Compass Opioid Stewardship 2026 Virtual Symposium-FREE NO CME-01-Chronic Pain in Care in 2026-Don Stader-Handouts

01-Chronic Pain in Care in 2026-Don Stader-Handouts

Pdf Summary

The document is a 2026 presentation on chronic pain management and chronic opioid therapy (COT) by Don Stader, MD, focusing on opioid stewardship, patient access barriers, pharmacy issues, stigma, and medical-legal risk. It notes a major decline in opioid prescribing since 2012 (about a 54% reduction, with prescriptions roughly halved), but emphasizes that “legacy” patients on long-term opioids often struggle to find new clinicians willing to continue or manage COT. The talk outlines significant risks to prescribers (criminal, civil, licensing, and payer consequences), contrasted with harms to patients when opioids are abruptly reduced or withheld, including a cited suicide case that resulted in a jury verdict against clinicians.<br /><br />A central theme is compassionate, patient-centered onboarding: understanding the patient’s story, building hope and respect, clearly communicating clinician obligations, and avoiding rapid forced changes or abandonment. The presenter describes a stepwise opioid stewardship framework: risk screening, stratification, mitigation, monitoring, and aberrancy management. Practical tools include PDMP checks each visit, controlled substance agreements, urine drug testing based on risk, standardized screeners (PEG, PHQ-9, GAD-7, COMM, SOAPP-R, ORT-OUD, AUDIT/CUDIT/DAST), careful documentation, labs, and naloxone counseling.<br /><br />Through a longitudinal case, the presentation demonstrates introducing a broader pain model (“5 medicines”: mind, movement, sleep, knowledge/bibliotherapy, and medications), identifying opioid-related harms (sleep apnea, opioid-induced hyperalgesia, endocrine effects), tapering adjunctive sedating meds, and gradually tapering opioids with patient collaboration and supportive medications. It provides an approach to handling aberrant behaviors with increased monitoring, boundaries, specialist referral, and—when opioid use disorder is identified—transitioning to buprenorphine (split dosing for pain). The conclusion: effective chronic pain care is nuanced but rewarding; patients on COT should not be automatically refused; clinicians should strengthen stewardship systems, communication skills, and addiction recognition/treatment, leveraging Compass program resources.

Keywords

chronic pain management

chronic opioid therapy (COT)

opioid stewardship

opioid prescribing decline since 2012

legacy opioid patients access barriers

PDMP checks and monitoring

controlled substance agreement

urine drug testing risk-based

opioid tapering patient-centered approach

buprenorphine transition for pain and OUD