Compass Opioid Stewardship Clinical Cases: Recent Episodes
Iowa Healthcare Collaborative
The Compass Opioid Stewardship Clinical Cases podcast aims to provide clinicians with practical skills for managing patients on chronic opioid therapy. This 11 part podcast series introduces a framework to approaching clinical encounters with legacy patients on long term opioid therapy. Episodes highlight clinical patient scenarios through roleplaying and are followed by a discussion of the science, structure and pertinent clinical skills by Board Certified Addiction Medicine physician Dr. Donald Stader and clinical pharmacist Dr. Rachael Duncan. Episodes address initial encounters, building therapeutic alliance, reframing pain understanding, managing risk, tapering opioids, implementing common sense harm reduction, and integrating multimodal pain management alternatives to opioids into your practice among many other topics.
In this episode, Dr. Stader calls Dr. Barnett to reflect on the philosophy of MI and how it has been transformative for his practice.
Additional Learning Resources:
Thomas Gordon’s Roadblocks to Communication
Motivational Interviewing Workshops
In this episode, Dr. Stader utilizes the principles of MI when navigating an encounter with Sam, a patient who just had a routine UA test positive for fentanyl, an opioid he is not prescribed. Dr. Barnett and Dr. Stader debrief the details of this case following the encounter including the delicate position a physician occupies when establishing patient boundaries.
In this episode, Dr. Stader implements the breadth of MI tactics discussed thus far in an encounter with Peggy, a pre-diabetic patient with high cholesterol to discuss diet changes.
In this episode, Dr. Stader meets with Rebecca following a trip to the ER for a fall about the potential need to take fall risk reduction measures as she starts to age. Dr. Barnett and Dr. Stader discuss how scaling can be used to gauge where patients' readiness to implement change.
In this episode, Dr. Stader meet with Mark who would like to increase his opioid prescription for his back pain. Dr. Barnett and Dr. Stader discuss the importance of establishing physician-patient boundaries when discussing change behavior.
In this episode, Dr. Stader conducts a new patient encounter with George. Following the encounter, Dr. Barnett and Dr. Stader talk about the four key principles of motivational interviewing: empathy, discrepancy, rolling with resistance and supporting self-efficacy in patients.
In this episode, Dr. Stader meets with Cindy, a fibromyalgia patient on longterm opioid therapy, to discuss decreasing her percocet following a DUI. Following the encounter, Dr. Barnett and Dr. Stader discuss the importance of pushing back against the innate urge to tell a patient the solution to their problem as it can lead to resistance.
In this episode, Dr. Stader introduces the OARS technique in an encounter with Paul who visits clinic regarding his surgeon’s wish for him to quit smoking pre-operatively. Following the encounter, Dr. Stader and Dr. Barnett dicuss how open questions, affirming patient sentiments, reflective statements and summarizing an encounter and assisting in moving a patient towards change behavior.
In this episode, Dr. Stader has an appointment with Tom, a chronic pain patient grappling with a new diagnosis of sleep apnea and the need to wear a CPAP machine. Following the encounter, Dr. Stader and Dr. Barnett discuss the stages of change patients traverse.
Dr. Don Stader calls mentor Dr. Peter Barnett to vent about some feelings of burnout he is experiencing with his patients not wanting to follow directions and Dr. Barnett helps him reframe his mentality and offers up motivational interviewing as a potential strategy to employ with his patients resisting change.
Putting it all together Toolkit
Opioid Prescribing and Treatment Guidance Toolkit
Compass Opioid Stewardship Program Website
Compass Opioid Stewardship Expert Spotlight
Spotify
Apple
Addiction is about giving up everything for one thing. Recovery is about giving up one thing for everything.
Opioid Therapy Risk-Assessment Screening Tools Table
Recommended Screening Tools for Pain + Opioid Risk Management Toolkit
A Comparison of Common Screening Methods for Predicting Aberrant Drug-Related Behavior among Patients Receiving Opioids for Chronic Pain Management
Summarized DSM-5 diagnostic categories and criteria for opioid use disorder
Risks for opioid abuse and dependence among recipients of chronic opioid therapy: results from the TROUP study
Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis
In this episode, Dr. Stader and Anne chat about how her pain has improved and she is getting more out of life. Following their encounter, Don and Rachael circle back on the 8 pillars of opioid stewardship tying it all together and and talk about modifying the framework to fit individual patients.
Show Notes:
Benzodiazepine Deprescribing Algorithm
Compass Opioid Stewardship Program
Compass Opioid Prescribing + Treatment Guidance Toolkit
The Iowa Healthcare Collaborative presents the Compass Opioid Stewardship Clinical Cases podcast in partnership with the Centers for Medicare and Medicaid Services. Visit their website for more information on the Compass Opioid Stewardship Program.
In this episode, Dr. Stader introduces buprenorphine as a possible agent to help manage Anne's chronic pain. Following their encounter, Don and Rachael discuss the use of buprenorphine for chronic pain and how to effectively cross titrate a patient from other opioids to the safer agent.
Show Notes:
Buprenorphine and X Waivers
IR Opioid Cross Taper to Buprenorphine Example
The Iowa Healthcare Collaborative presents the Compass Opioid Stewardship Clinical Cases podcast in partnership with the Centers for Medicare and Medicaid Services. Visit their website for more information on the Compass Opioid Stewardship Program.
In this episode, Dr. Stader and Anne discuss how her taper is going and they agree on some adjustments. Following their encounter, Don and Rachael take a deeper dive into the specific mechanics of tapering fentanyl and Oxycodone.
Show Notes:
Opioid + Benzodiazepine Tapering How-To Guide
Fentanyl 50 mcg TD Taper Example
The Iowa Healthcare Collaborative presents the Compass Opioid Stewardship Clinical Cases podcast in partnership with the Centers for Medicare and Medicaid Services. Visit their website for more information on the Compass Opioid Stewardship Program.
In this episode, Dr. Stader broached his concerns with Anne's medication regimen and they discuss the mechanics of tapering her off some of her medications. Following their encounter, Don and Rachael dive into the collaborative framework for a taper using the BRAVO approach.
Show Notes:
Optimizing Patient Communication: The Key to a Successful Taper
Provider Resources: Patient Communication Skills
JAMA 2021 Tapering and Mental Health Article
BMJ 2020 Tapering VA Study
BRAVO: A Collaborative Approach to Opioid Tapering
Opioid Tapering: The Risks and Benefits
The Iowa Healthcare Collaborative presents the Compass Opioid Stewardship Clinical Cases podcast in partnership with the Centers for Medicare and Medicaid Services. Visit their website for more information on the Compass Opioid Stewardship Program.
In this episode, Dr. Stader talks with Anne about her sleep study showing sleep apnea and his concern for her medication regimen contributing to it. Following their encounter, Don and Rachael dive into the nuts and bolts of screening for sleep disordered breathing.
Show Notes:
2021 BMJ Article Infographic: Diagnosing Sleep Apnea in Patients Taking Opioids for Chronic Pain
The Iowa Healthcare Collaborative presents the Compass Opioid Stewardship Clinical Cases podcast in partnership with the Centers for Medicare and Medicaid Services. Visit their website for more information on the Compass Opioid Stewardship Program.
In this episode, Dr. Stader educates Anne about naloxone and why its appropriate in her situation. Following their encounter, Don and Rachael dive into a deeper discusison of harm reduction and how to appropriately broach the subject to patients. Show Notes: Naloxone for Patients on Chronic Opioid Therapy The Iowa Healthcare Collaborative presents the Compass Opioid Stewardship Clinical Cases podcast in partnership with the Centers for Medicare and Medicaid Services. Visit their website for more information on the Compass Opioid Stewardship Program.
In this episode, Dr. Stader and Anne discuss her medication list and some of their adverse side effects. Following their encounter, Don and Rachael dive into medication risks arising from opioids and certain co-prescribed medications. Show Notes: 2020 Opioid + Sedative Use in COPD Study 2017 Bzd and Z-drug Review The Iowa Healthcare Collaborative presents the Compass Opioid Stewardship Clinical Cases podcast in partnership with the Centers for Medicare and Medicaid Services. Visit their website for more information on the Compass Opioid Stewardship Program.
In this episode, Dr. Stader meets again with Anne after reviewing her history and new pain tracking documents and starts to reframe pain to her. Following their encounter, Don and Rachael dive into the biopsychosocial approach and pain psychology. Show Notes: Behavioral Medicine for Pain: Resources for Clinicians and Patients Pain Management Algorithm Nonopioid Pharmacologic Treatments Non-Pharmacologic Treatments The Iowa Healthcare Collaborative presents the Compass Opioid Stewardship Clinical Cases podcast in partnership with the Centers for Medicare and Medicaid Services. Visit their website for more information on the Compass Opioid Stewardship Program.
In this episode, Don and Rachaeldiscuss informed consent and what tools to use for risk stratification and monitoring. Informed Consent and Controlled Substance Agreements Screening Tools for Pain and Opioid Risk Management Risk Management: Putting it All Together The Iowa Healthcare Collaborative presents the Compass Opioid Stewardship Clinical Cases podcast in partnership with the Centers for Medicare and Medicaid Services. Visit their website for more information on the Compass Opioid Stewardship Program.
In this episode, Dr. Stader gets to know Anne better and introduces his principles of opioid stewardship to her and how it will look. Following their encounter, Don and Rachael discuss the importance of therapetutic alliance and using evidence-based tools to track her treatment and pain. Show Notes: Compass Opioid Prescribing + Treatment Guidance Toolkit The Iowa Healthcare Collaborative presents the Compass Opioid Stewardship Clinical Cases podcast in partnership with the Centers for Medicare and Medicaid Services. Visit their website for more information on the Compass Opioid Stewardship Program.
In this episode, Dr. Stader meets Anne, a chronic pain patient new to his practice and they review her medical history. Following their encounter, Don and Rachael discuss the lack of longterm efficacy of opioids for pain management and their safety risks. Show Notes: Opioid Risks and Side Effects The Iowa Healthcare Collaborative presents the Compass Opioid Stewardship Clinical Cases podcast in partnership with the Centers for Medicare and Medicaid Services. Visit their website for more information on the Compass Opioid Stewardship Program.