Patient-Centered Approaches to Pain and End-of-Life Care with Concurrent Opioid Use Disorder
Session Summary: This session will review the diagnosis and treatment of opioid use disorder (OUD), the use of medications for OUD (MOUD) like buprenorphine and methadone, how to treat pain in patients on MOUD, and medication management at the end-of-life for patients on MOUD residing in nursing homes. Specific clinical scenarios like post-operative management of MOUD and transition to hospice care will be addressed. This session will address patient-centered approaches (e.g. co-production cycle and Patient Priorities Care) that include the patient-clinician-caregiver triad to facilitate decision making and value-based goals of care in these cases. This session will also review policy changes expanding MOUD prescribing and can count towards the 8-hour training requirement for DEA licensure (MATE Act).
Learning Objectives:
- Review special considerations for a patient-centered and culturally competent approach to the diagnosis and management of OUD in medically-complex populations residing in skilled nursing facilities.
- Integrate the management of acute and chronic pain with treatment of opioid use disorder using medications for opioid use disorder (MOUD), including considerations for safe opioid prescribing.
- Discuss the care of patients receiving MOUD at the end of life, including considerations for common hospice medications in conjunction with MOUD.
Kimberly Beiting, MD
Assistant Professor of Medicine
Vanderbilt University Medical Center, Division of Geriatrics
Kimberly J. Beiting, MD, is an Assistant Professor in the Division of Geriatric Medicine in the Department of Medicine at Vanderbilt University Medical Center. She is medical director of the geriatric medicine consult service. Her primary clinical and research interests center around the care of older adults with substance use disorders. She is a current recipient of a HRSA Geriatric Academic Career Award, a four-year career development award through which she is developing interprofessional education in the principles of age-friendly care for those caring for older adults with substance use disorders in a variety of care settings.
Justine Landi, MD
Justine Landi, MD, is an Assistant Professor of Medicine and faculty at the MacLean Center for Clinical Medical Ethics at University of Chicago. Her scholarly interests are focused on care of older adults with Opioid Use Disorder, specifically focused on the clinical and ethical challenges of managing OUD with co-occurring dementia in the outpatient, inpatient, and PALTC settings. She is a medical educator, specifically teaching medical students, residents, and fellows the principles of geriatric and palliative medicine, clinical medical ethics, and serious illness communication.
Rossana Lau-Ng, MD, MBA, CMD
Rossana Lau-Ng, MD, MBA, CMD, is a geriatrician and clinician educator who practices in post-acute and long-term care. She has a scholarly interest in interprofessional collaboration, addressing health inequities and the care of older adults with substance use disorder through education in skilled nursing facilities. She was awarded the HRSA-funded Geriatric Academic Career Award in 2019, and despite the pandemic, has successfully promoted and taught geriatric principles to interprofessional learners in nursing homes on the care of patients with opioid use disorder. She is the Medical Director of the Nursing Home Program at the Section of Geriatrics, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine. She is one of the founding members of the Decanter Program at Boston Medical Center, working with an interprofessional team addressing social determinants of health by identifying uninsured or underinsured patients in the hospital with skilled nursing and therapy needs, and transitioning them to post-acute care facilities.
Stacie Levine, MD
Stacie Levine, MD, is Professor and Chief of Geriatrics and Palliative Medicine at University of Chicago Medicine (UCM) and serves as the regional Medical Director of the Symphony Post Acute Network, a nursing home (NH) chain that owns 29 facilities operating in Illinois, Indiana, Michigan. Her academic interests focus on education and program development to improve care for vulnerable older adults and other patients with complex comorbid illnesses. She is an experienced mentor of physicians and allied health professionals and a national leader in geriatrics and palliative medicine with extensive experience in creation and dissemination of competency-based educational programs. Dr. Levine has extensive experience in NH care and have been conducting research on opioid and substance use disorders in persons transitioning to NHs. She is currently Co-PI of a large-scale, multi-centered project that involves longitudinal training in clinical and teaching skills, program development, leadership engagement, and patient advocacy for physicians, advanced practice practitioners, psychologists, social workers, and chaplains across the United States and internationally. Dr. Levine has served on various national scientific boards and committees. More recently, she is the Director-at-Large of the American Academy of Hospice and Palliative Medicine (AAHPM) Board of Directors, member of the AAHPM Governance Committee, and Chair of the AAHPM Workforce and Leadership Development Strategic Coordinating Committee. Dr.Levine has been the Bucksbaum Institute Faculty Scholar since 2012 and has been awarded Chicago's Top Doctors in 2013, 2018-2022.
