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On Demand Grand Rounds: You say Pain. I say Addiction. Let's Call the Whole Thing Off.
This presentation was originally reviewed on November 19, 2024, and in person and live streamed online on November 20, 2024, from 12:00 pm - 1:00 pm ET.
The views and opinions expressed by this presenter in this lecture are their own, and do not represent the views of Sheppard Pratt.
At the turn of the 21st century, pain management became a major public health concern, recognized as the 5th vital sign in VA healthcare, while opioid prescribing for chronic pain surged, leading to a fivefold increase in morphine milligram equivalents by 2010. In 2013, the DSM-5 redefined Substance Use Disorder (SUD) criteria, excluding tolerance and withdrawal for medically prescribed opioids. As the opioid epidemic unfolded, the limitations of long-term opioid therapy for chronic pain became evident, prompting current guidelines to discourage opioid initiation in favor of non-opioid approaches. However, some patients remain on long-term opioid therapy, struggling to taper without functional improvement, raising questions about whether these cases fit under mild Opioid Use Disorder (OUD) or require a new diagnostic category. This talk will address this ambiguity, outlining a clinical decision-making framework, and exploring the need for new diagnostic approaches when opioid harms outweigh benefits.
Target Audience
This activity is intended for physicians, nurses, psychologists, social workers, counselors and other mental health professionals.
Learning Objectives
At the conclusion of this activity, attendees will be able to:
- Define the complexity of an opioid use disorder diagnosis in the setting of long-term opioid therapy (LTOT) for chronic pain
- Apply a framework for managing opioid prescribing in the context of long-term opioid therapy for chronic pain
- Recognize a current debate regarding pros and cons of a new diagnosis for “ineffective and difficulty to taper” long term opioid therapy
Sheppard Pratt’s Professional Education Program is pleased to provide Wednesdays at Sheppard Pratt free of charge as a public service to the mental health community. Your tax-deductible donations will help maintain the outstanding quality of this service.
Sheppard Pratt is dedicated to improving quality of life through mental health, special education, and addiction services for children, adolescents, adults and older adults. Our patient-centered treatment approach, combined with our legacy of clinical excellence, sets us apart from other health systems on both a local and national level. We have been ranked among the nation’s top psychiatric hospitals for 24 consecutive years by U. S. News & World Report. Founded in 1853 by philanthropist Moses Sheppard, Sheppard Pratt Health System still abides by its Quaker traditions and values.
Sheppard Pratt regularly hosts renowned speakers from across the country at our headquarters in Towson. We provide educational opportunities on subjects including psychiatric disorders, issues of behavioral health, systems-based change, mental and somatic co-morbidities, psychiatric effects on health and health outcomes, advances in neurobiology, and clinical developments in concepts underlying drug treatment of psychiatric disorders. We are accredited by the Accreditation Council of Continuing Medical Education, the Maryland Nurses’ Association, the Maryland Board of Psychology, the Maryland Board of Social Work, and the National Board of Certified Counselors.
Please send your contributions to:
Sheppard Pratt Professional Education Program
Grand Rounds Fund
6501 North Charles Street, Baltimore, Maryland 21204
Professional Education Program: 410.938.4593
Conference Center at Sheppard Pratt: 410.938.3900
This lecture was supported by Grant Number 6H79FG000999-01M001 from SAMHSA. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of SAMHSA.
About the speaker
Ellen Lockard Edens, MD is Associate Professor in the Department of Psychiatry at Yale School of Medicine. She is an associate program director of the Yale Addiction Psychiatry fellowship and serves as Co-Director of the Chronic Pain Management/Opioid Safety Clinic, a primary-care based clinic that assesses the safety and efficacy of long-term opioid therapy in the management of chronic pain.
Disclosure Statements
Sheppard Pratt holds the standard that its continuing medical education programs should be free of commercial bias and conflict of interest. In accord with Sheppard Pratt's Disclosure Policy, as well as standards of the Accreditation Council for Continuing Medical Education (ACCME) and the American Medical Association (AMA), all planners, reviewers, speakers and persons in control of content have been asked to disclose any relationship he /she has with any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 24 months. All planners, reviewers and speakers have also been asked to disclose any payments accepted for this lecture from any entity besides Sheppard Pratt, and if there will be discussion of any products, services, or off-label uses of product(s) during this presentation.
Ellen Lockard Edens, MD, reports being shareholder and advisor for Aspire365. She will not discuss any commercial products or services. She will be discussing the off-label use of buprenorphine. All relationships have been mitigated through review.
Event Planners/Reviewers Disclosures: The following event planners and/or reviewers are reported as having no financial interest, arrangement or affiliation with any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 24 months: Todd Peters, MD, Elizabeth Ryznar, MD, MSc, Louis Marino, MD, Devi Bhuyan, PsyD, Faith Dickerson, PhD, Carrie Etheridge, LCSW-C, Tom Flis, LCPC, Alfredo Sagisi, DNP, MS, RN, FACHE, Lisa E. Seldon, DNP, MSA, RN, NEA-BC, Lisa Illum, MLIS, MEd, and Jennifer Tornabene.
Physician Statement: Sheppard Pratt is accredited by The Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. Sheppard Pratt designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nurse Statement: Sheppard Pratt is approved as a provider of nursing continuing professional development by the Maryland Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. This activity provides 1.0 contact hour for nurses.
Psychologist Statement: Sheppard Pratt is authorized by the State Board of Examiners of Psychologists as a sponsor of continuing education. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CE activity. Sheppard Pratt designates this educational activity for a maximum of 1.0 contact hour for Psychologists.
Social Worker Statement: Sheppard Pratt is authorized by the Board of Social Work Examiners of Maryland to offer continuing education for Social Workers. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CE activity. This activity is approved for 1.0 contact hour in Category II credits for Social Workers.
Counselor Statement: Sheppard Pratt has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 5098. Programs that do not qualify for NBCC credit are clearly identified. Sheppard Pratt is solely responsible for all aspects of the program. This activity is available for 1.0 NBCC clock hour.
Available Credit
- 1.00 ACEP NBCC clock hours
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Category II credits for Social Workers
- 1.00 Psychologists
- 1.00 MNA Contact Hours for Nurses
- 1.00 Participation
ON DEMAND WEBINAR: FOR BEST RESULTS WATCH USING GOOGLE CHROME
Grand Rounds: You say Pain. I say Addiction. Let's call the whole thing off.
Ellen Lockard Edens, MD
Associate Professor, Department of Psychiatry
Associate Program Director, Yale Addiction Psychiatry Fellowship
Yale School of Medicine
Co-Director, Chronic Pain Management/Opioid Safety Clinic
New Haven, CT
Originally reviewed on November 19, 2024
Originally broadcast live November 20, 2024, from 12:00 pm - 1:00 pm ET.
Enduring Activity Credit Expiration Date: December 28, 2026.
Activity Time: One hour recorded webinar lecture with a 15-minute evaluation process. Total Time: 1:15.
TO EARN CONTINUING EDUCATION CREDIT FOR YOUR ATTENDANCE
On the OVERVIEW or REGISTER/TAKE COURSE tab, select the GREEN RECTANGLE, TAKE COURSE to begin.
Complete the Pretest and select NEXT in the bottom right corner of the screen. Use the NEXT button for best results.
The PowerPoint handout will be available for download.
After downloading the handout, select NEXT to begin and watch the video.
You may need to select play for the video to begin.
After the video follow the prompts to complete the posttest, evaluation, and attestation of credit.
Once you have completed all the components of the Course Progress bar, the certificate will be immediately downloadable.
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Questions? Look at our FAQ’s at https://cme.sheppardpratt.org/content/faq or Email cme@sheppardpratt.org
Required Hardware/software
Optimal System Configuration
Flash Player: Adobe Flash Player 10.1+
Browser: Firefox 3+, Internet Explorer 8.0+, Safari 4.0+, or Google Chrome 7.0+
Operating System: Windows XP+ or Mac OS X 10.4+
Internet Connection: 1 Mbps or higher
Minimum Requirements
Windows PC: 500-MHz Pentium II; Windows XP or higher; 128 MB RAM; Video Card at least 64MB of video memory; Sound Card at least 16-bit; Macromedia Flash Player 10 or higher, audio playback with speakers for programs with video content; Firefox 1.1+, Internet Explorer 7.0+, Safari 1.0+, Google Chrome, or Opera
Macintosh: Mac OS X 10.3 or higher with latest updates installed; 1.83MHz Intel Core Duo or faster; RAM: 128MB or more; Video Card: at least 64MB of video memory; Sound Card: at least 16-bit
Hardware/Software Specifications
This internet-based CME activity is best experienced using Internet Explorer 8+, Mozilla Firefox 3+, Safari 4+. This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat, Microsoft PowerPoint, and Windows Media Player.