By Maria A. Sullivan, MD, PhD
Associate Professor of Clinical Psychiatry, Division on Substance Abuse, Columbia University/New York State Psychiatric Institute
Module Description: In the past two decades, efforts to more aggressively manage pain have resulted in sharp rises in the prescribing and misuse of high-potency opioids. Older adults represent an increasing proportion of the total U.S. population, and up to half of older individuals have a chronic pain disorder. Older patients carry specific risks for non-adherence to narcotic analgesics, including polypharmacy, cognitive and functional impairment, and attitudes toward pain and aging. This module provides clinicians with an overall plan for pain assessment, screening for comorbid psychiatric and substance use disorders, and implementing universal precautions for opioid prescribing. Tools for minimizing risk of opioid misuse are reviewed, including risk stratification, identifying aberrant behaviors, and monitoring urine toxicology. The advantages and disadvantages of buprenorphine and methadone for management of chronic pain are considered.
Note: This online module is not designated for AMA PRA Category 1 Credit™.