Tackling the Opioid Epidemic:  Strategies for Clinical Intervention and Care

Scott McNairy, MD

Introduction

Dr. Scott McNairy has 36 years of experience in the delivery of clinical health care focused on treatment for chronic pain, addictive and combat stress disorders.  He is Board Certified in the Addiction Psychiatry. His post-graduate training in psychiatric medicine began here at the Mayo Clinic 1975-1979. He is most indebted to early Mayo consultants for pioneering novel addiction and pain medicine treatment practices which serve as a foundation for his active engagement in combatting the current opioid epidemic, which is todays’ topic. Dr. McNairy has had a lifelong interest in using evidence-based psychopharmacology, blended with alternative and complementary treatment approaches. Scott was an early board member for Minneapolis Pathways, one of the first health crisis resource centers for life-threatening medical illness in the country. Many of those practices are now well–integrated in to mainstream healthcare for cancer and end of life care. He helped pilot mind body medicine training groups for returning combat veterans suffering from stress disorders and substance abuse. His clinical outcome studies have included 1) development of a medication management support group for opioid dependent patients treated with buprenorphine to promote treatment success and 2) the use of parenteral depot naltrexone for high medical risk, chronic and treatment refractory alcohol dependent veterans which dramatically reduces overall costs of care and disease progression. He champions greater use of addiction pharmacotherapy underutilized in primary care and psychiatry and trains physicians for the DEA buprenorphine waivered licensure.  He promotes the integration of substance abuse services in primary care just as mental health has done.  Another current interest is in utilization of pharmacy data mining for monitoring treatment outcomes that will enhance patient safety and care. At the University of Minnesota Minneapolis VA campus Dr. McNairy directs the fellowship in addiction psychiatry and has helped in the creation of the first ABAM addiction medicine fellowships soon to be recognized by ABMS and the Board of Preventive Medicine. Dr. McNairy fosters the knowledge, skills and abilities of his trainees seeking competencies in addictions practice and research. He is recognized for his excellence in teaching and modeling positive encounters in the patient setting.  It all begins and ends with care of the patient for Dr. McNairy. He places primary emphasis on restoration of function and prevention of deterioration as outcomes for success. He is known for his ability to integrate the treatment of chronic and complex disorders with care and compassion. Dr. McNairy is an integral part of a treatment team comprised of physicians, nurses, social workers and psychologists without whom he could not have achieved the success that he has.

Learning Objectives

1. Recognize the role that unintended consequences played in physician over-prescribing of opioids due to the interplay of pharmaceutical marketing, changing patient expectations regarding pain treatment and the reinforcement by the very professional credentialing bodies that regulate healthcare.
2. Understand the current neurobiology of opioid dependence and the degree to which neuroadaptation with chronic use makes abstinence based treatment approaches highly unsuccessful.
3. Know the four FDA approved medications for the treatment of opioid dependence, intoxication and withdrawal and how they are best used in the clinical setting.
4. Learn what all clinicians can do to advocate for evidence-based treatment of opioid dependence in the setting in which they practice such that there is "no wrong door" to access to safe, effective and lifesaving care.

Live webcast available at:  http://videos.mayo.edu/live
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Credit Statements

• Mayo Clinic College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. 
• Mayo Clinic College of Medicine designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.   

Archived webcast available at: Psychiatry & Psychology Video Library

Industry Acknowledgment (if applicable): None.

Disclosure Summary

As a provider accredited by ACCME, Mayo Clinic College of Medicine (Mayo School of Continuous Professional Development), must ensure balance, independence, objectivity and scientific rigor in its educational activities.   Course Director(s), Planning Committee Members, Faculty, and all others who are in a position to control the content of this educational activity are required to disclose all relevant financial relationships with any commercial interest related to the subject matter of the educational activity.  Safeguards against commercial bias have been put in place.  Faculty also will disclose any off label and/or investigational use of pharmaceuticals or instruments discussed in their presentation.  Disclosure of this information will be published in course materials so those participants in the activity may formulate their own judgments regarding the presentation.

Listed below are individuals with control of the content of this program who have disclosed…

Relevant financial relationship(s) with industry:  None

No relevant financial relationship(s) with industry:
Brian Palmer, M.D., Michael Bostwick, M.D., Karen Grothe, Ph.D., Lois Krahn, M.D., Jarrod Leffler, Ph.D., Larissa Loukianova, M.D., Mary Machulda, Ph.D., Patricia Maus, M.D., Amber Pearson, Jeffrey Staab, M.D., Cosima Swintak, M.D., Kristin Vickers Douglas, Ph.D., Cynthia Harbeck-Weber, Ph.D., Michael Zaccariello, Ph.D., Georgina Rink

Speaker: Scott McNair, MD

References to off-label usage(s) of pharmaceuticals or instruments in their presentation:

None