OPIOID TREATMENT PROGRAM (OTP) WITH MEDICATION         Opioid Treatment / Drug Addiction Detoxification Program Dr. Teddie Joe Snodgrass is certified by the Drug Enforcement Agency (DEA) to prescribe and use Schedule III, IV, or V Opioid drugs for the maintenance and detoxification treatment of Opioid addiction in accordance with the Drug Addiction Treatment Act of 2000 (DATA 2000) (21 U.S.C. § 823(g)(2)). Section 303 of the Comprehensive Addiction and Recovery Act (CARA), signed into law July 22, 2016, made several changes to the law regarding office-based Opioid addiction treatment, with buprenorphine including expanding prescription privileges to certain providers for five years until October 1, 2021. Dr. Snodgrass provided his Notice of Intent (NOI) to the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) and a waiver under 21 U.S.C. § 823(g)(2)(B) to treat patients for opioid detoxification. For a list of approved buprenorphine and other products that may be prescribed see: https://www.samhsa.gov/medication-assisted-treatment/treatment The Drug Enforcement Administration (DEA) has assigned Dr. Snodgrass a special “X” certification number for the specific treatment and detoxification of Opioid treatment in conjunction with Medication-Assisted Treatment (MAT). The DEA has issued regulations that require this “X” number, along with your DEA registration number, to be included on all prescriptions issued for the treatment of Opioid addiction. Dr. Snodgrass’ listing may be found on the SAMHSA Buprenorphine Practitioner Locator website at:  https://www.samhsa.gov/medication-assisted-treatment/physician-program-data/treatment-physician-locator                             PATIENT OPIOID MEDICATION FACT SHEET DANGERS AND PROBLEMS OF OPIOID MEDICATIONS  “Opioids” are strong medicines that are used for pain. If you use these for a long time they may cause problems. Your provider at Snodgrass’ Pain & Family Clinic is in charge of seeing you regularly. Your provider needs to make sure your medicine is helping your pain and that you are staying with the Snodgrass’ Chronic Pain Medication Management Agreement. Your provider needs to make sure you are not having problems with your medicine. You need to know what may happen if you take these medicines for a long time: Brain: Feeling sleepy or confused. This is why you CANNOT take this medicine with alcohol or illegal drugs. This is also why you should be careful while driving. Breathing: Slow breathing or feeling “out-of-breath.” Taking more than the prescribed amount of medication, or taking them with alcohol or other illegal drugs can cause you to stop breathing and die. Skin: Itching or rash. Gut: Problems going to the bathroom and being constipated, or feeling like you are going to throw-up. Using these with other medicine: Some drugs may act differently with this medicine. This medicine may act differently with other medicine. Allergies: Tell your provider if you have ever had a bad reaction to a medicine. Tell your provider if you have ever been told to never take a medicine again. Tolerance: Your body may get used to this medicine after taking it for a long time. Your doctor may need you to take more of the medicine to work the same or change the medicine. Dependency: This is NOT the same as addiction. You must not stop taking your medicine all of a sudden. Not taking your medicine the way your provider has told you may make you sick. You might have more pain. You might feel like you are going to throw-up or have pain in your gut. You may get sweaty or feel restless or nervous. Overdose: Sometimes people take more medicine hoping for less pain. This can make you sick or cause death. Using alcohol or illegal drugs will make you overdose easier. Addiction: This happens when you want to use the medicine even though your pain is gone or not helped by the medicine. Addictions or alcohol problems you’ve had before: This medicine may cause you to start using alcohol or drugs you had problems with before. “Pseudo-addiction”: When pain is still bad, sometimes people do things like make up stories to get more medicine. They may also go to other providers to get more medicine. This practice is highly discouraged by Snodgrass’ Pain & Family Clinic. A multi-State inquiry is done at each visit by the Snodgrass’ Pain & Family Clinic to see if you are narcotic shopping. If it is discovered you are narcotic shopping, your Snodgrass Chronic Pain Medication Management Agreement will automatically be terminated, you will owe the current office visit, your will be weaned or tapered off your current pain medications, and you will never be prescribe any further controlled narcotic prescriptions at any Snodgrass’ Pain & Family Clinic’s. You must tell your provider if the pain is uncontrolled with your current pain medicine regime so appropriate adjustments for your pain can be made by our providers.                             STRATEGIES FOR PREVENTING CHRONIC PAIN Preventing Chronic Pain - Following these basic guidelines may help prevent acute pain from becoming chronic. Effective management of conditions that increase the risk of chronic pain (ex: Effectively managing Diabetes to prevent diabetic neuropathy, weight loss/weight control strategies to limit the painful conditions such as arthritis and low back pain associated with obesity). Screen for and offer intervention for drug and/or alcohol abuse, dependence or problematic consumption. Tobacco cessation – Smoking is associated with an increased risk of back pain and other pain disorders and smokers have high pain intensity scores (with associate functional implications) than do non-smokers. Effective treatment of depression and anxiety which are risk factors for developing chronic pain as well as significant complicating factors in managing chronic pain. Preventive strategies to prevent conditions that might result in chronic pain (ex: vaccinating for herpes zoster to prevent acute zoster and post herpetic neuralgia). Try non-opioid therapies. In most cases, treat acute pain with non-opioid analgesics, physical therapy or other non-opioid therapies. Consider opioid if non-opioid strategies do not provide adequate relief and/or the severity of pain/clinical presentation warrants that choice. Use opioids with caution. Follow these guidelines if prescribing opioids for acute pain. Dispense on the number of doses needed, based on the usual severe enough to require opioids for that condition. Use the lowest potency opioid effective for the condition. Reevaluated, rather than simply continuing opioids, if pain persists beyond the normal time of acute pain treatment. Continuing opioids may represent initiation of COT without a proper chronic pain assessment. Your provider at Snodgrass’ Pain & Family Clinic is in charge of seeing you regularly. Your provider needs to make sure your medicine is helping your pain and that you are staying with the Snodgrass’ Chronic Pain Medication Management Agreement. Your provider needs to make sure you are not having problems with your medicine.                             SUBACROMIAL IMPINGEMENT SYNDROME (Shoulder Pain) Essentials of Diagnosis 1. Shoulder pain with overhead motion 2. Night pain with sleeping on shoulder 3. Pain with internal rotation 4. Numbness and pain radiation below the elbow are usually due to cervical spine disease. General Information 1. Patient will complain of pain, instability, weakness, or loss of Range Of Motion (ROM). 2. Establish patient’s hand dominance, occupation and recreational activities     a. Baseball pitcher may complain of pain while throwing while elders with full thickness rotator cuff tears may not complain of pain because the demands on the joint are low. Imaging 1. Anteroposterior scapula (glenohumeral) – can rule out glenohumeral joint arthritis; useful in visualizing rotator cuff tears because degenerative changes can appear between the acromion and greater tuberosity of the shoulder. 2. Anteroposterior acromioclavicular joint – evaluates joint for inferior spurs 3. Lateral scapula (scapular Y) – evaluates the acromial shape. 4. Axillary lateral - visualizes the glenohumeral joint as well and for the presence of os acromiale; shows superior evaluation of the humeral head in relation to the center of the glenoid. Treatment 1.2004 Cochran review – corticosteroid injections are slightly better than placebo 2.Conservative treatment – education, activity modification and Physical Therapy (PT) exercises.                                                           Opioid Medication Fact Sheet Snodgrass' Chronic Pain Medication Management Agreementment                 Strategies For Preventing Chronic Pain