AOCOPM 2025 Midyear Educational Conference-C1 - Prescribing Opioids in the Age of Fentanyl Part I

Video Transcription

Video Summary

This lecture, presented by a Denver-based certified addiction psychiatrist, discusses the complex challenges of prescribing opioids amid the fentanyl crisis. It begins with opioid pharmacology, highlighting how opioids block pain perception via mu-opioid receptors but don’t address pain causes. The lecture emphasizes opioids’ addictive potential through dopamine reward pathways, which complicates cessation due to withdrawal and craving. The speaker outlines the historical opioid epidemic driven by overprescribing in the 1990s-2000s, which led to increased heroin use and the rise of fentanyl – a potent opioid that evades typical treatments like buprenorphine due to high receptor affinity. The presentation stresses the ongoing overdose crisis, the pervasive presence of fentanyl adulterated with substances like xylazine, and challenges in treating opioid use disorder (OUD), noting that only 25% of those needing treatment receive it.<br /><br />Alternatives to opioids for pain management include physical therapy, osteopathic manipulation, acupuncture, massage, behavioral therapy, mindfulness, supplements, heat/cold therapy, transcutaneous nerve stimulation, yoga, Tai Chi, and hypnotherapy. The lecturer advocates individualized, multimodal pain treatment plans that integrate psychological and physical aspects. Education about risks and non-opioid therapies is critical for improving patient outcomes and reducing reliance on opioids in the fentanyl era.

Keywords

chemicals in clothing

health risks

dermatologic problems

respiratory issues

toxicology assessment

textile safety

patch testing

opioid pharmacology

fentanyl crisis

addiction psychiatry

opioid epidemic

opioid use disorder

non-opioid pain management

multimodal pain treatment

overdose prevention