Recovery based Pain Management at Central City Concern

1. Rachel Solotaroff, MD, MCR Medical Director, Central City Concern April 29, 2014 Recovery based Pain Management at Central City Concern

2. Recovery-Based Pain Management • Combine activity-based and mindfulness-based approaches • Provide education and services to enable new choices • Utilize supportive and positive peer relationships • Foundational concepts of Hope, Power and Responsibility • Index the program to the need and readiness of the individual • Integrated MH, SA and primary care • Utilize medication-assisted treatment

3. Chronic Pain Recovery Pyramid Level Three Hot Sauce/Suboxone Weekly Acupuncture RENEW Monthly Group Visits with OT/PCP Behavioral Health Assessment Monthly “Activity Groups” Level One Primary Care Only q 2-3 mo visits Risk Stratification Method for Chronic Pain and COT Graduation Criteria: -- Level 3: completion of Hot Sauce -- Level 2: Progress toward goals Engaged in Behavioral health (if nec) Reduction in opiate dosage • High addiction risk: • Brief relapse • Early Recovery • Minimal support Level Two Risk Management -- UDS – q 3 months -- pill count – q 6 months -- ADR’s – q 3 months -- PDMP: annually • Low addiction risk BUT: • Low self-management • Low social supports • Low function/activity • Low addiction risk: • Good self-management • Good support • Good function/activity

4. How Does Risk Stratification Occur? • Controlled Substances Review Committee: • Reviews all episodes of serious misuse or misconduct • Reviews all requested new starts on chronic opiate therapy • Provides guidance for complex pain management cases • Benefits: • Provides uniform, standardized approach to prescribing • PCP’s relieved at no longer having to “go at it alone”; “makes being strict less personal”; “enables discussions around public health concerns”

5. Chronic Pain Recovery Program Road Map • CP Identified at Intake: • -- ROI’s • -- CP acknowledgemt • -- BH Screen: • ORT • PHQ • GAD-7 • PTSD Screen OT Assess Behavioral Health • CSRC Reviews Data and recommends: • -- No Controlled Substances + Care Plan Recs -- OR -- • -- Controlled Substances + Level of Care + Care Plan Recs: • Hot Sauce/Suboxone(Level 3) • RENEW Provider Groups (Level 2) • Primary Care Only (Level 1) • Other recs such as BH, medication regiment, monitoring guidelines, etc. 4 weeks PCP Appt #1 PCP Appt #2 Income & Employment Volunteering, Training, Jobs H&P, Record Review, UDS, OPDMP query If + BH Screen

6. Thank you!rachel.solotaroff@ccconcern.org

7. Hot Sauce Model and Curriculum 12-week Level One A&D group, in primary care setting Facilitated by CADC Support and clinical supervision from outpatient A&D program By referral only (controlled substance agreement violation, early recovery, otherwise high risk) Zero tolerance for absences, dirty UDS

8. Hot Sauce Model and Curriculum

9. Hot Sauce Model and Curriculum

10. RENEW Model and Curriculum 12 Monthly groups in primary care setting Facilitated by Occupational Therapist or other QMHP Support and clinical supervision from Behavioral Health Medical Director PCP may attend group, or may see patients individually after group for brief medication management visit Focus on mindfulness and activity-based approaches to managing pain Patients encouraged to come to at least one “Wellness Group” per month in addition to their group provider visist

11. RENEW Model and Curriculum