM Knowledge+. Pain Management and Opioids CME.
The Curbside Consults series complements the foundational information in Rotation Prep by taking a deep dive into key clinical topics with expert clinicians and educators. These podcasts explore and critique the evidence behind clinical practice and break down statistical concepts for the busy clinical trainee.