Experienced HM clinicians tackle opioid issues


Societal trends – and ills – don’t stop at the hospital door, and opioid use is no exception. Hospitalists are frequently presented with difficult cases involving patients who have been using opioids for long periods of time, including some who show signs of opioid addiction. These cases present challenges for treatment and sometimes tense situations in which patients request delivery of pain medication that a hospitalist might consider excessive or potentially harmful.

Two experienced hospitalists will guide HM17 attendees through this dicey terrain in “The Hospitalist’s Role in the Opioid Epidemic” session, scheduled for Tuesday, May 2, 1:35–2:35 p.m., as part of the Quality Track.

Dr. Shoshana Herzig

Shoshana Herzig, MD, MPH, director of hospital medicine research at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School, Boston, who will sit on the session’s panel, said she hopes those who attend come away with a better sense of their role in the opioid-use issue and how they can make a positive difference.

“We will be discussing how hospitalists have contributed to the opioid epidemic, and how we can be part of the solution,” she said. “We hope hospitalists will leave the talk with a better understanding of how their prescribing practices contribute to opioid-related adverse events, and how to prescribe more safely and appropriately, to minimize risks and maximize benefits.”

Dr. Hilary Mosher, assistant head of internatl medicine, University of Iowa

Dr. Hilary Mosher

Hilary Mosher, MD, MFA, FHM, clinical assistant professor of internal medicine at the University of Iowa in Des Moines and physician with the Iowa City Veterans Affairs Medical Center, said she will talk about the challenges of assessing and treating pain that’s experienced by hospitalized patients who have chronic pain conditions and have been treated with long-term opioid therapy.

“Both chronic pain and long-term opioid therapy are high-prevalence conditions,” she said. “While hospitalists are often comfortable with their knowledge and skills in treating acute pain, many of us find that our patients have multiple or complex pain conditions that include chronic pain components.”

Despite the best of intentions, hospitalists are increasingly concerned that they might take steps in treatment that could actually contribute to opioid abuse. This session will, in part, be geared toward avoiding those pitfalls.

“Treatment of pain during hospitalization is more challenging in patients who regularly take opioid medications,” Dr. Mosher said. “The growing concern that hospitalists might inadvertently contribute to risky or excessive opioid use though well-intentioned, inpatient and discharge prescribing makes it even more essential that we increase our knowledge, skills, and confidence in this area.”

The Hospitalist’s Role in the Opioid Epidemic
Tuesday, May 2, 1:35–2:35 p.m.

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