AOCOPM 2025 Midyear Educational Conference-C2 - Prescribing Opioids in the Age of Fentanyl Part II

Video Transcription

Video Summary

The lecture covers comprehensive insights into opioid use for pain management, emphasizing the balance of risks and benefits. Opioids like morphine remain highly effective for acute pain and surgical contexts, but the goal is to restore patient functionality rather than induce euphoria. Key strategies include hitting opioid doses hard and fast for acute pain, then tapering within a week to prevent dependence, particularly in younger patients. Chronic pain management with opioids is controversial and often ineffective, with alternative multimodal therapies encouraged.<br /><br />Risks such as addiction, dependence, overdose (especially from fentanyl contamination), and side effects like opioid-induced constipation are highlighted. Early detection and intervention for substance use disorder (SUD) are critical, involving validated screening tools, urine drug testing, and patient education including signed informed consent. Collaborative, patient-tailored pain plans with clear functional goals improve outcomes and reduce adversarial dynamics.<br /><br />Special considerations pertain to patients on addiction treatments like buprenorphine or naltrexone, requiring nuanced pain control approaches. Providers are urged to partner with certified addiction specialists and apply motivational interviewing for patient engagement. Legal and regulatory frameworks influence prescribing practices, mandating thoughtful risk management. The ongoing fentanyl epidemic parallels historic substance crises, underscoring the need for informed, multidisciplinary responses to optimize safety and efficacy in opioid-based pain treatment.

Keywords

Dr. Bobby Pillowby

environmental health

occupational medicine

JP-5 jet fuel spill

Joint Base Pearl Harbor Hickam

public health challenges

risk communication

opioid use

pain management

risk-benefit balance

acute pain treatment

opioid tapering

chronic pain controversy

addiction and dependence

substance use disorder screening

fentanyl epidemic