Compass Opioid Stewardship Clinical Cases

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.

Buprenorphine and X Waivers Toolkit Buprenorphine Protocol Toolkit

Motivational Interviewing Toolkit

Risk Monitoring Toolkit Aberrancy Management Toolkit

Informed Consent & Controlled Substance Agreement Toolkit

Risk Mitigation Toolkit

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 P...

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 Colla...

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 Clini...

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...

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 Colla...