1 00:00:02,240 --> 00:00:02,899 At athenahealth, 2 00:00:03,279 --> 00:00:06,480 we know your ambulatory practice wants healthier, a 3 00:00:06,480 --> 00:00:09,779 healthier business, healthier care teams, and healthier patients. 4 00:00:10,160 --> 00:00:12,400 But the complexities of modern health care tech 5 00:00:12,400 --> 00:00:14,240 make it hard for you and your care 6 00:00:14,240 --> 00:00:15,855 teams to focus on what matters 7 00:00:16,414 --> 00:00:19,295 most? That's where athenahealth can help. Our AI 8 00:00:19,295 --> 00:00:22,594 native all in one solutions reduce administrative burdens, 9 00:00:22,894 --> 00:00:25,875 streamline billing and payments, and deliver critical insights 10 00:00:25,934 --> 00:00:28,734 when clinicians need it most. That means fewer 11 00:00:28,734 --> 00:00:31,614 clicks, more time for patients, and stronger bottom 12 00:00:31,614 --> 00:00:31,829 lines. 13 00:00:32,710 --> 00:00:35,989 Practicing medicine is complex, but running a practice 14 00:00:35,989 --> 00:00:37,850 can be that much simpler with athenahealth. 15 00:00:38,549 --> 00:00:42,250 See how simpler is healthier@athenahealth.com. 16 00:00:44,085 --> 00:00:46,085 This is Carly Beam with the Becker Spine 17 00:00:46,085 --> 00:00:48,725 and Orthopedics podcast. And today, I'm thrilled to 18 00:00:48,725 --> 00:00:51,125 be joined by doctor Asif Elias at Rothman 19 00:00:51,125 --> 00:00:51,625 Orthopedics. 20 00:00:52,325 --> 00:00:54,484 Doctor Elias, thank you so much for being 21 00:00:54,484 --> 00:00:56,965 here today. It's an absolute pleasure to join 22 00:00:56,965 --> 00:00:59,039 you. Thank you so much. Now before we 23 00:00:59,039 --> 00:01:01,060 dive into our questions, can we 24 00:01:01,439 --> 00:01:03,840 hear a little bit from you about your 25 00:01:03,840 --> 00:01:05,060 work and your background? 26 00:01:06,159 --> 00:01:06,799 Of course. 27 00:01:07,439 --> 00:01:08,420 My specialty 28 00:01:08,799 --> 00:01:11,920 is, as a physician is, an orthopedic surgeon, 29 00:01:11,920 --> 00:01:12,739 and, specifically, 30 00:01:13,200 --> 00:01:13,859 I specialize 31 00:01:14,495 --> 00:01:17,155 in hand surgery and orthopedic trauma surgery. 32 00:01:17,935 --> 00:01:21,234 I'm also a, professor of orthopedic surgery 33 00:01:21,694 --> 00:01:23,935 at the Drexel University College of Medicine and 34 00:01:23,935 --> 00:01:26,674 Thomas Jefferson University, and I'm also an associate 35 00:01:26,734 --> 00:01:27,234 dean, 36 00:01:28,079 --> 00:01:30,560 for clinical research at the Drexel University College 37 00:01:30,560 --> 00:01:31,219 of Medicine. 38 00:01:31,680 --> 00:01:34,239 But relative to what we're discussing today, I'm 39 00:01:34,239 --> 00:01:36,799 all I also serve as the president of 40 00:01:36,799 --> 00:01:38,659 the Rothman Opioid Foundation, 41 00:01:39,120 --> 00:01:40,879 which I look forward to talking about with 42 00:01:40,879 --> 00:01:42,020 you in greater detail. 43 00:01:42,475 --> 00:01:44,475 Yeah. Absolutely. And, you know, I I heard 44 00:01:44,475 --> 00:01:45,515 on Rothman, you guys, 45 00:01:46,395 --> 00:01:49,194 renewed your partnership with Drexel and their athletic 46 00:01:49,194 --> 00:01:50,895 groups. So I wanna congratulate 47 00:01:51,435 --> 00:01:54,075 you and the team on that. But, as 48 00:01:54,234 --> 00:01:55,055 Indeed. Indeed. 49 00:01:55,435 --> 00:01:58,109 Yeah. As for the Rothman Opioid Foundation, can 50 00:01:58,109 --> 00:02:00,969 you talk about kind of top priorities that 51 00:02:01,270 --> 00:02:05,109 you have going into the 2025, 52 00:02:05,109 --> 00:02:07,450 and how's that kind of align with the 53 00:02:07,750 --> 00:02:09,610 broader mission of what you do? 54 00:02:10,175 --> 00:02:12,415 Of course. Just I'll say first a couple 55 00:02:12,415 --> 00:02:14,415 words about the foundation. So first of all, 56 00:02:14,415 --> 00:02:14,995 the foundation, 57 00:02:15,935 --> 00:02:19,294 officially is called the Rothman Institute Foundation for 58 00:02:19,294 --> 00:02:21,155 opioid research and education. 59 00:02:21,775 --> 00:02:23,215 That's a mouthful, so we call it the 60 00:02:23,215 --> 00:02:26,800 Rothman Opioid Foundation for short. It's a five 61 00:02:26,800 --> 00:02:28,419 zero one c three nonprofit 62 00:02:28,719 --> 00:02:30,180 foundation. So although 63 00:02:30,560 --> 00:02:31,219 it is 64 00:02:31,599 --> 00:02:32,900 born out of, 65 00:02:33,599 --> 00:02:36,260 and staffed by many folks involved with Rothman 66 00:02:36,319 --> 00:02:38,740 Orthopaedics, including myself, it is a separate 67 00:02:39,135 --> 00:02:42,034 nonprofit entity. And we started this entity, 68 00:02:42,495 --> 00:02:43,395 I wanna say, 69 00:02:43,855 --> 00:02:45,855 almost six, seven years ago at least at 70 00:02:45,855 --> 00:02:47,155 this point, if not more, 71 00:02:47,615 --> 00:02:48,835 where we recognize 72 00:02:49,534 --> 00:02:50,194 the need 73 00:02:50,735 --> 00:02:52,514 around the opioid crisis 74 00:02:53,055 --> 00:02:56,099 locally in the, Greater Philadelphia area and then 75 00:02:56,099 --> 00:02:58,340 broader nationally. And at that point, we were 76 00:02:58,340 --> 00:03:01,060 also doing we're already doing a good amount 77 00:03:01,060 --> 00:03:02,039 of work around, 78 00:03:02,900 --> 00:03:06,099 opioid sparing pain management research, and we felt 79 00:03:06,099 --> 00:03:07,639 that we need to really dedicate 80 00:03:08,259 --> 00:03:09,239 time and resources 81 00:03:09,974 --> 00:03:12,455 to to redouble our efforts and really focus 82 00:03:12,455 --> 00:03:14,215 our efforts around this because we wanted to 83 00:03:14,215 --> 00:03:15,034 make a meaningful 84 00:03:15,414 --> 00:03:16,474 difference recognizing 85 00:03:16,854 --> 00:03:17,435 the edge, 86 00:03:18,694 --> 00:03:20,555 associated with opioid abuse 87 00:03:21,014 --> 00:03:23,250 that we were seeing. So we established this 88 00:03:23,490 --> 00:03:24,629 nonprofit foundation, 89 00:03:25,169 --> 00:03:27,509 and the mission of the foundation is threefold. 90 00:03:27,810 --> 00:03:29,270 One is to educate 91 00:03:29,729 --> 00:03:31,509 patients and prescribers 92 00:03:32,050 --> 00:03:35,830 on safe opioid use and prescribing respectively. 93 00:03:36,935 --> 00:03:39,675 Two is to perform or and or fund 94 00:03:40,294 --> 00:03:43,354 research around opioid sparing or alternative 95 00:03:43,655 --> 00:03:45,275 pain management strategies. 96 00:03:45,895 --> 00:03:49,435 And third is to advocate for evidence based 97 00:03:49,895 --> 00:03:50,715 pain management 98 00:03:51,170 --> 00:03:53,189 policies. So working with legislators 99 00:03:53,490 --> 00:03:54,389 at a local, 100 00:03:54,849 --> 00:03:56,550 state, and national level, 101 00:03:57,170 --> 00:03:59,969 to put forward strategies that make sense, essentially 102 00:03:59,969 --> 00:04:01,830 serving as a think tank for legislators, 103 00:04:02,770 --> 00:04:03,585 looking to, 104 00:04:04,224 --> 00:04:06,784 looking at various legislation, if you will, and 105 00:04:06,784 --> 00:04:08,385 and examples that are many that I can 106 00:04:08,385 --> 00:04:09,585 I can talk to you about that we've 107 00:04:09,585 --> 00:04:10,885 worked on with legislators? 108 00:04:12,224 --> 00:04:14,465 Specific to your question about what we're looking 109 00:04:14,465 --> 00:04:16,964 to do at the 2025 110 00:04:17,490 --> 00:04:19,829 is, we have a number of ongoing 111 00:04:20,129 --> 00:04:21,269 efforts, including, 112 00:04:22,129 --> 00:04:22,629 education 113 00:04:23,009 --> 00:04:25,730 and research and advocacy as already mentioned as 114 00:04:25,730 --> 00:04:27,410 our core mission. One of the things that 115 00:04:27,410 --> 00:04:29,250 we're focusing on the second half of this 116 00:04:29,250 --> 00:04:32,685 year is on our annual symposium, and we 117 00:04:32,685 --> 00:04:33,985 typically hold a symposium 118 00:04:34,524 --> 00:04:36,064 at the second half of the year 119 00:04:36,845 --> 00:04:39,904 at an important topic, and we bring together, 120 00:04:40,925 --> 00:04:43,759 different key stakeholders. And we're looking 121 00:04:44,220 --> 00:04:45,439 at medical cannabis. 122 00:04:46,060 --> 00:04:48,160 And we're looking at it from a scientific 123 00:04:48,699 --> 00:04:49,199 perspective, 124 00:04:49,579 --> 00:04:52,379 a research perspective, and a policy perspective. I'm 125 00:04:52,379 --> 00:04:55,019 bringing in researchers, bringing in clinicians, and bringing 126 00:04:55,019 --> 00:04:56,159 in policymakers, 127 00:04:57,099 --> 00:04:59,585 to discuss this symposium. We're scheduled to have 128 00:04:59,585 --> 00:05:00,965 this in early November. 129 00:05:01,824 --> 00:05:03,425 And can you talk about some of the 130 00:05:03,425 --> 00:05:06,225 legislative work that you've done specifically for, 131 00:05:07,185 --> 00:05:08,245 opioids bearing? 132 00:05:09,105 --> 00:05:10,865 Absolutely. So there's a number of things that 133 00:05:10,865 --> 00:05:12,725 we've worked on with legislators, 134 00:05:13,459 --> 00:05:15,220 and I'll focus on our work at the 135 00:05:15,220 --> 00:05:18,100 state level. Again, we're we're based out of 136 00:05:18,100 --> 00:05:20,759 Pennsylvania and Southeastern Pennsylvania specifically. 137 00:05:21,540 --> 00:05:23,379 And some of the really important things that 138 00:05:23,379 --> 00:05:26,680 we've done is one is, bring forth eprescribing, 139 00:05:27,060 --> 00:05:28,279 electronic prescribing. 140 00:05:29,225 --> 00:05:31,785 Understand that several years ago, if you wanted, 141 00:05:32,225 --> 00:05:32,665 to, 142 00:05:33,225 --> 00:05:36,024 write a prescription for an opioid for a 143 00:05:36,024 --> 00:05:38,185 patient, you had to write it in paper 144 00:05:38,185 --> 00:05:40,365 on an old fashioned prescription pad. 145 00:05:41,000 --> 00:05:43,660 And the problem with that strategy was that 146 00:05:44,120 --> 00:05:46,600 one is the prescription could get lost. It 147 00:05:46,600 --> 00:05:47,579 could get altered. 148 00:05:47,959 --> 00:05:49,720 Two, it was very hard for the patients 149 00:05:49,720 --> 00:05:51,720 to get them because they would have to 150 00:05:51,720 --> 00:05:53,800 come see you or see someone to get 151 00:05:53,800 --> 00:05:55,819 them in hand. And, thirdly, you would often, 152 00:05:56,384 --> 00:05:58,144 because the difficulty in getting getting them, you 153 00:05:58,144 --> 00:06:00,785 would often write more than necessary sometimes because 154 00:06:00,785 --> 00:06:02,625 you wanted to make it easier for the 155 00:06:02,625 --> 00:06:05,745 patient. E prescribing has created a system that's 156 00:06:05,745 --> 00:06:08,144 obviously not only just modern and kinda more 157 00:06:08,144 --> 00:06:09,605 consistent with our modern, 158 00:06:10,544 --> 00:06:11,605 style of living, 159 00:06:11,910 --> 00:06:12,889 but also it 160 00:06:13,270 --> 00:06:14,490 it eliminated manipulating 161 00:06:14,870 --> 00:06:16,490 a prescription. It allowed 162 00:06:16,870 --> 00:06:19,050 doctors to prescribe at a more, 163 00:06:20,949 --> 00:06:23,290 and limited number recognizing 164 00:06:23,590 --> 00:06:25,935 that it's easier and better to it's it's 165 00:06:25,935 --> 00:06:28,415 better to refill than to, you know, write 166 00:06:28,415 --> 00:06:30,754 too much and and then the patient may 167 00:06:31,055 --> 00:06:32,355 take more than necessary. 168 00:06:32,895 --> 00:06:35,074 And it also allows us to better monitor 169 00:06:35,134 --> 00:06:38,335 what patients are consuming. So e prescribing was 170 00:06:38,335 --> 00:06:39,615 one of the big things that we had 171 00:06:39,615 --> 00:06:42,459 championed that has has come forth. And you 172 00:06:42,459 --> 00:06:44,300 would think all states have this, but you'd 173 00:06:44,300 --> 00:06:46,860 be surprised to hear that many states don't. 174 00:06:46,860 --> 00:06:48,459 And and Pennsylvania is one of those states 175 00:06:48,459 --> 00:06:50,800 that was slow to allow for e prescribing. 176 00:06:51,259 --> 00:06:53,100 The second big thing that we worked on 177 00:06:53,100 --> 00:06:55,100 from a legislative perspective, and there are others, 178 00:06:55,100 --> 00:06:57,074 but the big two I wanna highlight is 179 00:06:57,074 --> 00:06:59,795 the prescription drug monitoring program. And this is 180 00:06:59,795 --> 00:07:00,295 basically 181 00:07:00,754 --> 00:07:02,055 an online database, 182 00:07:02,514 --> 00:07:03,014 where, 183 00:07:03,555 --> 00:07:05,814 anyone who receives a controlled substance, 184 00:07:06,115 --> 00:07:08,514 that that prescription has to be registered in 185 00:07:08,514 --> 00:07:09,175 this database. 186 00:07:09,560 --> 00:07:11,800 What that allows is for prescribers to be 187 00:07:11,800 --> 00:07:14,040 able to check that database before they prescribe 188 00:07:14,040 --> 00:07:15,879 to make sure that the that the patient, 189 00:07:16,199 --> 00:07:18,439 is not getting too much or from too 190 00:07:18,439 --> 00:07:19,660 many different people. 191 00:07:20,120 --> 00:07:21,500 So it, allows 192 00:07:22,040 --> 00:07:23,020 much more transparency 193 00:07:24,120 --> 00:07:25,100 related to 194 00:07:25,615 --> 00:07:27,615 opioid prescriptions, which makes it, 195 00:07:28,055 --> 00:07:31,235 which informs the their physician, but also causes 196 00:07:31,294 --> 00:07:33,154 the the public to be much more, 197 00:07:33,774 --> 00:07:34,894 cautious with, 198 00:07:35,615 --> 00:07:36,194 of opioids. 199 00:07:37,055 --> 00:07:38,990 Got it. And can you talk about some 200 00:07:38,990 --> 00:07:41,870 of the biggest challenges that you're seeing when 201 00:07:41,870 --> 00:07:44,290 it comes to, you know, effective pain management 202 00:07:44,350 --> 00:07:44,830 and, 203 00:07:45,230 --> 00:07:47,410 specifically opioid sparing approaches? 204 00:07:48,430 --> 00:07:49,569 There are many challenges. 205 00:07:50,029 --> 00:07:52,689 Obviously, first and foremost, we want to 206 00:07:53,264 --> 00:07:55,524 provide adequate pain control 207 00:07:56,305 --> 00:07:57,185 for our, 208 00:07:57,504 --> 00:08:00,064 patients and for the public for their for 209 00:08:00,064 --> 00:08:01,425 their injuries. And one of the things I 210 00:08:01,425 --> 00:08:02,404 always like to 211 00:08:02,785 --> 00:08:03,845 emphasize that, 212 00:08:04,225 --> 00:08:06,544 we as a foundation and also as a 213 00:08:06,544 --> 00:08:08,430 broader practice, we are not 214 00:08:08,829 --> 00:08:11,009 anti opioids. We can't do 215 00:08:11,470 --> 00:08:13,550 many of the things that we do for 216 00:08:13,550 --> 00:08:15,009 our patients and the public 217 00:08:15,310 --> 00:08:18,930 in terms of surgeries and managing painful conditions 218 00:08:19,229 --> 00:08:20,289 without opioids. 219 00:08:20,964 --> 00:08:23,044 The the strategy really is how do you 220 00:08:23,044 --> 00:08:25,544 manage patients' pain with minimizing 221 00:08:26,084 --> 00:08:29,044 or mitigating the risk associated with opioids? And 222 00:08:29,044 --> 00:08:29,544 opioids 223 00:08:29,925 --> 00:08:31,464 have a risk of dependency 224 00:08:32,085 --> 00:08:34,360 and abuse that can sometimes spiral 225 00:08:34,660 --> 00:08:36,820 into even death of a patient, and that's 226 00:08:36,820 --> 00:08:38,340 what we're trying to avoid. So how can 227 00:08:38,340 --> 00:08:39,860 you do this in a manner? How can 228 00:08:39,860 --> 00:08:41,860 you manage someone's pain in a manner to 229 00:08:41,860 --> 00:08:43,460 do this safely? So that's really kind of 230 00:08:43,460 --> 00:08:44,740 what we're trying to do and not to 231 00:08:44,740 --> 00:08:47,320 be anti opioids necessarily, but be very cognizant 232 00:08:47,379 --> 00:08:49,674 and ultimately be well. We like to use 233 00:08:49,674 --> 00:08:52,014 the term to be opioid stewards. So 234 00:08:52,315 --> 00:08:55,434 stewardship of of opioids and pain management in 235 00:08:55,434 --> 00:08:57,454 general. So trying to help 236 00:08:57,995 --> 00:09:00,235 stand that that's what we're trying to do 237 00:09:00,235 --> 00:09:01,054 is important. 238 00:09:01,569 --> 00:09:02,870 Balancing the challenges 239 00:09:03,889 --> 00:09:05,509 of different patient dynamics, 240 00:09:06,049 --> 00:09:07,889 you know, patients are all different. They have 241 00:09:07,889 --> 00:09:09,350 different conditions, different, 242 00:09:09,809 --> 00:09:10,309 comorbidities, 243 00:09:10,690 --> 00:09:14,245 different psychiatric dynamics, maybe histories of substance abuse. 244 00:09:14,544 --> 00:09:17,504 Those are very challenging problems to manage. And 245 00:09:17,504 --> 00:09:20,245 then also to create some consistency of care 246 00:09:20,304 --> 00:09:22,784 from the physician side as well so that, 247 00:09:22,784 --> 00:09:24,865 you know, we're not being too erratic or 248 00:09:24,865 --> 00:09:27,184 different in terms of how we approach pain, 249 00:09:27,184 --> 00:09:29,044 and we do it in a very deliberate, 250 00:09:29,850 --> 00:09:32,809 and an evidence based manner where, again, we're 251 00:09:32,809 --> 00:09:33,309 prioritizing 252 00:09:33,690 --> 00:09:36,169 good pain control. But what we've learned is 253 00:09:36,169 --> 00:09:37,929 when you apply and I can talk about 254 00:09:37,929 --> 00:09:39,629 some of these strategies. When you apply 255 00:09:40,009 --> 00:09:40,509 various, 256 00:09:40,889 --> 00:09:42,269 pain management strategies, 257 00:09:42,965 --> 00:09:45,524 for a patient's pain, you can manage your 258 00:09:45,524 --> 00:09:46,745 pain very effectively 259 00:09:47,045 --> 00:09:47,945 without relying 260 00:09:48,725 --> 00:09:51,365 on on opioids, which in contrast to say 261 00:09:51,365 --> 00:09:53,684 ten, fifteen, twenty years ago, we would use 262 00:09:53,684 --> 00:09:55,945 opioids as our first line to manage 263 00:09:56,259 --> 00:09:57,699 pain. But now we know that there's a 264 00:09:57,699 --> 00:09:59,319 lot of alternative ways to manage, 265 00:09:59,940 --> 00:10:02,199 pain before we have to go to opioids. 266 00:10:02,899 --> 00:10:05,319 I like that. Then that idea of stewardship 267 00:10:05,539 --> 00:10:09,159 and really just like a risk based strategic 268 00:10:09,379 --> 00:10:11,159 approach you're taking with pain management. 269 00:10:12,194 --> 00:10:14,454 Yeah. It's recognizing the responsibility 270 00:10:15,235 --> 00:10:16,194 that we have as 271 00:10:17,394 --> 00:10:18,134 with opioids, 272 00:10:19,154 --> 00:10:21,735 and and recognize the risk to, 273 00:10:22,194 --> 00:10:22,434 the 274 00:10:23,154 --> 00:10:25,074 our our patient, but also our public. And 275 00:10:25,074 --> 00:10:27,379 one of the issues that that is always 276 00:10:27,379 --> 00:10:28,360 central to 277 00:10:29,059 --> 00:10:31,960 opioid prescribing is this concept of diversion. 278 00:10:32,420 --> 00:10:34,180 What that means is if you're my patient 279 00:10:34,180 --> 00:10:36,519 and I give you a prescription for opioids, 280 00:10:36,980 --> 00:10:39,720 it's not only that you as the individual 281 00:10:40,259 --> 00:10:41,160 may potentially 282 00:10:41,875 --> 00:10:44,514 become dependent upon opioids. It's that everyone in 283 00:10:44,514 --> 00:10:46,835 your community or in your sphere of influence 284 00:10:46,835 --> 00:10:49,154 could potentially have access to those opioids. So 285 00:10:49,154 --> 00:10:50,434 if I give you a certain amount of 286 00:10:50,434 --> 00:10:50,934 prescriptions, 287 00:10:51,315 --> 00:10:53,394 opioids, and you don't use them, it's now 288 00:10:53,394 --> 00:10:55,475 in your home, and it's a it's access 289 00:10:55,475 --> 00:10:57,600 to a lot of other people in your 290 00:10:57,600 --> 00:11:00,559 sphere of influence. So we every pill has 291 00:11:00,559 --> 00:11:01,459 value for, 292 00:11:02,399 --> 00:11:04,399 abuse potentially in sales. So we had to 293 00:11:04,399 --> 00:11:05,299 be very careful 294 00:11:05,759 --> 00:11:08,000 in our prescribing of them. That's where that 295 00:11:08,000 --> 00:11:08,500 concept 296 00:11:09,134 --> 00:11:12,995 of, diversion and and stewardship lends itself from. 297 00:11:13,615 --> 00:11:16,175 Got it. And, I know you're an expert 298 00:11:16,175 --> 00:11:18,415 in hand surgery, but I'd love to kind 299 00:11:18,415 --> 00:11:18,995 of hear 300 00:11:19,455 --> 00:11:20,514 any interesting, 301 00:11:20,975 --> 00:11:21,475 strategies 302 00:11:21,855 --> 00:11:23,929 or research findings that you've 303 00:11:24,230 --> 00:11:25,929 found, in pain management 304 00:11:26,389 --> 00:11:29,190 and reducing opioid reliance across just the different 305 00:11:29,190 --> 00:11:31,850 areas of orthopedic care from hand surgery, 306 00:11:32,470 --> 00:11:33,610 spine, joints? 307 00:11:34,790 --> 00:11:35,290 Indeed. 308 00:11:35,674 --> 00:11:36,495 As you mentioned, 309 00:11:37,195 --> 00:11:40,154 my subspecialty of orthopedics is hand surgery as 310 00:11:40,154 --> 00:11:42,875 well as orthopedic trauma surgery. But, one of 311 00:11:42,875 --> 00:11:45,115 my passions from both a research and a 312 00:11:45,115 --> 00:11:48,394 policy perspective is pain management and orthopedics in 313 00:11:48,394 --> 00:11:48,894 general 314 00:11:49,320 --> 00:11:51,960 and in surgery in general. So there's a 315 00:11:51,960 --> 00:11:55,320 there's a number of of areas of research 316 00:11:55,320 --> 00:11:56,059 and innovation, 317 00:11:56,920 --> 00:11:58,460 that we have been pursuing, 318 00:11:59,000 --> 00:12:01,480 and I'll mention a couple here. One is, 319 00:12:01,720 --> 00:12:03,480 and I mentioned this once before, but I'll 320 00:12:03,480 --> 00:12:05,534 go more detail now. One is this concept 321 00:12:05,534 --> 00:12:06,514 of multimodal 322 00:12:06,894 --> 00:12:08,514 pain management strategies. 323 00:12:09,134 --> 00:12:10,575 So what does that mean? That means that 324 00:12:10,575 --> 00:12:13,475 there's this concept called the pain pathway that 325 00:12:13,534 --> 00:12:16,034 where you have an injury or surgical, 326 00:12:16,735 --> 00:12:18,894 or surgery in a certain location, there's there's 327 00:12:18,894 --> 00:12:21,410 pain that generated from that. So that's from 328 00:12:21,410 --> 00:12:24,669 the the local tissue trauma or manipulation that 329 00:12:25,289 --> 00:12:27,629 that sensitize the the tissue in that 330 00:12:28,409 --> 00:12:28,909 region, 331 00:12:29,449 --> 00:12:30,269 that pain 332 00:12:30,570 --> 00:12:32,570 perception that has to be carried through the 333 00:12:32,570 --> 00:12:33,070 nerves 334 00:12:33,404 --> 00:12:36,125 to through different points along the the nervous 335 00:12:36,125 --> 00:12:37,904 system, and then and then ultimately, 336 00:12:38,365 --> 00:12:41,004 it's then perceived in the brain. So there's 337 00:12:41,004 --> 00:12:43,664 this pathway, if you will. And there's medications 338 00:12:43,804 --> 00:12:45,824 that can affect the pathway at, 339 00:12:46,204 --> 00:12:49,290 at various points. When we use opioids, 340 00:12:49,910 --> 00:12:53,029 we're affecting pathway in the brain through what's 341 00:12:53,029 --> 00:12:55,429 called the mu receptor, m u, the mu 342 00:12:55,429 --> 00:12:57,509 receptor. But we can affect it in in 343 00:12:57,509 --> 00:12:59,269 lots of different ways. We can affect it 344 00:12:59,269 --> 00:13:02,065 by using a local anesthetic in the site 345 00:13:02,065 --> 00:13:04,544 of surgery so that there's no pain, even 346 00:13:04,544 --> 00:13:05,605 proceed whatsoever. 347 00:13:06,065 --> 00:13:08,644 We can write for medications such as NSAIDs 348 00:13:08,705 --> 00:13:09,105 that, 349 00:13:09,664 --> 00:13:11,745 decrease the inflammation in the site of an 350 00:13:11,745 --> 00:13:13,580 area, which also decrease 351 00:13:13,960 --> 00:13:16,200 the decrease the the development of pain. We 352 00:13:16,200 --> 00:13:18,460 can prescribe medications such as gabapentinoids, 353 00:13:19,399 --> 00:13:23,000 commonly common ones are gabapentin or Neurontin or 354 00:13:23,000 --> 00:13:24,860 pregabalin, also known as Lyrica, 355 00:13:25,194 --> 00:13:26,495 that slow conduction 356 00:13:27,355 --> 00:13:30,074 and perception of pain. And then, obviously, we 357 00:13:30,074 --> 00:13:32,315 can use analgesics that affect the brain such 358 00:13:32,315 --> 00:13:32,815 as, 359 00:13:33,274 --> 00:13:35,914 Tylenol and opioids. The thought is if you 360 00:13:35,914 --> 00:13:38,554 use these in combination, they can decrease the 361 00:13:38,554 --> 00:13:41,660 overall pain experience, and you can then reserve 362 00:13:41,660 --> 00:13:44,160 the use of opioids only for strictly, 363 00:13:44,860 --> 00:13:45,360 backup, 364 00:13:45,820 --> 00:13:48,220 or for severe breakthrough pain. So one of 365 00:13:48,220 --> 00:13:50,220 the things that we've championed is this concept 366 00:13:50,220 --> 00:13:52,379 of multimodal pain management where you use a 367 00:13:52,379 --> 00:13:53,600 combination of medications 368 00:13:54,195 --> 00:13:56,195 that you don't use if you need them, 369 00:13:56,195 --> 00:13:58,835 but but on a consistent basis. So that 370 00:13:58,835 --> 00:13:59,335 means, 371 00:13:59,955 --> 00:14:02,195 you apply a local anesthetic in the surgical 372 00:14:02,195 --> 00:14:04,434 side. You give every patient a combination of 373 00:14:04,434 --> 00:14:05,095 a Tylenol 374 00:14:05,955 --> 00:14:07,394 as if they can tolerate it and a 375 00:14:07,394 --> 00:14:07,894 gabapentinoid 376 00:14:08,355 --> 00:14:11,230 if they And that's your first line agents, 377 00:14:11,230 --> 00:14:13,569 and those are safe and non nondependency 378 00:14:14,429 --> 00:14:16,429 causing, and it doesn't make you drowsy or 379 00:14:16,429 --> 00:14:19,389 affect your your your clarity of mind. And 380 00:14:19,389 --> 00:14:22,029 and that's often all anybody needs and therefore 381 00:14:22,029 --> 00:14:24,415 mitigates even the need or eliminates the need 382 00:14:24,415 --> 00:14:26,415 for even opioids altogether. Or if you do 383 00:14:26,415 --> 00:14:28,735 need them, you need a much smaller amount. 384 00:14:28,735 --> 00:14:31,235 And we've done research in all various specialties 385 00:14:31,455 --> 00:14:34,894 of orthopedics from joint replacements to hand surgery 386 00:14:34,894 --> 00:14:37,440 to sports medicine to spine surgery that have 387 00:14:37,440 --> 00:14:40,100 shown these have really made a big difference. 388 00:14:40,559 --> 00:14:42,320 One of the other areas of innovation that 389 00:14:42,320 --> 00:14:44,500 we've really focused on is counseling. 390 00:14:45,040 --> 00:14:47,440 As health care providers, we routinely speak to 391 00:14:47,440 --> 00:14:49,360 our patients and try to educate our patients 392 00:14:49,360 --> 00:14:51,700 of various things about their condition and surgery. 393 00:14:52,285 --> 00:14:53,804 One of the things that we advocate for 394 00:14:53,804 --> 00:14:54,785 is also doing, 395 00:14:55,245 --> 00:14:56,865 some form of formal, 396 00:14:57,965 --> 00:14:59,424 opioid pain management 397 00:14:59,725 --> 00:15:00,225 counseling, 398 00:15:01,004 --> 00:15:03,725 or opioid counseling. And we've looked at different 399 00:15:03,725 --> 00:15:05,085 ways to do that and to see the 400 00:15:05,085 --> 00:15:07,085 effects of them. And we found that when 401 00:15:07,085 --> 00:15:07,585 you, 402 00:15:08,009 --> 00:15:09,389 as a health care provider, 403 00:15:10,170 --> 00:15:11,550 deliberately and specifically 404 00:15:12,009 --> 00:15:15,769 provide some pain management education or counseling before 405 00:15:15,769 --> 00:15:18,570 surgery, patients, do a much better job of 406 00:15:18,570 --> 00:15:22,029 managing their pain and consume much less opioids. 407 00:15:22,674 --> 00:15:24,195 One of the things we advocate for is 408 00:15:24,195 --> 00:15:27,815 routine preoperative counseling through a a routine discussion. 409 00:15:27,875 --> 00:15:28,674 It could be through, 410 00:15:29,634 --> 00:15:30,134 information 411 00:15:30,514 --> 00:15:32,215 packet, or what we recommend 412 00:15:32,754 --> 00:15:35,815 is a short video that helps patients understand 413 00:15:36,350 --> 00:15:38,509 what pain is, how they can manage their 414 00:15:38,509 --> 00:15:40,670 pain, what opioids are, what the risk of 415 00:15:40,670 --> 00:15:43,230 opioids are, how how what you can take 416 00:15:43,230 --> 00:15:44,830 before you need opioids, and if you do 417 00:15:44,830 --> 00:15:46,990 take opioids, how to take them safely to 418 00:15:46,990 --> 00:15:49,555 avoid any other problems associated with them. That's 419 00:15:49,555 --> 00:15:53,175 just two examples using multimodal pain management strategies 420 00:15:53,235 --> 00:15:56,435 and using preoperative counseling is two big innovations 421 00:15:56,435 --> 00:15:58,915 that we've come across that, that have really 422 00:15:58,915 --> 00:16:01,475 changed the way that we manage our patient's 423 00:16:01,475 --> 00:16:01,975 pain. 424 00:16:02,470 --> 00:16:03,769 Those both sound great. 425 00:16:04,149 --> 00:16:05,750 And, you know, my last question, when you 426 00:16:05,750 --> 00:16:08,149 think about this what broader health care trends 427 00:16:08,149 --> 00:16:08,970 have you been 428 00:16:09,350 --> 00:16:11,929 tracking, especially in pain management techniques? 429 00:16:13,029 --> 00:16:14,789 Well, so we've touched on a couple of 430 00:16:14,789 --> 00:16:15,029 them. 431 00:16:15,669 --> 00:16:17,514 One one of the things I I I'll 432 00:16:17,514 --> 00:16:19,294 comment on is that 433 00:16:19,834 --> 00:16:21,615 broadly, we are seeing 434 00:16:22,154 --> 00:16:22,975 much more 435 00:16:23,674 --> 00:16:24,174 awareness 436 00:16:24,955 --> 00:16:27,134 by both the public and prescribers 437 00:16:27,595 --> 00:16:30,575 of the of the dangers of opioids and 438 00:16:31,034 --> 00:16:32,414 a movement towards 439 00:16:33,299 --> 00:16:35,620 opioid sparing pain management strategies is something that 440 00:16:35,620 --> 00:16:37,720 we've been advocating for and creating, 441 00:16:38,179 --> 00:16:40,820 and provide direction direction for for for some 442 00:16:40,820 --> 00:16:42,840 time now. We're starting to see it take, 443 00:16:43,379 --> 00:16:45,700 foot more and more around not only our 444 00:16:45,700 --> 00:16:47,539 region, but nationally. And we're seeing that in 445 00:16:47,539 --> 00:16:48,039 ways 446 00:16:48,355 --> 00:16:51,235 related to decreased opioid prescribing and just greater 447 00:16:51,235 --> 00:16:53,235 patient awareness. You'll even see it in in 448 00:16:53,235 --> 00:16:55,955 in pop culture in terms of shows and 449 00:16:55,955 --> 00:16:57,794 movies that have really started to focus on 450 00:16:57,794 --> 00:17:00,535 the the dangers of opioid abuse and addiction. 451 00:17:01,399 --> 00:17:03,879 So that's a that's a very positive trend 452 00:17:03,879 --> 00:17:04,940 that we're seeing, 453 00:17:05,320 --> 00:17:07,240 and we we hope to continue to contribute 454 00:17:07,240 --> 00:17:09,720 to that. But the one trend that's very 455 00:17:09,720 --> 00:17:10,859 concerning, though, 456 00:17:11,400 --> 00:17:12,220 is that we're 457 00:17:12,519 --> 00:17:16,144 a meaningful decrease in opioid related overdose deaths. 458 00:17:16,144 --> 00:17:18,144 Now I'm gonna preface that by saying that 459 00:17:18,144 --> 00:17:19,444 2024 460 00:17:19,585 --> 00:17:21,264 was the first year there was a slight 461 00:17:21,264 --> 00:17:22,804 decrease from the year before. 462 00:17:23,264 --> 00:17:26,224 Prior to that, almost every year after year, 463 00:17:26,224 --> 00:17:27,684 there was a steady increase 464 00:17:28,144 --> 00:17:30,884 in opioid related deaths in The United States. 465 00:17:31,460 --> 00:17:33,380 Over a hundred people are dying from opioid 466 00:17:33,380 --> 00:17:35,859 deaths every single day across The US, and 467 00:17:35,859 --> 00:17:37,079 opioid related deaths 468 00:17:37,380 --> 00:17:39,539 are the leading cause of death of of 469 00:17:39,539 --> 00:17:43,220 young adult Americans surpassing car accidents and gunshot 470 00:17:43,220 --> 00:17:43,720 injuries. 471 00:17:44,154 --> 00:17:45,835 So it's a big problem. And although we 472 00:17:45,835 --> 00:17:47,835 did see a slight drop last year, it's 473 00:17:47,835 --> 00:17:49,275 not a big drop, a slight drop from 474 00:17:49,275 --> 00:17:51,355 the year before, it's the numbers are still 475 00:17:51,355 --> 00:17:51,855 extremely 476 00:17:52,234 --> 00:17:52,734 high. 477 00:17:53,035 --> 00:17:55,434 Now we hopefully, this that one year down 478 00:17:55,434 --> 00:17:57,035 will be a trend, but one year right 479 00:17:57,035 --> 00:17:58,634 now is not a trend. It's just one 480 00:17:58,634 --> 00:18:01,470 year. We will see. But we're concerned by 481 00:18:01,849 --> 00:18:05,609 the fact that despite increased awareness, despite strong 482 00:18:05,609 --> 00:18:07,230 research, despite greater, 483 00:18:08,089 --> 00:18:09,630 awareness of the public, despite, 484 00:18:10,329 --> 00:18:13,309 more conscientious prescribing by by prescribers, 485 00:18:14,375 --> 00:18:17,174 we're not seeing a strong decrease. And one 486 00:18:17,174 --> 00:18:18,794 of the for that is 487 00:18:19,254 --> 00:18:21,335 the illicit opioid drug. 488 00:18:22,774 --> 00:18:23,274 Unfortunately, 489 00:18:23,575 --> 00:18:24,075 fentanyl 490 00:18:24,454 --> 00:18:27,254 illicit fentanyl production and sales continues to be 491 00:18:27,254 --> 00:18:29,034 rampant across the country. 492 00:18:29,549 --> 00:18:32,190 And more worse than that, we're also seeing 493 00:18:32,190 --> 00:18:34,029 some complications related to, 494 00:18:35,309 --> 00:18:37,170 the illicit fentanyl abuse, 495 00:18:37,710 --> 00:18:40,430 and the fentanyl market beyond opioid related deaths. 496 00:18:40,430 --> 00:18:41,410 We're also seeing 497 00:18:41,870 --> 00:18:42,370 increasing, 498 00:18:43,884 --> 00:18:44,384 adulteration 499 00:18:45,085 --> 00:18:45,585 of 500 00:18:46,045 --> 00:18:48,305 fentanyl with a substance called Xylazine, 501 00:18:49,484 --> 00:18:50,224 which is 502 00:18:50,765 --> 00:18:52,144 a a animal or veterinary 503 00:18:52,525 --> 00:18:53,025 sedative, 504 00:18:53,805 --> 00:18:55,565 for large animals. And, 505 00:18:56,599 --> 00:18:59,900 it's being mixed with fentanyl to increase its 506 00:19:00,039 --> 00:19:00,539 effect. 507 00:19:01,160 --> 00:19:03,559 But the side effect that we're seeing from 508 00:19:03,559 --> 00:19:05,180 mixing of Xylazine 509 00:19:05,559 --> 00:19:06,220 with fentanyl 510 00:19:06,839 --> 00:19:08,299 are these really severe, 511 00:19:08,839 --> 00:19:12,625 necrotic wounds or, that are forming on people's 512 00:19:12,625 --> 00:19:14,244 limbs who are injecting these 513 00:19:14,625 --> 00:19:17,505 drugs. And these these, wounds can be quite 514 00:19:17,505 --> 00:19:18,005 aggressive, 515 00:19:19,105 --> 00:19:22,865 cutting through, melting away skin, muscle, tendon, and 516 00:19:22,865 --> 00:19:25,845 down to bone, even cause even requiring amputations. 517 00:19:26,759 --> 00:19:28,920 Last year, the Roth and Opioid Foundation held 518 00:19:28,920 --> 00:19:30,539 a symposium just dedicated 519 00:19:30,920 --> 00:19:33,559 to xylazine associated wounds. We had focused on 520 00:19:33,559 --> 00:19:34,859 that last year. We had, 521 00:19:35,400 --> 00:19:37,559 the product of that was development of a, 522 00:19:37,799 --> 00:19:39,340 of a working group because 523 00:19:40,035 --> 00:19:41,894 Philadelphia has the highest concentration 524 00:19:42,275 --> 00:19:45,174 of these, of this type of drug, xylazine, 525 00:19:45,475 --> 00:19:45,975 adulterated, 526 00:19:47,555 --> 00:19:48,055 fentanyl. 527 00:19:48,595 --> 00:19:50,994 So we create a working group and create 528 00:19:50,994 --> 00:19:53,634 a consensus paper on how best to manage 529 00:19:53,634 --> 00:19:55,789 these wounds. But in terms of your question 530 00:19:55,789 --> 00:19:57,329 about what are some of the trends, 531 00:19:57,789 --> 00:20:00,990 we're seeing better awareness and better prescribing, but 532 00:20:00,990 --> 00:20:03,070 we're also seeing we are not seeing a 533 00:20:03,070 --> 00:20:05,650 meaningful decrease in opulated deaths nationally. 534 00:20:06,684 --> 00:20:09,244 Oh, doctor Elias, thank you so much for 535 00:20:09,244 --> 00:20:11,005 joining us today. It's been a pleasure speaking 536 00:20:11,005 --> 00:20:12,525 with you, and I look forward to connecting 537 00:20:12,525 --> 00:20:14,765 with you down the line. Thank you, Carly, 538 00:20:14,765 --> 00:20:16,205 so much for having me and giving me 539 00:20:16,205 --> 00:20:18,045 the opportunity to talk about the Ralph and 540 00:20:18,045 --> 00:20:20,144 Opioid Foundation and the work that we're doing. 541 00:20:22,220 --> 00:20:25,019 At athena Health, we know your ambulatory practice 542 00:20:25,019 --> 00:20:26,000 wants healthier, 543 00:20:26,380 --> 00:20:29,259 a healthier business, healthier care teams, and healthier 544 00:20:29,259 --> 00:20:29,759 patients. 545 00:20:30,140 --> 00:20:32,460 But the complexities of modern health care tech 546 00:20:32,460 --> 00:20:34,299 make it hard for you and your care 547 00:20:34,299 --> 00:20:36,015 teams to focus on what matters most. 548 00:20:36,654 --> 00:20:38,355 That's where athenahealth can help. 549 00:20:38,734 --> 00:20:41,535 Our AI native all in one solutions reduce 550 00:20:41,535 --> 00:20:42,595 administrative burdens, 551 00:20:42,974 --> 00:20:45,934 streamline billing and payments, and deliver critical insights 552 00:20:45,934 --> 00:20:48,734 when clinicians need it most. That means fewer 553 00:20:48,734 --> 00:20:51,615 clicks, more time for patients, and stronger bottom 554 00:20:51,615 --> 00:20:51,900 lines. 555 00:20:52,779 --> 00:20:55,980 Practicing medicine is complex, but running a practice 556 00:20:55,980 --> 00:20:57,839 can be that much simpler with athenahealth. 557 00:20:58,539 --> 00:21:02,240 See how simpler is healthier at athenahealth.com.