Enhanced Skills Program: Addiction Medicine Integrated Pain and Chemical Dependency Rotation Goals and Objectives

Medical Expert

By the end of the rotation, the Addiction Medicine resident will be able to:

Knowledge

Recognize the relationship between the pain and the substance use condition
Understand approaches to prevention and mitigation of risk relative to diversion and unauthorized use of pain medications.
Knowledge of the use of methadone and buprenorphine as pain management modalities as well as addiction management modalities
Knowledge of the use of non-opioid strategies for the management of pain

Medical Assessment

Perform a comprehensive substance use evaluation in patients with acute and chronic pain.
Identify the inappropriate use of or dependence on medications prescribed to treat pain.
Assess pain patients for psychiatric co-morbidity
Perform a comprehensive pain assessment (history and physical) in patients with acute and chronic pain

Clinical Judgment and Management

Recognize and treat substance use conditions (e.g. intoxication, withdrawal, use disorders) in the setting of acute and chronic pain
Effectively use “pain medication agreements/contracts” in managing patients on chronic pain medications
Use laboratory tests, including urine drug testing, in the assessment and management of patients with chronic pain
Evaluate and oversee pain medication administration in patients with substance use disorders.

By the end of the rotation, the Addiction Medicine resident will be able to:

Counsel patients on the appropriate use of chronic pain medications
Appropriately document in the medical record a patient with chronic pain and addiction
Communicate with the family doctor the nature of the proposed treatment plan

By the end of the rotation, the Addiction Medicine resident will be able to:

Understand the importance of team-based health care in the treatment of pain, especially when pain and addiction are co-occurring conditions in a given patient
Work with other members of the care team to perform comprehensive multi-modal pain assessments and management plans including assessment and management of psychiatric conditions that can be concurrent with chronic pain
Work with a range of health care providers in the health care system, including surgeons, physiatrists, neurologists, physical therapists and others, exchanging information and utilizing consultation and referral appropriately
Assess and promote coordination of care for patients on chronic pain medication who are being cared for by multiple providers.

By the end of the rotation, the Addiction Medicine resident will be able to:

Demonstrate knowledge of how limitations in medical imaging resources may affect selection and timing of diagnostic testing for a given patient
Demonstrate thoughtful and responsible use of resources in the provision of patient care, allowing for comprehensive and necessary evaluation while avoiding unnecessary interventions

By the end of the rotation, the Addiction Medicine resident will be able to:

Discuss with primary care providers potential risks to patients with abrupt discontinuation of opioid therapy and alternatives to abrupt discontinuation
Discuss with other care providers safe prescribing of opioids
Counsel all patients who use opioids about the risk of unintentional overdose and provide education on the use of naloxone

By the end of the rotation, the Addiction Medicine resident will be able to:

Understand the existing literature on the benefits and harms of use of opioids for chronic pain
Demonstrate an awareness of personal limitations, seeking advice when necessary. Accept advice graciously.

By the end of the rotation, the Addiction Medicine resident will be able to:

Take initiative and responsibility for assigned tasks
Maintain appropriate boundaries, including appropriate draping for a physical examination and appropriate presentation of a case to a group in the presence of the patient