Lecture 11. Opioid Management Overview, Turan
53% of prescription opioids were found to be: taken from a friend or relative
Safe Drug Disposal: Drug Take Back site at local police stations
DisposeRx: crush up med, mix it with this thing and it becomes a gel ad its unusable
Fentanyl: 50x more potent than heroin, is often laced in other drugs
Drug OD deaths reach a record high during: COVID
Signs of OD: small, constricted pupils, losing consciousness, slow weak breathing, chocking, limp body, cold or clammy skin, discolored skin
OD Response: evaluate symptoms of OD → call 911 → naloxone → supported position → monitor response
Naloxone class: pure mu receptor antagonist
Can you give a 2nd dose of naloxone: yes
Pharmacy Practice Act: allows naloxone for purchase without a prescription in all NJ pharmacies
Good Samaritan Laws: if you are calling the police or ambulance for someone who seems to be ODing and you were also doing illegal stuff, you won’t get in trouble for it
People at risk for OD: opioid dependence, on prescription opioids or CNS depressants, household members on opioids
Treatment of OD: opioid agonist therapy (methadone or buprenorphine → reduce effects of withdrawal and cravings) OR opioids antagonist therapy (ER naltrexone) + counseling behavioral therapy
Inpatient Overdose Treatment: long-term residential treatment (6-12 months); short-term residential treatment
X Waiver Program: eliminated; anyone with prescribing capabilities can prescribe buprenorphine
First Supply: if the first supply is 5 days supply vs 30 day supply you’re less likely to get addicted
Commerical plans have a _ day limit for all initial opioids prescriptions: 5
PDMP (Prescription Drug Monitoring Plan): electronic database that tracks controlled substance prescription, gabapentin, and HGH; doctors and retail pharmacists have access (doctors should be checking it quarterly)
New Jersey Law S3A3: no need for prior auth for substance use disorder prescription drugs
When prescribing opioids, start with: immediate release
Monitoring patients on opioids: treatment plan, PDMP use, periodic and random urine drug screens; check medical records; follow-up visits, risk screening tool
Increased risk of overdose is two-fold at the dose of: 50 MME/day
2022 Guidelines: breaks down the types of pain (chronic, acute, subacute); multidisciplinary approach; the doctor has the final say
Prescriber-focused Programs: programs focused on screening and monitoring physicians prescribing (high-risk provider intervention program, 5-day limit letter, PDMP letter, prescriber newsletters, fraud waste and abuse - sus docs)
Member-focused Programs: programs focused on limiting the patients (cDUR, UM, pharmacy lock-in, retrospective DUR, controlled substance alert, opioid alert, triple therapy alert, double therapy alert, MAT and opioid overlap DUE, multiple naloxone fills, duplicate short-acting/long-acting opioid DUE, MAT adherence, 200 MME, opioids naive 50 MME, prenatal vitamin and opioid identification, stimulants and opioids
Prior authorization for ALL: new starts on long-acting opioids
53% of prescription opioids were found to be: taken from a friend or relative
Safe Drug Disposal: Drug Take Back site at local police stations
DisposeRx: crush up med, mix it with this thing and it becomes a gel ad its unusable
Fentanyl: 50x more potent than heroin, is often laced in other drugs
Drug OD deaths reach a record high during: COVID
Signs of OD: small, constricted pupils, losing consciousness, slow weak breathing, chocking, limp body, cold or clammy skin, discolored skin
OD Response: evaluate symptoms of OD → call 911 → naloxone → supported position → monitor response
Naloxone class: pure mu receptor antagonist
Can you give a 2nd dose of naloxone: yes
Pharmacy Practice Act: allows naloxone for purchase without a prescription in all NJ pharmacies
Good Samaritan Laws: if you are calling the police or ambulance for someone who seems to be ODing and you were also doing illegal stuff, you won’t get in trouble for it
People at risk for OD: opioid dependence, on prescription opioids or CNS depressants, household members on opioids
Treatment of OD: opioid agonist therapy (methadone or buprenorphine → reduce effects of withdrawal and cravings) OR opioids antagonist therapy (ER naltrexone) + counseling behavioral therapy
Inpatient Overdose Treatment: long-term residential treatment (6-12 months); short-term residential treatment
X Waiver Program: eliminated; anyone with prescribing capabilities can prescribe buprenorphine
First Supply: if the first supply is 5 days supply vs 30 day supply you’re less likely to get addicted
Commerical plans have a _ day limit for all initial opioids prescriptions: 5
PDMP (Prescription Drug Monitoring Plan): electronic database that tracks controlled substance prescription, gabapentin, and HGH; doctors and retail pharmacists have access (doctors should be checking it quarterly)
New Jersey Law S3A3: no need for prior auth for substance use disorder prescription drugs
When prescribing opioids, start with: immediate release
Monitoring patients on opioids: treatment plan, PDMP use, periodic and random urine drug screens; check medical records; follow-up visits, risk screening tool
Increased risk of overdose is two-fold at the dose of: 50 MME/day
2022 Guidelines: breaks down the types of pain (chronic, acute, subacute); multidisciplinary approach; the doctor has the final say
Prescriber-focused Programs: programs focused on screening and monitoring physicians prescribing (high-risk provider intervention program, 5-day limit letter, PDMP letter, prescriber newsletters, fraud waste and abuse - sus docs)
Member-focused Programs: programs focused on limiting the patients (cDUR, UM, pharmacy lock-in, retrospective DUR, controlled substance alert, opioid alert, triple therapy alert, double therapy alert, MAT and opioid overlap DUE, multiple naloxone fills, duplicate short-acting/long-acting opioid DUE, MAT adherence, 200 MME, opioids naive 50 MME, prenatal vitamin and opioid identification, stimulants and opioids
Prior authorization for ALL: new starts on long-acting opioids