CPCP: Safe Opioid Prescribing

Ishwaree Chogle, MD

Ishwaree Chogle, MD

Sophia Yuan, MD, PhD

Sophia Yuan, MD, PhD

Brandon Hoffer, M4

Brandon Hoffer, M4

So we had yet another excellent Clinical Problems in Consultation Psychiatry (CPCP) and this one is entitled “Opioid: Addiction, Withdrawal, and Guidelines for Safe Prescribing.” It was produced by two resident physicians, Dr. Sophia Yuan, MD, PhD, and Dr. Ishwaree Chogle, MD. And a fourth year medical student Brandon Hoffer also did a great job on this.

General hospital Psychiatry and Psychiatry Addictions Consultants are often called to assist in helping to diagnose and treat patients with opioid addiction. There is a lot in the news these days about this issue.

This should be an interesting CPCP post as I have an expert colleague, Dr. George Dawson, MD, who can apply his 30-plus years of experience to this complicated topic. There may be some room for remarks about the Federation of State Medical Boards’ (FSMB) role here, especially regarding the production of the book, Responsible Opioid Prescribing: A Clinician’s Guide” by Dr. Scott M. Fishman, MD.

I’ve posted about this before, including remarks about the book itself, in which I have not found evidence for bias by the author in favor of prescribing opioids. In fact, Dr. Fishman points out that the evidence for treating chronic, non-malignant pain with opioids is not great. This may lend some controversy to the presenters’ data, so we might walking the tightrope on that issue.

There is a sort of cloud cast over the FSMB as well, particularly with respect to the questions raised by congressmen about the money passed back and forth regarding the book’s production. The last I heard from one of our state congressmen, the FSMB is still the subject of an ongoing investigation by the U.S. Senate Subcommittee on Finance.Studying Responsible Opioid Prescribing

Moreover, the FSMB annoys me and many other doctors by insisting on promulgating the duplicative and burdensome Maintenance of Licensure (MOL), a wasteful project which does not embody the principle of lifelong learning as its supporters claim. I sponsored a resolution to support lifelong learning and oppose MOL at the Iowa Medical Society House of Delegates meeting in April 2013, which was co-sponsored by the Iowa Psychiatric Society. This resolution was adopted without any opposition.

I have to admit I was a bit surprised about the recommendation to use Tramadol for detoxification. That’s uncommon in my neck of the woods.

As usual, the traineed made some excellent slides to get the point across. In order to see the picture galleries of photos or powerpoint slides, click on one of the slides, which will open up the presentation to fill the screen. Use the arrow buttons to scroll left and right through the slides or up and down to view any annotations.

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