Pain and Addiction Course Focuses on Use of Buprenorphine

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(From left) R. Corey Waller, MD, MS, Mark A. Weiner, MD, and Robert B. Raffa, PhD, listen to Howard G. Kornfeld, MD, make a point during the Pain and Addiction Course Thursday.

One of the staples of the Med-Sci Conference, the Pain and Addiction Course, received a makeover this year. The daylong session moved from presenting an overview of several topics to zero in with in-depth presentations on current uses of buprenorphine in a variety of areas, and the roles of other pain and addiction treatment strategies, from marijuana to benzodiazepines.

“We made a significant effort to change not only the content, but the way it was delivered. The content was concentrated heavily on buprenorphine as both a medication for the treatment of opioid addiction, but also the treatment for patients who have both addiction and pain,” said R. Corey Waller, MD, MS, ABAM Diplomate, Vice Chair of the Pain and Addiction Common Threads Program Committee.

“We discussed how that plays into the chronic treatment of those patients and how we guide treatment of patients in a hospital who happen to be on these medications but need treatment for surgery, delivery of child, or a number of other areas,” said Dr. Waller, Director of the Center for Integrative Medicine at Spectrum Health, Grand Rapids, Michigan.

The course opened with four presentations about buprenorphine, starting with its development in the 1960s to its molecular mechanisms to its current role in treating pain around the world. One of the leading researchers of buprenorphine, Joseph Pergolizzi, MD, Adjunct Assistant Professor at Johns Hopkins University School of Medicine, discussed how it is used to a greater degree in Europe than in the United States.

“It was nice to get a perspective about how well this medication works internationally. Its effectiveness crosses cultural boundaries really well. We talked about the ‘super-utilizer’ patients and the difficult approach with non-compliant patients with complicated pain syndromes,” Dr. Waller, said adding that presentations explained the use of clinically relevant pathways in treatment.

“We delved into this group of patients who are of interest. The super-utilizers are those 5 percent of patients responsible for 40 percent of medical costs, and a very high percentage of those have a substance use disorder.”

Other presentations focused on patients with chronic pain using marijuana, and patients treated for pain after surgery using buprenorphine-based medications.

“There is evidence and there are established pathways to treat these complicated patients with chronic pain so we don’t have to ignore them or worry as much. There are safe pathways to treat their pain as well as their opioid-use disorder,” Dr. Waller said. “It also is important to find ways to assist our hospital-based colleagues in the treatment of their patients.”

The course concluded with presentations more focused on addiction issues, such as pharmacologic and non-pharmacologic treatments.

“We talked about what role benzodiazepines play and how complicated it can be to treat co-occurring disorders, especially with other controlled substances, such as benzodiazepines,” Dr. Waller said. “The research shows that there is not much place for the use of benzodiazepines.

“The integration of pharmacologics with 12-step programs becomes very important because one without the other is much less effective. When you apply both, you get this force multiplier effect. Just writing a prescription doesn’t fix the patient and just talking to them doesn’t fix them.”