A Change of Plans: Adjusting Treatment and Prescribing Protocols to Address the Opioid Epidemic

This activity is part of a series


Mark S. Gold, MD
Adjunct Professor of Psychiatry, Washington University School of Medicine, St. Louis, MO
ASAM's Annual Lifetime Achievement John P. McGovern Award & Prize Winner
17th University of Florida Distinguished Alumni Professor, Gainesville, FL
Mark S. Gold, MD

Mark S. Gold, MD, is a teacher of the year, translational researcher, author, mentor, and inventor, best known for his work on the brain systems underlying the effects of opiate drugs, cocaine, and food. He has worked as an advisor to many White House Drug Czars, White House NIDA and NIMH directors over his career of 40+ years. He is an author and inventor who has published over 1,000 peer-reviewed scientific articles, texts, and practice guidelines. This pioneering work started with detoxification studies using clonidine and lofexidine as a non-opiate detox followed by oral naltrexone at Yale in the late 70s and continued at the University of Florida (UF). Dr. Gold translated opioid studies using mouse, rat, and non-human primate models before developing his opioid withdrawal hypothesis with his Yale colleagues. He then led the first studies to demonstrate non-opioid treatment efficacy for alpha-2 agonists. He also led rapid detoxification and clonidine to naltrexone studies in the late 70s and early 80s. Dr. Gold, trying to find patients who would take oral naltrexone, began his studies of Impaired Health Professionals and employees in health and safety occupations.

Dr. Gold has received a number of national awards for his research, including the Lifetime Achievement Award of the National Association of Addiction Treatment Professionals, Foundations Fund Prize (APA), PRIDE Lifetime Achievement Award, DEA 30 Years of Service Pin, the McGovern Award for Lifetime Achievement (ASAM-ABAM 2015), National Leadership Award (NAATP), DARE Lifetime Achievement Award, Public Relations Society’s Silver Anvil Award, and China Academy of Sciences and DARE awards for his career in research and prevention (2015). More recently, he received the PATH Foundations Lifetime Achievement Award (2016) as one of the “fathers” of addiction medicine, presented to him by President Obama’s White House Drug Czar Michael Botticelli. Dr. Gold was awarded Distinguished Alumni Awards at Yale University, University of Florida, and Washington University in St. Louis as well as the Wall of Fame at the UF College of Medicine.

Dr. Gold was a Professor, Eminent Scholar, Distinguished Professor, Distinguished Alumni Professor, Chairman, and Emeritus Eminent Scholar during his 25 years at the University of Florida. His work is widely cited by his peers. It includes citation classics in cocaine neurobiology, opioid addiction neurobiology and treatment, and food and process addictions. He proved that cocaine was misclassified as safe, or the champagne of drugs, leading to revision in the DSM 3 and diagnosis of addiction. He has been called a groundbreaking researcher, father of medication-assisted recovery, the first to translate rat experiments into theory and treatments for human addicts, and mentor of the next generation of addiction researchers and clinicians. Working closely with Bart Hoebel at Princeton University, Dr. Gold helped develop the food addiction theory he posited in the 80s. With Nicole Avena, he worked on sugar self-administration models for hedonic overeating and developed new treatments for overeating and obesity. Kelly Brownell and Dr. Gold’s Food and Addiction, published by Oxford University Press, has been widely recognized as groundbreaking. Although working on food and drug-like reinforcement systems has been an important part of his work for 30 years, he has also worked on dual disorders, anorexia and bulimia nervosa. Dr. Gold worked closely with Al Rhoton and Bill Luttge to establish the UF Brain Institute. He was an original member of the McKnight Brain Institute and Director working to develop programs in Psychiatry, Addiction, Neurology, and Neurosurgery.

Since his retirement as a Director of the McKnight Brain Institute, Chairman, Distinguished Professor, and a full-time academic in 2014, Dr. Gold has continued his teaching, mentoring, research, and writing. He finished his 5-year State Department grant on opium smokers and the effects of second- and third-hand opium on children in Afghanistan. He has worked on de novo clinical addiction programs at the Medical College of Georgia, Northwestern, UF, and Tulane Lakeview Health. Dr. Gold regularly lectures at national and international meetings, medical societies, grand rounds around the United States, and international and national scientific meetings on his career, bench-to-bedside science in eating disorders, obesity, and addictions. Recently, he gave a keynote speech at the National Opioid Summit and Florida Opioid Summit as well as for the DEA-DOJ. He speaks regularly at medical schools across the United States, recently at Yale University, Mayo Clinic, Tulane, Washington University in St. Louis, Stanford, University of Connecticut (UConn), UCSF, Emory, Harvard-McLean-Borden Cottage, and UNC. He has given recent keynote addresses at American College of Psychiatrists, CADCA, ASAM, NAATP, APA, and Biological Psychiatry as well as a many states, medical, and psychiatric associations, dealing with the opioid epidemic.

Dr. Gold is an Adjunct Professor in the Department of Psychiatry at Washington University and an active member of the Clinical Council at the Washington University School of Medicine’s Public Health Institute. He has Wash University mentees and works with them regularly. He is the Director of Research for the DEA Educational Association, working closely with DEA and moderating their quarterly educational events broadcast from DEA Headquarters around the world.

A. Omar Abubaker, DMD, PhD
Professor and S. Elmer Bear Chair, Department of Oral and Maxillofacial Surgery
Virginia Commonwealth University School of Dentistry, Richmond, VA
A. Omar Abubaker, DMD, PhD

Dr. A. Omar Abubaker earned a Bachelor of Dental Surgery degree (BDS) from University of Alexandria, Egypt in 1975. He also earned a Doctor of Dental Medicine (DMD) degree and a Ph.D. in Anatomical Sciences from School of Dental Medicine, University of Pittsburgh. He completed his residency in Oral and Maxillofacial Surgery at Presbyterian University Hospital in Pittsburgh. He also completed a one-year research fellowship in Oral and Maxillofacial Surgery sponsored by the American Association of Oral and Maxillofacial Surgery at University of Pittsburgh Medical Center.

Dr. Abubaker was appointed to the faculty of the Department of Oral and Maxillofacial Surgery in the School of Dentistry, and at the Department of Surgery, school of Medicine, Virginia Commonwealth University in July 1991 with the rank of assistant professor. In 1996 he was promoted to associate professor with tenure and in 2002 to full professor. In 2002, he was appointed to serve as the Chairman of the Department of Oral and Maxillofacial Surgery, Chief of Division of Oral and Maxillofacial Surgery in the Department of Surgery, VCU School of Medicine and Chairman of Department of Dentistry at VCU Health System. In 2014 he was appointed as the Elmer Bear Endowed Chair of the Department of Oral and Maxillofacial Surgery at VCU School of Dentistry.

Dr. Abubaker co-authored two textbooks in oral and maxillofacial Surgery, over 50 chapters and over 40 scientific articles in peer review journals. He presented before many local, national and international scientific meetings.

In 2016, Dr. Abubaker earned a Graduate Certificate in Addiction Studies from the International Program in Addiction Studies from a coalition between Virginia Commonwealth University, The University of Adelaide, Australia and Kings College London, England. Over the past four years he has developed an interest in education and research in the field of addiction. Over the past two years he presented on the topic of substance use disorder, opioid epidemic and pain management to more than 50 local, regional and national groups and organizations.

Hassan R. Mir, MD, MBA
Director of Orthopaedic Residency Program, University of South Florida
Director of Orthopaedic Trauma Research, Florida Orthopaedic Institute
Professor, University of South Florida, Tampa
Hassan R. Mir, MD, MBA
Siegfried O. F. Schmidt, MD, PhD, FAAFP
Professor, Department of Community Health and Family Medicine, Director, Chronic Pain Management Program at Main, UF Health Family Medicine – Springhill, University of Florida, Gainesville, FL
Siegfried O. F. Schmidt, MD, PhD, FAAFP

Statement of Need

Nurses, physician assistants, and nurse practitioners are at the forefront of primary care, orthopedic surgery, and oral surgery patient care. Clinicians practicing in the primary care setting are well suited to manage chronic pain as they are adept at managing chronic disease and associated comorbidities, coordinating care, and applying a biopsychosocial approach to multimodal pain management. Incorporating best practice strategies for the evaluation of pain, integration of risk assessment tools, and ongoing patient education and monitoring will optimize safe and responsible prescribing.

Additionally, the Orthopedic Trauma Association has released new acute pain guidelines that emphasize precise prescribing with multimodal treatment plans that integrate non-opioid medications, cognitive, physical, and system strategies to help patients cope with their pain.

Along with orthopedists, oral surgeons play a role in responsible prescribing of opioids. In a survey conducted by Dr. Abubaker, Chair of the Department of Oral and Maxillofacial Surgery at Virginia Commonwealth University School of Dentistry, the average number of opioid tablets being prescribed after dental surgery was 20; this, along with the additional risk factor of young age, has proven that the implementation of new guidelines for prescribing after dental surgery procedures is key to minimizing the use of opioids while still meeting patients’ pain needs.

In this free 3-part Snack, expert faculty discuss how best to manage pain in primary care, orthopedic, and dental settings, with a focus on finding a balance between compassion for patient care and patient safety.

Learning Objectives

At the end of this CME/CE activity, participants should be able to:

  • Recognize the growing burden of the opioid epidemic and the role of all stakeholders in addressing the opioid epidemic in their community.
  • Educate patients about their pain to optimize safe and effective, multimodal treatment plans.
  • Upon evaluation of current clinical workflow for opioid prescribing, incorporate two best practice strategies to optimize safe and competent prescribing and minimize potential for abuse and diversion.

The following learning objectives pertain only to those requesting CNE or CPE credit:

  • Recognize the growing burden of the opioid epidemic and the role of all stakeholders in addressing the opioid epidemic in their community.
  • Educate patients about their pain to optimize safe and effective, multimodal treatment plans.
  • Describe two best practice strategies to optimize safe and competent prescribing and minimize potential for abuse and diversion.

Financial Support

Supported by an educational grant from Johnson & Johnson.

Target Audience

Dentists, physician assistants, nurse practitioners, and nurses.

Credit Information

Note to Nurse Practitioners

Nurse Practitioners can apply for AMA PRA Category 1 Credit through the American Academy of Nurse Practitioners (AANP). AANP will accept AMA PRA Category 1 Credit  from organizations accredited by the Accreditation Council for Continuing Medical Education. Nurse practitioners can also apply for credit through their state boards.

Note for California Nurses

This continuing nursing education activity was approved by the California Board of Registered Nursing. CME Outfitters, LLC’s provider number is CEP15510.

Dentists (ADA CERP) 0.75

ADA CERP: CME Outfitters, LLC is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to the Commission for Continuing Education Provider Recognition at ADA.org/CERP. CME Outfitters, LLC designates this activity for 0.75 continuing education credits. Concerns or complaints about a CE provider may be directed to the provider, or to the Commission for Continuing Education Provider Recognition at ADA.org/CERP.

Disclosure Declaration

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and mitigated any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process.

Dr. Gold has no disclosures to report.

Dr. Abubaker has no disclosures to report.

Dr. Mir reports that he is a consultant for OrthoGrid Systems, Inc.; Smith & Nephew; StabilizOrtho; Trice Medical; and Zimmer Biomet.

Dr. Schmidt has no disclosures to report.

Disclosures were obtained from the CME Outfitters, LLC staff: No disclosures to report.

  • Mae Ochoa, RPh (peer reviewer) has no disclosures to report.
  • Jan Perez (planning committee) has no disclosures to report.
  • Sharon Tordoff (planning committee) has no disclosures to report.

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

Obtaining Credits

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A Change of Plans: Adjusting Treatment and Prescribing Protocols to Address the Opioid Epidemic
Event Date: 03/01/2019