Cutting Through the Hype: Marijuana and CBD Oil for Pain

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AAPM 2020 Session to Explain the Risks and Benefits of Cannabis Use for Pain Treatment

Join moderator Mark S. Wallace, MD, on Friday, February 28, 11 am-12 pm, during the AAPM 36th Annual Meeting in National Harbor for a session dedicated to helping pain care providers unpack the evidence and indications for TCH/CBD treatments. Dr. Wallace is professor of clinical anesthesiology and the chair, division of pain medicine in the department of anesthesiology, UCSD School of Medicine.

SESSION DETAILS

 

Cannabis products as an alternative to opioids

In 2018, the United States opioid epidemic raged with more than 45,000 overdose deaths. Pain clinicians and patients are increasingly turning to alternative, non-opioid treatments to combat acute and chronic pain, including cannabis products. The strength of evidence to support using cannabis to treat pain is not widely understood. This session will review the available evidence and includes a talk from Dr. Wallace that specifically addresses the question of whether cannabis should be used to reduce opioid use.

Understanding the biology of the endocannabinoid system

The February 28 session will also address the biology of cannabis. David A. Edwards, MD PhD, chief of the division of pain medicine at Vanderbilt, will deliver a talk that discusses how exogenous cannabinoids are hypothesized to treat pain.

What about CBD oil for pain?

The U.S. marketplace has been flooded with CBD oil products that are promoted for all kinds of uses, including pain management. Thomas P. Pittelkow, DO MPH, assistant professor of anesthesiology in the division of pain medicine at Mayo Clinic in Rochester, MN, will speak directly to the risks and benefits of CBD oil for pain.

Registration for the meeting is live, and early-bird rates end January 8, 2020.

REGISTER NOW

 

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8:00 AM–5:00 PM Wednesday, February 26

Pharmacologic Management of Pain: Expanding the Options, Improving Outcomes (001)

A recording of this preconference course is now available in the AAPM Education Center

 ORDER NOW

The pharmacologic management of acute and chronic pain is an important aspect of most if not all clinicians’ daily practices. However, strategies aimed at optimizing the use of nonopioid analgesics while mitigating the potential risks associated with opioid use can be difficult to implement. This course will provide timely, useful, and practical information about the use of opioid and nonopioid analgesics to treat adults with acute and chronic pain. The growing and evolving controversy of the therapeutic application of cannabis and cannabis-related products is an additional question facing providers.

With pain management-leading faculty for numerous well-regarded institutions, this course will help the learner better integrate various medications from different pharmacologic classes in order to optimize a rational polypharmacy approach to managing chronic pain, including comorbid symptoms of depression, anxiety, and sleep disturbances and implementing evidence-based assessment and treatment strategies supported by recent guidelines to optimize appropriate opioid analgesic use while applying a patient-centered approach to mitigate the risks of abuse, misuse, addiction, and diversion. Strategies to help improve opioid tapering and managing opioid use disorder will be explored.

Introduction

W. Michael Hooten & Steven Stanos

Opioid Pharmacology

Jeffrey Gudin

Do the Right Thing? Navigating the 3 R’s: Recommendations, Rules, and Regulations to Manage Patients on Chronic Opioid Therapy

Halena Gazelka

Opioid Tapering and Case Presentation

Charles Argoff

Anticonvulsants for Neuropathic Pain

James Watson

Analgesic Antidepressants for Chronic Pain

Ajay Wasan

Pharmacologic Management of Pain-Related Sleep Disruption

Ajay Wasan

Topical Analgesics for Acute and Chronic Pain

Steven Stanos

Muscle Relaxers

Steven Stanos

Arachnoiditis and Aberrant Drug-Related Behavior: Management and Treatment Options

W. Michael Hooten & Steven Stanos

Rapid Fire Pharmacotherapy Review

NSAIDs for Chronic Pain

Zachary McCormick

Buprenorphine

Charles Argoff

Ketamine for Acute and Chronic Pain

W. Michael Hooten

Anticoagulant Management in Pain Medicine

Zachary McCormick

Pharmacologic Management of Migraine Headache

James Watson

Cannabinoids: From Bench to Bedside to Dispensary

Pharmacology of the Cannabinoids

Mark Wallace

Regulatory Environment of Medical Cannabis

David Edwards

Integration of Medical Cannabis into Your Clinical Practice

Grace Forde

Medical Cannabis: Dosing, Dispensaries, and Quality Control

Michelle Sexton

Learning Objectives:

  • Apply the recent epidemiological evidence related to prescription opioid abuse and misuse, prescription opioid and heroin overdose deaths, and the risks associated with concomitant benzodiazepine use.
  • Review opioid analgesic medications to better understand the potential benefits and short-comings of abuse deterrent formulations.
  • Assess and interpret aberrant drug-related behaviors and integrate risk assessment tools/strategies into clinical practice.

Commercial Support:

The AAPM 2020 preconference course Pharmacologic Management of Pain: Expanding the Options, Improving Outcomes is supported in part by an educational grant from the following commercial supporters as of February 7, 2020: Collegium Pharmaceutical, Inc.

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11:00 AM–12:00 PM Friday, February 28

Cutting Through the Hype: Marijuana and CBD Oil for Pain (203)

In 2018, the United States opioid epidemic raged on with more than 45,000 overdose deaths. Several states have legalized medical or recreational marijuana, and all forms of cannabis products are being used for the treatment of pain. In many cases, patients and prescribers prefer using cannabis as an alternative to opioids, but the strength of the evidence for this is not widely understood. This session will provide learners with knowledge of the strength of evidence for using cannabis products for treatment of pain and opioid reduction as well as help learners gain an understanding of the acute and chronic risks of THC/CBD treatments.

Cannabinoid Biology

David Edwards

CBD Oil for Pain?

Thomas Pittelkow

Cannabis to Reduce Opioid Use?

Mark Wallace

Learning Objectives:

  • Describe the biology of the endocannabinoid system and how exogenous cannabinoids are hypothesized to treat pain.
  • Assess the strength of peer-reviewed evidence for the use of cannabis and CBD oil for the treatment of pain.
  • Explain the risks and benefits of cannabis use for pain treatment.
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Moderator:

Mark Wallace

Co-Presenters:

David Edwards

Thomas Pittelkow

7:00 AM–8:30 AM Friday, February 28

AAPM Foundation Spotlight: Opioid Reduction (102)

Members of a consensus committee formed to address the care of those on long-term, high-dose opioids, especially “legacy patients,” will discuss methods and ethics of compassionate management with extensive audience participation. Criteria for maintaining vs. weaning, opioid use “gray zones,” the role of buprenorphine, i.a., will be discussed.

This is a non-CME event.

AAPM Foundation Opioid Reduction Consensus Project Introduction

Charles Argoff, MD

High Dose Patients: Taper or Maintain?

Ajay Manhapra

What Should Be Done About Dangerous Combinations

Michael Hooten, MD

When Is Referral Actually Abandonment

Mark Sullivan

Continue or Curtail, Consensual or Coercive: Who Decides?

Ed Covington

How to Taper

Mark Sullivan

Complex Persistent Dependence

Jane Ballantyne, MD FRCA

Fiscal Responsibility Versus Duties as Healers

Steven Stanos, DO

A Balancing Act: Tools to Help Taper

Jennifer Murphy, PhD

Learning Objectives:

  • Determine whether and how to reduce opioids.
  • Develop and implement a plan for comfortable opioid and sedative reduction.
  • Effectively manage those who, despite no opioid use disorder, respond poorly to both opioid escalation and reduction.
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3:00 PM–4:00 PM Saturday, February 29

Headache Rapid-Fire: Headache Management Pearls for the Pain Provider (315)

Headache, facial pain, and interventions commonly are are referred to a pain specialist, as they often are under-represented in pain training. This will be a fast-paced, case-based, audience-involved session focusing on practical clinical pearls in the diagnosis and treatment of headache disorders seen in pain medicine practices.

Headache Rapid-Fire Panel

James Watson, Dmitri Souza, Meredith Barad

Learning Objectives:

  • Recognize common headache syndromes seen in pain medicine practices and evidence-based treatment recommendations.
  • Interpret the role of interventional procedures in various headache syndromes.
  • Identify unique treatments appropriate for spontaneous intracranial hypotension headache, cluster headache, severe acute on chronic headache, and refractory chronic daily headaches.
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Moderator:

James Watson

Co-Presenters:

Meredith Barad

Dmitri Souza

11:15 AM–12:15 PM Saturday, February 29

Opioid Therapy 2020: Past, Present, and Future (306)

This session will discuss the challenges surrounding the safe and effective use of opioids in chronic noncancer and cancer pain populations. An update on current evidence on opioid efficacy for chronic noncancer pain will be provided. Opioid treatment guidelines will be reviewed. Additional methods to mitigate risk will be described.

Opioid Safety: Still in Search of the Holy Grail for Low-Abuse-Potential Opioids

ToNhu Vu

Guidelines, Regulations, and Recommendations: Cancer and Non-Cancer Pain

Halena Gazelka

The Role of Opioids in Chronic Pain Management: Assessing the Evidence

David Provenzano

Learning Objectives:

  • Define opioid guidelines for cancer and chronic pain.
  • Employ methods to mitigate risk when using opioids.
  • Characterize current evidence for opioid efficacy in noncancer chronic pain.
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Moderator:

David Provenzano

Co-Presenters:

Halena Gazelka

ToNhu Vu

9:15 AM-10:15 AM Saturday, February 29

Going Deeper into Opioid Deprescribing: Addressing the Concerns of Prescribers and Patients to Optimize Outcomes (302)

This session clarifies the assessment of opioid use behaviors and delivery of individualized, patient-centered opioid reduction strategies across the continuum of opioid use and patient behaviors. The multidisciplinary faculty will summarize the best available evidence and emphasize practical tools rooted in patient safety for optimized patient engagement and success.

Demystifying Opioid Deprescribing Across the Continuum While Providing Individualized, Whole Person Pain Care

Aram Mardian

Addressing Complexities of Opioid Deprescribing with Patient-Centered Approaches: Supportive Psychological Strategies, Low-Cost Technologies, and Self-Management Tools

Beth Darnall

Seamless Integration of Opioid Use Disorder Management in Patients with Chronic Pain

Anita Karnik

Learning Objectives:

  • Use three behavioral strategies to enhance readiness to engage in a collaborative opioid taper.
  • Distinguish opioid use disorder from complex persistent opioid dependence and simple opioid dependence.
  • Describe recent federal cautions related to opioid deprescribing.
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Moderator:

Aram Mardian

Co-Presenters:

Beth Darnall

Anita Karnik

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