Safe and Alternative Prescribing

A recent study found that only 47% of surveyed physicians expressed confidence in their care of chronic noncancer pain (CNCP) patients.¹   This lack of confidence may be related to a fear of over-prescribing opioids, thereby contributing to the current overdose crisis.

There are resources available to help physicians become more confident in their ability to safely prescribe opioids.  However, the same study found these have been underutilized.  For example, it found that only 67% were aware of the 2016 Centers for Disease Control and Prevention’s guidelines for safe opioid prescribing, only 55% were enrolled in the state Prescription Drug Monitoring Program and only 2% always or frequently prescribed naloxone to patients.  Becoming familiar with these resources can greatly enhance a physician’s prescribing decisions.

Additionally, there are several alternatives to opioids that may help patients with chronic pain that physicians might want to consider.  These include treatments such as Transcutaneous Electric Nerve Stimulation (TENS), over the counter and prescribed non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and steroids, behavioral therapies, and nerve blocks.  For more information about non-opioid therapies, please go to https://www.cdc.gov/overdose-prevention/manage-treat-pain/nonopioid-therapies.html?CDC_AAref_Val=https://www.cdc.gov/opioids/patients/options.html. 

¹Jon O Ebbert, Lindsey M Philpot, Casey M Clements, Jenna K Lovely, Wayne T Nicholson, Sarah M Jenkins, Tim J Lamer, Halena M Gazelka, Attitudes, Beliefs, Practices, and Concerns Among Clinicians Prescribing Opioids in a Large Academic Institution, Pain Medicine, Volume 19, Issue 9, September 2018, Pages 1790–1798, https://doi.org/10.1093/pm/pnx140

CDC training: The 2022 Clinical Practice Guidelines for Prescribing Opioids for Pain. Continuing education units are available for physicians, nurses, and other health professionals who complete this training by registering on CDC TRAIN.

Safe and Alternative Prescribing Webinar Presented June 2024:

Despite pain being one of the primary reasons for individuals seeking medical attention, medical practitioners frequently lack experience in how to characterize and treat pain. The average medical school student receives about 8 hours of education in this area, leaving many of the treatment options foreign and underutilized. This lack of training has, in part, fueled the opioid epidemic. There is an additional paucity of medical practitioners who feel confident in differentiating chronic pain from opioid addiction and despite the reduced regulations surrounding Buprenorphine prescribing, it remains underutilized as well, especially in this population.

Training Resources (Some require a fee $$)

Mental Health First AID

• DBHDD: (Free but must pay for materials): Mental Health First Aid (MHFA) training is offered through an 8-hour course where participants learn about 1) Risk factors and warning signs for mental health issues. 2) Information on depression, anxiety, trauma, psychosis, and substance use disorders. 3) A 5-step action plan to assess a situation, identify appropriate interventions, and help people access mental health services. 4) Resources available to help people experiencing a mental health issue.

Suicide Prevention

• Cobb Collaborative

Community Resiliency Model (CRM)

• Cobb Collaborative: CRM® introduces a set of wellness skills designed to help adults and children learn to track their own nervous systems in order to bring the body, mind and spirit back into greater balance, and to encourage people to pass the skills along to family, friends and their wider community. CRM®’s goal is to help to create “trauma-informed” and “resiliency-focused” communities that share a common understanding of the impact of trauma and chronic stress on the nervous system and how resiliency can be restored or increased using this skills-based approach.

Naloxone Administration

• Georgia Overdose Prevention

Screening, Brief Intervention and Referral Treatment (SBIRT)

• National Council on Mental Wellbeing ($$): Recognizing and managing substance use is often a missing link in the integration of mental health, substance use and primary care. Screening, Brief Intervention and Referral to Treatment (SBIRT) and Youth SBIRT (YSBIRT) fill that gap by helping you identify, reduce and prevent risky or unhealthy alcohol and drug use among your patients. The National Council’s virtual or in-person 3-hour introductory and refresher SBIRT and YSBIRT courses will equip individuals or groups with the skills necessary to use evidence-based screening tools effectively to assess substance use risk levels, cover appropriate responses including how to conduct brief interventions, and how to facilitate referrals for treatment effectively and efficiently.

Motivational Interviewing

• National Council on Mental Wellbeing ($$): Whether you’re a clinician in a health care organization, a supervisor trying to boost staff morale or a case manager supporting recovery, the National Council’s introductory and intermediate Motivational Interviewing (MI) trainings will help you create conversations that empower and persuade others to make meaningful changes.  Join us in-person or virtually for these interactive, high energy and evidence-based trainings to learn the four fundamental processes of Motivational Interviewing — engaging, focusing, evoking and planning.

Responding to Addiction (4 hours) or Understanding and Addressing Addiction (1 hour) (Anti-Stigma)

• CDPH: Responding to Addiction (and Understanding and Addressing Addiction) is a curriculum designed to help law enforcement, corrections, healthcare, faith leaders, teachers, employers, and other professionals navigate addiction treatment and recovery. The interactive, multidisciplinary training teaches participants about the science of addiction and equips them with the knowledge and tools to understand and address it. The curriculum and manual were developed and written by Jessica Hulsey, founder of the Addiction Policy Forum, and reviewed by an expert review panel composed of prominent researchers and physicians in the addiction field.

Crisis Intervention Team (CIT) Training

• GPSTC: The Georgia Crisis Intervention Team (CIT) Training course prepares law enforcement officers and other public safety personnel with the skills to assist people with mental illness, co-occurring disorders, substance abuse, developmental disorders, or other brain disorders, who are in crisis, thereby advancing public safety and reducing stigma. This course is an intensive 40-hour, five-day curriculum that is comprised of both classroom instruction and practical exercises, delivered by mental health professionals, other subject matter experts, and CIT law enforcement instructors. This course is approved by the Georgia Peace Officers Standards and Training (POST) Council.