Latest / Pharmacy Podcast Network / Pain Pearls: Part 2 with Dr. Sing Ping Chow | Pain Pod

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Pain Pearls: Part 2 with Dr. Sing Ping Chow | Pain Pod · Pharmacy Podcast Network

• 0:05
  Speaker 1: You are listening to the global network of podcasters dedicated
• 0:09
  Speaker 1: to the pharmacy profession.
• 0:10
  Speaker 2: Welcome to the Pharmacy podcast Network.
• 0:22
  Speaker 3: This is the Pain Pod.
• 0:25
  Speaker 4: You want to see pain look at me?
• 0:34
  Speaker 3: Welcome to the Pain Pod, the podcast for all things
• 0:39
  Speaker 3: pain management, hosted by the Pain Guy, doctor Mark Grow.
• 0:48
  Speaker 3: We'll be collaborating with numerous pain management experts, talking about
• 0:52
  Speaker 3: substance usage disorders, the latest treatment modalities, and the most
• 0:57
  Speaker 3: important important focusing on the pain of our patients as.
• 1:01
  Speaker 4: Leading providers of pain care.
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  Speaker 3: And now here's our host, a man wanted in all
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  Speaker 3: fifty states, a suburban city like Mountain Man without the beard,
• 1:16
  Speaker 3: from the hills of West Virginia and certified in weapons
• 1:21
  Speaker 3: of mass destruction.
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  Speaker 4: Response Yes, doctor Mark sorby welcome back everyone to the
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  Speaker 4: Pain Pod. Now a couple episodes, you might be thinking, man,
• 1:38
  Speaker 4: we've been listening to this pain guy a good bit.
• 1:41
  Speaker 4: Unless this is your first Pain Pod episode ever, of course,
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  Speaker 4: and welcome either way. As we always say, come one,
• 1:47
  Speaker 4: come all to the Pain Pod. So here today we
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  Speaker 4: actually we're gonna kind of I think this might be
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  Speaker 4: enduring this this style. So this is actually an invite
• 1:56
  Speaker 4: and an intro, but we're gonna go over pain Pearls
• 2:01
  Speaker 4: part two of Hopefully Many. We had a Clinical Pearls
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  Speaker 4: pain pod addition back in the day. You could certainly
• 2:07
  Speaker 4: check out that episode. We're gonna do part two of
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  Speaker 4: Hopefully Many, and this is going to be with a guest.
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  Speaker 4: And I got a feeling that most, if not all
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  Speaker 4: of you probably already know doctor Singping. But at the
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  Speaker 4: same time, hey, there's folks, there's a lot of there's
• 2:23
  Speaker 4: a lot of humans on this planet, right, so maybe not,
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  Speaker 4: but we're certainly going to welcome him here to the
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  Speaker 4: pain Pod. But our overall idea here today it's just
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  Speaker 4: going over a little cornic hopeia, clinical pearls in the
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  Speaker 4: realm of pain management, and maybe a little bit beyond
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  Speaker 4: as well too. So doctor Singping, welcome aboard. Perhaps you
• 2:46
  Speaker 4: want to give everybody a little what's your story?
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  Speaker 1: Well, Hi, Mark, and thank you so much for having
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  Speaker 1: me today. It's such a pleasure to be speaking with you. Finally,
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  Speaker 1: absolutely so, my name is Singping. I am a board
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  Speaker 1: certified pain management pharmacist. I guess should I say pain
• 3:05
  Speaker 1: board certify because it's a new board exam.
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  Speaker 4: Hey, the bottom line is, you got your board certified
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  Speaker 4: and what we're talking about, so audience pain podination. This
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  Speaker 4: guy knows his stuff. That's what I'll translate to.
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  Speaker 2: I love it.
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  Speaker 1: I am Alsomate, the co founder of Pain Arts Consulting.
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  Speaker 1: So my story, I just happened to stumble into the field.
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  Speaker 1: And I think, as I was talking through other folks,
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  Speaker 1: sometimes we pain management isn't something that we just chose,
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  Speaker 1: and I've definitely met other folks that we just stumbled into.
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  Speaker 1: At the time when I was applying for PGY two,
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  Speaker 1: I just couldn't get into ambulatory care and that was
• 3:52
  Speaker 1: my original route, and so at the time I was like,
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  Speaker 1: you know what, I would just choose quote unquote something
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  Speaker 1: and hopefully I'll be able to breage back to maybe
• 4:03
  Speaker 1: amblatary care. So I guess a better I think a
• 4:07
  Speaker 1: better question for me to answer would be what made
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  Speaker 1: me stay right because after the residency, I can always
• 4:14
  Speaker 1: have the option to just like jump ship and just
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  Speaker 1: change my route, right, And so I really stayed because
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  Speaker 1: pain management is a very character building field, not like
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  Speaker 1: anything else. And I also get to solve really complex
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  Speaker 1: problems and those are very real world problem that some
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  Speaker 1: people unfortunately have to face. And it's beyond just just physical,
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  Speaker 1: and there's also the spiritual, and there's also the financial
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  Speaker 1: situation of so many things that and you are being
• 4:56
  Speaker 1: part of the team to solve that really complex problems.
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  Speaker 1: And that's really what made me stay.
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  Speaker 4: Yeah, feeling you're not alone. That's uh, that's inherent with
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  Speaker 4: I'm sure other sectors or genres of care within pharmacy
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  Speaker 4: and healthcare in general, but you know us uh us
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  Speaker 4: pain folks. It's I think you just summarized the experience
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  Speaker 4: and the intention of many of us. Quite frankly, it's
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  Speaker 4: it's a lot of complicated things that escalates quickly, but boy,
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  Speaker 4: the the outcomes are pretty quick once they're figured out right,
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  Speaker 4: and you're really helping people. So awesome to know that.
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  Speaker 2: Thank you, Yeah, thank you, thank you.
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  Speaker 1: The outcome definitely like it's it's very it's impactful, and
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  Speaker 1: I like to think about the impacts like it takes
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  Speaker 1: time and some some of it it can be fast.
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  Speaker 1: But some of that you just have to recognize that
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  Speaker 1: you have to keep trying, like especially.
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  Speaker 2: In in the.
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  Speaker 1: In the realm of substance, you for example, knowing that
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  Speaker 1: it's a relapsing disease and and and you have to
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  Speaker 1: be very careful. You have to be you have to
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  Speaker 1: embrace this disease, stay as a relapsing disease, and and
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  Speaker 1: and and try to keep trying and keep giving opportunities
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  Speaker 1: and keep working with them. And the outcome might not
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  Speaker 1: be inmedate, but when you do, I think that's very gratifying.
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  Speaker 2: So that's kind of another reason why I state.
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  Speaker 4: Absolutely it's it's and you know this isn't some campfire
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  Speaker 4: conversation on motivation or anything like that, but there's a
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  Speaker 4: reality to that. And boy, you're talking to the right
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  Speaker 4: guy here, because well, you haven't been in my office
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  Speaker 4: at the university yet anyway. I mean maybe someday, I
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  Speaker 4: don't know. But when I when I first started at
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  Speaker 4: Western University School of Pharmacy, I brought two things with me.
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  Speaker 4: One was a box of tissues because I figured that
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  Speaker 4: might be needed in dealing with learners. Definitely hit that
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  Speaker 4: nail on the head. The second thing I brought was
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  Speaker 4: a couple of letters that go on the wall and
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  Speaker 4: I put them above my door and they spell out
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  Speaker 4: never give up, because I figured, well, there's probably gonna
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  Speaker 4: be a lot of conversations, particularly in the exponential education,
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  Speaker 4: realm rotations, life happens a lot. And then taking care
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  Speaker 4: of patients, like you said too of you know, even
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  Speaker 4: in patient care, it's never giving up is incredibly important.
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  Speaker 4: You know, we got to know our barriers and all
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  Speaker 4: that kind of stuff. But I you know, that's what
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  Speaker 4: our patients deserve, that's what our learners deserve. And I
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  Speaker 4: tell you what those two things I brought. I didn't
• 7:37
  Speaker 4: bring a computer. I figured they'd provide that and you
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  Speaker 4: know the rest of the stuff in the room, but
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  Speaker 4: to this day, still need those two things. So love
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  Speaker 4: what you're bringing up there, singping, thank you. All right.
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  Speaker 4: So our intention here is this cornicopia of pain conundrums
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  Speaker 4: and hopefully some solutions, tools and you know, knowledge for
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  Speaker 4: everyone here and going over the pain pearls. So we
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  Speaker 4: got a handful of them here. We've been chit chatting
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  Speaker 4: in the past, kind of lining things up for folks.
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  Speaker 4: But I know you were pretty strong willed on the
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  Speaker 4: idea of like, hey, let's can we just can we
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  Speaker 4: talk about methodone and pain a little bit maybe a
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  Speaker 4: dash of unfortunately cancer in there as well too, but
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  Speaker 4: you know, really wanted to talk a little bit more
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  Speaker 4: about methodone and particularly in pain management, of course. And
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  Speaker 4: I always you know, even on the personal side, I
• 8:25
  Speaker 4: guess it's professional, but I always view that, like Charles
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  Speaker 4: Dickens said, it's the best of times, it's the worst
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  Speaker 4: of times. And what I mean by that is it
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  Speaker 4: has such utility within pay management. But then we'll spend
• 8:38
  Speaker 4: hours going over the intricate pharmacological considerations for its utilization overall,
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  Speaker 4: and they go hand in hand. You got to respect
• 8:45
  Speaker 4: that pharmacology along the way, of course. So what are
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  Speaker 4: your thoughts hit us up here on methodone and pain?
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  Speaker 1: Hmm, mathone and pain, especially when you say cancer pain.
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  Speaker 1: I really think it's a great tool. I even up
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  Speaker 1: to this point, I think we probably have come across
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  Speaker 1: some some mechanism, some proposed mechanism. Let it be an
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  Speaker 1: M D A S NRI I.
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  Speaker 2: Whatever it is.
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  Speaker 1: Like I feel like methadone isn't our traditional opiod like
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  Speaker 1: morphine and oxycodon, and.
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  Speaker 2: Methadone is. So I would say, when it works, it
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  Speaker 2: works so.
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  Speaker 1: And and and you and I think, you know, you know,
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  Speaker 1: you know what I mean, Like when when when when
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  Speaker 1: a patient having cancer look absolutely like like terrible, like
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  Speaker 1: they just they're just suffering and when they have tried
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  Speaker 1: out different things. And I work in patients, so I'm
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  Speaker 1: always working under time pressure trying to figure out what's
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  Speaker 1: the best thing I can get the pain under control
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  Speaker 1: and then you know, hopefully send you back to the
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  Speaker 1: outpatient and do the rest of the titration and monitoring.
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  Speaker 1: And so when patients come in and they're already on
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  Speaker 1: some sort of let it be hydrocodone or oxycodone, maybe
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  Speaker 1: a little bit of adjuvant, and their pain is still
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  Speaker 1: not control in in cases of cancer, then that's something
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  Speaker 1: that I immediately would be something that I'll be considering.
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  Speaker 2: And I remember, I.
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  Speaker 1: Think a better again, you know, something that I've been thinking,
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  Speaker 1: which I also saw on a LinkedIn post. I forgot
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  Speaker 1: how long ago was should we be using methodone more
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  Speaker 1: upfront then trying out like the conventional like morphine or hydrocodone, oxycholone,
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  Speaker 1: and like, wait, maybe let's see, let's see if they
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  Speaker 1: work before we do methadone, because that is still kind
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  Speaker 1: of the practice that I am seeing and I'm also.
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  Speaker 2: More comfortable with now.
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  Speaker 1: I think there is definitely some wisdom to using methodone upfront,
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  Speaker 1: knowing that like I would say, if they if patients respond,
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  Speaker 1: they respond very very well. Now, if we do that upfront,
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  Speaker 1: and let's say, for example, later on, which I rarely
• 11:33
  Speaker 1: have that kind of scenario, is you know, I usually
• 11:36
  Speaker 1: go from conventional opio to methadone. I rarely go from
• 11:39
  Speaker 1: methodone back to conventional opiod because most of the time
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  Speaker 1: they already try different things and then they end up
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  Speaker 1: with medione. Now if they don't respond to methodone at
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  Speaker 1: some point and then they go back to conventional methodal
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  Speaker 1: I mean they go back to conventional opioid, what would
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  Speaker 1: be what what should we expect? And I think that
• 12:00
  Speaker 1: is something that I'm not quite sure. So I think
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  Speaker 1: I think a very good almost like a debate or
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  Speaker 1: or like a point of view, is should we use
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  Speaker 1: method up front or should we wait? I think that's
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  Speaker 1: something that's worth investigating.
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  Speaker 4: Absolutely, and I have a distinct feeling that it's one
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  Speaker 4: of those if you ask ten pharmacists, you'll get fourteen
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  Speaker 4: replies because it's you know, there's the ancient, well known
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  Speaker 4: cop out answer of anything of like, oh, well, it
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  Speaker 4: depends on the patient. Absolutely. How about we get to
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  Speaker 4: the question, though you know, there's certainly a time and place,
• 12:38
  Speaker 4: and you know we kind of dive into that a
• 12:41
  Speaker 4: little bit with uh oh, wait for it, folks, the
• 12:43
  Speaker 4: big word bup and orphine. All right, I talked about
• 12:47
  Speaker 4: ope you right out there. Of course. In fact, I'll
• 12:50
  Speaker 4: add a little pearl on here for us conversation anyway.
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  Speaker 4: But you know, the methodone before or after checking into
• 12:58
  Speaker 4: the egg, same thing happens with bupe and orphan. Know,
• 13:00
  Speaker 4: the concerns of you know, opioid rotation or switching along
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  Speaker 4: the way, they're real and and it's you know, we
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  Speaker 4: can go by the observations like you mentioned of you know,
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  Speaker 4: typically it's you know, once once you go a methadone,
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  Speaker 4: probably not going back or whatever, or or onward, but
• 13:17
  Speaker 4: it's still it can be. But those you know, that
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  Speaker 4: factors into I think what you alluded to earlier of
• 13:23
  Speaker 4: the you know, there's a lot of tricky situations out there,
• 13:26
  Speaker 4: and by gully, that's what we're there for, particularly as pharmacists,
• 13:29
  Speaker 4: but healthcare professionals in general too, is to to help
• 13:32
  Speaker 4: navigate those you know, all of our bcpmps out there.
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  Speaker 4: I can't do it because you know, it's on the
• 13:40
  Speaker 4: Specialty Council for making the thing of course, but you
• 13:45
  Speaker 4: know same ping, you're you're one of there's you know
• 13:47
  Speaker 4: a good amount of others out there where we're there.
• 13:50
  Speaker 4: We're ready to help, just like those that are specialized
• 13:53
  Speaker 4: within endo chronology for diabetes and beyond and you know
• 13:57
  Speaker 4: all those intricacies along the way there. So those kind
• 13:59
  Speaker 4: of conversations certainly need to continue. I'd even give a
• 14:02
  Speaker 4: shout out to one of our you know, targeted organizations
• 14:05
  Speaker 4: within pharmacy, the SPPCP you guys and Pain Buttonation have
• 14:10
  Speaker 4: heard me say it before, and and that's why it
• 14:13
  Speaker 4: rolls off the tongue because that's that's a Campbell's soup
• 14:15
  Speaker 4: of letters there. But the Society of Pain out of
• 14:19
  Speaker 4: Care Pharmacists, there's even a virtual conference every year and
• 14:23
  Speaker 4: lots of different networking events and certainly opportunities for engagement
• 14:27
  Speaker 4: to have those kinds of conversations. And it's really important
• 14:30
  Speaker 4: because they're longer conversations. They're not going to be pulled
• 14:33
  Speaker 4: off in you know, one tenth of a podcast anywhere.
• 14:36
  Speaker 4: So so thank you for diving out a little bit
• 14:39
  Speaker 4: deeper into that, good sir. Now, I think it came
• 14:43
  Speaker 4: up naturally. They're in conversation, bue and orphine. Good golly,
• 14:46
  Speaker 4: we can talk for hours and hours on that puppy,
• 14:49
  Speaker 4: but I'll pull up one thing as far as BUEP
• 14:52
  Speaker 4: and orphine, because this seems to get talked about a lot,
• 14:56
  Speaker 4: not necessarily public, but within healthcare. You know, the whole
• 15:00
  Speaker 4: morphine miligram equivalent MMY or OIMI. You know, the conversion
• 15:05
  Speaker 4: factors along the way there. Uh, you know the general
• 15:08
  Speaker 4: journey we've detailed on other paint pot episodes of you know,
• 15:12
  Speaker 4: going from zero point one as an MM factor to
• 15:14
  Speaker 4: magically zero point three a few months later, as far
• 15:17
  Speaker 4: as CDC guideline releases back in the day, and then
• 15:20
  Speaker 4: it became Bruno where we really don't talk about that
• 15:23
  Speaker 4: for you know, various reasons along the way. But keeping
• 15:27
  Speaker 4: all that in mind with lots of other things that
• 15:30
  Speaker 4: you know, of course, would you say there's a true
• 15:33
  Speaker 4: buprenorphine MMY factor or conversion along the way or you know,
• 15:37
  Speaker 4: what's your thoughts in that regard.
• 15:40
  Speaker 1: O tough tough questions? To be honest, I do not
• 15:46
  Speaker 1: think so, okay, or it really depends on the context
• 15:54
  Speaker 1: of what we're looking at. I think I think that's
• 15:58
  Speaker 1: really a better way to think about it. So when
• 16:00
  Speaker 1: we think about when we think about like an opiate conversion,
• 16:05
  Speaker 1: we are having like for example, we we know we
• 16:10
  Speaker 1: do it like a billion times already going from oxycote
• 16:13
  Speaker 1: onto like a dialogue it to like a morphine for example. Right,
• 16:17
  Speaker 1: and then when we look at when we look at
• 16:22
  Speaker 1: how the conversion factor of bupernorv of bprenrving, how it evolved,
• 16:28
  Speaker 1: like you were saying, like it went from small number
• 16:31
  Speaker 1: to another number to all set and like it was
• 16:33
  Speaker 1: being taken out.
• 16:35
  Speaker 2: And then if we look at the if we look.
• 16:38
  Speaker 1: At the the balbuca for example, we look at how
• 16:44
  Speaker 1: they suggest with whatever evidence that that they provide. Right,
• 16:50
  Speaker 1: we see that the dose range of the of the
• 16:55
  Speaker 1: bal buca or or when when patients is like on
• 16:58
  Speaker 1: certain MME or O me, it's so wide, and then
• 17:02
  Speaker 1: and then you convert to you know, a particular or
• 17:05
  Speaker 1: a specific recommended balbuka dose. And when I see something,
• 17:11
  Speaker 1: when I see like a dose range being that wide,
• 17:14
  Speaker 1: that is almost like telling me that we don't know
• 17:16
  Speaker 1: as much, right, because if we if we know, then
• 17:21
  Speaker 1: I would expect that the dose range would be more precise,
• 17:25
  Speaker 1: not like from thirty to ninety. And then it's it's
• 17:28
  Speaker 1: some sort of balbuka dose. I would expect something like
• 17:32
  Speaker 1: maybe thirty to fifty. That's more like a sweet spot
• 17:35
  Speaker 1: of an omme, not like a huge gap. So I
• 17:38
  Speaker 1: think that's kind of I think that's really my argument
• 17:41
  Speaker 1: number one, and.
• 17:43
  Speaker 2: My argument number two would be when we think.
• 17:47
  Speaker 1: About like an MM or ome conversion, I think something
• 17:51
  Speaker 1: to really help us apply and appreciate those those rules
• 17:56
  Speaker 1: and conversion is when a patient is having, for example,
• 18:00
  Speaker 1: acute pain on on a chronic opioid and in this scenario,
• 18:06
  Speaker 1: let's say, for example, the patient is on the box
• 18:10
  Speaker 1: like in a milligram dose of bilpri North.
• 18:12
  Speaker 2: Theme, if we really, if we really use.
• 18:15
  Speaker 1: Whatever conversion bill per North in conversion out there, we
• 18:21
  Speaker 1: can easily get like hundreds of MME or ome with
• 18:27
  Speaker 1: the milligram of bilper North thee Now, if we use
• 18:32
  Speaker 1: that principle of PRN, you know, the ten to twenty
• 18:36
  Speaker 1: percent of your of your total daily MME, and use
• 18:40
  Speaker 1: that as a PRN, then we can easily get like
• 18:44
  Speaker 1: a number of a of a PRN dose for a
• 18:49
  Speaker 1: breakthrough pain let's say post off. Then it would be
• 18:52
  Speaker 1: like a huge amount.
• 18:54
  Speaker 2: But do in reality, in reality, do we do that.
• 18:57
  Speaker 1: No, Like in my practice, patients can if they're on
• 19:02
  Speaker 1: like milligram of su boxon, they will be getting oxycodone
• 19:07
  Speaker 1: starting Those would be like ten to fifteen and then
• 19:10
  Speaker 1: if it still don't work, we go up. But we
• 19:13
  Speaker 1: rarely go right off the bat base off of whatever
• 19:16
  Speaker 1: amount that we convert to and do the ten to
• 19:19
  Speaker 1: twenty percent, and because that would be a huge dose,
• 19:22
  Speaker 1: but most of the time patients would already be responding
• 19:25
  Speaker 1: to that, to that relatively small doses of the oxycodone.
• 19:30
  Speaker 1: So that mismatch of the MME or whatever conversion that
• 19:35
  Speaker 1: kind of tells me the way to convert.
• 19:39
  Speaker 2: Per northine is not linear.
• 19:40
  Speaker 1: It's not as direct as we see from morphine or oxycodone.
• 19:46
  Speaker 1: And of course I would also say that when the
• 19:50
  Speaker 1: MME exceeds a certain amount in my experience, like anything
• 19:55
  Speaker 1: above like a one fifty to two hundred, things start
• 19:58
  Speaker 1: to be very skewed.
• 19:59
  Speaker 4: You can just the way it's like you get somewhere
• 20:02
  Speaker 4: and then you.
• 20:03
  Speaker 2: Know we're yeah, and then it don't follow anymore.
• 20:06
  Speaker 1: So I think you have to really be be cognizant
• 20:10
  Speaker 1: of both the limitation of the of the MME conversion
• 20:15
  Speaker 1: and the fact that dupreneur thing whatever that we know
• 20:19
  Speaker 1: right now, we don't know a lot about the conversion.
• 20:22
  Speaker 1: I don't think there's a lot of studies that really
• 20:24
  Speaker 1: look into that and really kind of take it with
• 20:27
  Speaker 1: a grain of salt and roll with what we got.
• 20:30
  Speaker 4: That's phenomenal advice for all of us everyone out there,
• 20:34
  Speaker 4: of course, But you know, it's we were just talking
• 20:38
  Speaker 4: about methodon even and it's like, oh my goodness, there's
• 20:40
  Speaker 4: so many different versions, at least throughout the hot tub
• 20:44
  Speaker 4: time machine of our lives. You know, as far as
• 20:47
  Speaker 4: the conversion factors for that, like, oh, it was you know,
• 20:49
  Speaker 4: it was Calculus, and then it became the twenty sixteen
• 20:53
  Speaker 4: CDC Guy Lanes, We're like, oh, it's four, eight, ten
• 20:55
  Speaker 4: or twelve every twenty milligram increments. Don't worry about how
• 20:59
  Speaker 4: fast we went over that, folks, because that's ancient history.
• 21:01
  Speaker 4: Because then after that, based on our reference from before that,
• 21:04
  Speaker 4: it magically became four point seven, and like, okay, truth
• 21:10
  Speaker 4: be told, even if it was four, I mean, it'll
• 21:11
  Speaker 4: get it done based on the products. But you know,
• 21:13
  Speaker 4: to your point, I think that emphasizes, you know, yes, methodone,
• 21:16
  Speaker 4: but then bupe and orphine as well, where it has
• 21:19
  Speaker 4: its place to guide and to help us clinicians along
• 21:22
  Speaker 4: the way. It just can't become law out there, right,
• 21:27
  Speaker 4: because you got to have that flexibility along the way,
• 21:29
  Speaker 4: and there's a there's a time and place, and when
• 21:31
  Speaker 4: you get the overlap with OUD, it's a whole nother
• 21:34
  Speaker 4: ballgame along the way as well too. So and I
• 21:37
  Speaker 4: appreciate by the way that you didn't stay in the
• 21:39
  Speaker 4: back corner there. You brought up Hey, patient with OUD
• 21:43
  Speaker 4: all all of a sudden has a cute pain as
• 21:45
  Speaker 4: well too, because hey, we're human, it happens, right, So
• 21:49
  Speaker 4: lots going on there, and we could talk about bupe
• 21:51
  Speaker 4: and orphine for many more times episodes and days for
• 21:54
  Speaker 4: that matter, But I want to jump into at least
• 21:57
  Speaker 4: one more category here of medicine, and this one, well, boy,
• 22:02
  Speaker 4: so recently, you know, you look at we not that
• 22:06
  Speaker 4: long ago, had an episode, you know, opiodology, the opioids
• 22:09
  Speaker 4: story here on the pain Pod and even on my
• 22:12
  Speaker 4: website paying dot Us. I got some charts on there,
• 22:15
  Speaker 4: did some not investigative reporting, but everybody always talks about
• 22:17
  Speaker 4: the pendulum for opioids and like, oh well, all the extremes,
• 22:21
  Speaker 4: you know, oh, lock them all up, well, then what
• 22:23
  Speaker 4: are you going to utilize? And oh, opioid for everybody
• 22:27
  Speaker 4: that doesn't tend to work out too well either. The
• 22:29
  Speaker 4: extremes are always a concerned somewhere along the way there,
• 22:31
  Speaker 4: all of a sudden, gabba pentanoids, gaba penton pre gabbling predominantly,
• 22:36
  Speaker 4: you know, entered the ring, and you know, then that became, oh, well,
• 22:39
  Speaker 4: it's not an opioid, so let's just utilize that. I's
• 22:43
  Speaker 4: been countless interviews in the last year or so, we
• 22:46
  Speaker 4: even in coverage of that and various things like I
• 22:48
  Speaker 4: think it was Pharmacy Today, Pharmacy Times, drug Topics, you
• 22:51
  Speaker 4: name it, interviews, articles, you know, going over this reality there.
• 22:55
  Speaker 4: So you know, what are your thoughts on the whole
• 22:59
  Speaker 4: gabba pennoids or gabba penton specifically, often like that whole
• 23:03
  Speaker 4: idea within the opioid story in the big picture too.
• 23:08
  Speaker 1: I definitely have heard and seeing more news related to
• 23:14
  Speaker 1: gabapentin in the last year, and when I first came
• 23:22
  Speaker 1: across that concern, it almost struck me as oh gosh,
• 23:27
  Speaker 1: like you you add gappa pent in to an opio
• 23:30
  Speaker 1: and the patient will just have respiratory depression. That that
• 23:34
  Speaker 1: was that was the impression or I guess that's kind
• 23:37
  Speaker 1: of what's being almost like being portrayed, or when when
• 23:42
  Speaker 1: words get really simplified to like a headline and this
• 23:45
  Speaker 1: is what it's seemingly being insinuated. But in reality, if
• 23:53
  Speaker 1: we're looking at the FDA warning that came out, it
• 23:59
  Speaker 1: was a few years go, and it was saying that
• 24:05
  Speaker 1: it was using some older data that looked into patients
• 24:08
  Speaker 1: who are on opioid with gabapentin. Yes, they see that
• 24:13
  Speaker 1: there is more concern about the respiratory depression, and we
• 24:17
  Speaker 1: have to also acknowledge that patients in that state they
• 24:20
  Speaker 1: may also be sicker.
• 24:22
  Speaker 2: And now I think we have a newer.
• 24:25
  Speaker 1: Discussion right now is because we want to use non
• 24:29
  Speaker 1: opioid the best we can.
• 24:31
  Speaker 2: So now like you were saying.
• 24:33
  Speaker 1: Is that there is like an increase in galva pentent prescription.
• 24:39
  Speaker 1: Let it be you know, we use it for the
• 24:42
  Speaker 1: neuropathic pain or maybe not even for a neuropathic pain whatsoever.
• 24:47
  Speaker 1: Now we definitely I feel like part of the signal
• 24:50
  Speaker 1: that's coming through is because now that we're really using
• 24:54
  Speaker 1: a lot of gabapentent. So now we hear more feedback
• 24:57
  Speaker 1: to that. I think the bottom line of what a
• 25:01
  Speaker 1: clinician and as a patient we have to understand with
• 25:06
  Speaker 1: this message is that one if I.
• 25:12
  Speaker 2: Think we need to have a more.
• 25:16
  Speaker 1: More transparent discussion about the therapeutics and what risks are
• 25:23
  Speaker 1: the patients willing to assume, right, because any kind of medication,
• 25:28
  Speaker 1: any kind of medication, is a chemical and and and
• 25:30
  Speaker 1: there's almost like no free lunch, Like I wish there's
• 25:33
  Speaker 1: something out there that's that's one hundred percent efficacy but
• 25:36
  Speaker 1: zero you know, Scie effects.
• 25:39
  Speaker 4: But unfortunately we're not.
• 25:43
  Speaker 2: We're not there yet right yet. It's the very that
• 25:46
  Speaker 2: the keyword here, we're not there yet.
• 25:48
  Speaker 1: So like if if your pain, let's say, for example,
• 25:53
  Speaker 1: if your pain is not controlled, let's say you're on opioid,
• 25:59
  Speaker 1: then what are.
• 26:01
  Speaker 2: Really your options?
• 26:02
  Speaker 4: Right?
• 26:02
  Speaker 1: Like the options in terms of therapeutics the easiest thing,
• 26:07
  Speaker 1: right because you just take a pill and that's it,
• 26:10
  Speaker 1: not no procedures, you don't have to go for an injection,
• 26:14
  Speaker 1: you don't have to really travel for anything. So the
• 26:16
  Speaker 1: easiest thing you want to opt in for if you
• 26:19
  Speaker 1: want to option for medications, there isn't a lot out
• 26:22
  Speaker 1: there available unfortunately, so you you will come down to
• 26:27
  Speaker 1: maybe increasing the opioid.
• 26:29
  Speaker 2: That's option one.
• 26:30
  Speaker 1: But you also have to understand that when you increase
• 26:33
  Speaker 1: the opioid, then you're going to have the tolerance and
• 26:36
  Speaker 1: maybe you're not even gonna going to tolerate the dose increase.
• 26:41
  Speaker 1: Then you will have to consider if we were to
• 26:46
  Speaker 1: use an adjuvant like ap pentent, Yes, the risk is
• 26:50
  Speaker 1: out there, but is it the risk that you are
• 26:54
  Speaker 1: willing to assume. I think I think that's really the
• 26:58
  Speaker 1: data that's really the converse we need to engage the
• 27:02
  Speaker 1: patients with because maybe before we're just like, okay, well
• 27:06
  Speaker 1: we'll give you some gaba pendent, all right, and then
• 27:08
  Speaker 1: and then and then we'll be done with this with
• 27:10
  Speaker 1: this visit. But I think now we should be having
• 27:13
  Speaker 1: the conversation and be like, we know, we now know
• 27:16
  Speaker 1: that there is association with the I think it's it's
• 27:19
  Speaker 1: it's not just respiratory depression, it's more c and as
• 27:22
  Speaker 1: depression because we know that we know that people will
• 27:25
  Speaker 1: will fall and unfortunately, who are the patients who are
• 27:29
  Speaker 1: having pain? For the most part, older patients and older
• 27:32
  Speaker 1: patients already have all these risks from being frail and
• 27:37
  Speaker 1: all the fall risks. So I think it's way more
• 27:40
  Speaker 1: important right now to be as transparent as we can
• 27:45
  Speaker 1: engage the patients to make the decisions together. And if
• 27:51
  Speaker 1: they do opt in to do gaba pentent, then we
• 27:55
  Speaker 1: have to work even closer and really outlined. These are
• 27:59
  Speaker 1: the things said you want to watch out for. Maybe
• 28:02
  Speaker 1: you even want to keep a pain diary instead of
• 28:04
  Speaker 1: you know, maybe back then, I don't know what they
• 28:06
  Speaker 1: were doing before and just start a medication and assume
• 28:08
  Speaker 1: that just because it's a non opiate and it's safe.
• 28:11
  Speaker 1: Maybe we just have to do more monitoring and instead
• 28:15
  Speaker 1: of saying that okay, gabapentin and opio it, now that
• 28:18
  Speaker 1: it hit the headline, so we should avoid I don't
• 28:20
  Speaker 1: think avoiding it is this is the answer, because we
• 28:24
  Speaker 1: don't really have that many therapeutic options out there. I
• 28:27
  Speaker 1: think the message is to do more monitoring and work
• 28:31
  Speaker 1: closer with the patient.
• 28:33
  Speaker 4: Absolutely, it's you know, the menu is relatively limited. We
• 28:37
  Speaker 4: certainly have a great number of combinations of different pain
• 28:41
  Speaker 4: therapeutics for our patients, but you know, we have to
• 28:45
  Speaker 4: do our due diligence there, audience, what we didn't hear
• 28:48
  Speaker 4: there was saying, oh, let's quantify everything, and you know
• 28:51
  Speaker 4: we have mms, let's make gmes and benzomes and all
• 28:56
  Speaker 4: that like and come up with a number. And you
• 28:58
  Speaker 4: don't go above a number. That is so pragmatic and
• 29:01
  Speaker 4: it would make satisticians or mathematicians very happy. But what
• 29:04
  Speaker 4: about our patients? You know, what would be the outcome there?
• 29:08
  Speaker 4: And it's you know, it's just assessing how does it
• 29:11
  Speaker 4: work and what's the dose for each medicine and the
• 29:15
  Speaker 4: totality of all of them together, So very well said.
• 29:17
  Speaker 4: Of course, all right, all right, we went over like
• 29:21
  Speaker 4: two or three different groupings there of pain medications, illustrious ones,
• 29:27
  Speaker 4: way bigger picture here, particularly as a b C PMP yourself,
• 29:32
  Speaker 4: what are your thoughts on should healthcare systems invest in
• 29:35
  Speaker 4: pain pharmacists?
• 29:36
  Speaker 1: Again, very deep question. The short answer to that would
• 29:42
  Speaker 1: be yes, And I.
• 29:45
  Speaker 4: Mean I was kind of hoping for you.
• 29:49
  Speaker 1: Yes, And I think I can definitely elaborate this into
• 29:54
  Speaker 1: like a lecture long discussion and the if I can,
• 30:00
  Speaker 1: if I can provide the biggest reason is because pain management,
• 30:05
  Speaker 1: especially with pain medication management, which I love emphasizing with
• 30:11
  Speaker 1: my patients when I when I first introduced myself as
• 30:14
  Speaker 1: a pain management pharmacist, I would tell them that within
• 30:17
  Speaker 1: pain management, I do paid medication management.
• 30:21
  Speaker 2: And I think this is.
• 30:22
  Speaker 1: A weakness for a lot of clinicians if they have
• 30:27
  Speaker 1: not dedicate, like a a dedicated training to just pain
• 30:33
  Speaker 1: medication management. Over the years, I've been practicing for almost
• 30:40
  Speaker 1: five years now and I have trained students and residents.
• 30:44
  Speaker 1: And every year when I when I ask my student,
• 30:50
  Speaker 1: like what what have you learned so far? I usually
• 30:54
  Speaker 1: keep this question very general, like.
• 30:56
  Speaker 2: What what have you learned so far?
• 30:58
  Speaker 1: And they would say, you know, I learned some sort
• 31:01
  Speaker 1: of open conversion, and then they start listing out all
• 31:05
  Speaker 1: the medication names, but there isn't a lot of context
• 31:10
  Speaker 1: to what is for what. But they're already P four right,
• 31:14
  Speaker 1: and so when they graduate, whether they would do a
• 31:20
  Speaker 1: PG ON one And I think even for PG I
• 31:22
  Speaker 1: one for my program, we didn't really have a lot
• 31:26
  Speaker 1: of focus in pain management. So I think a lot
• 31:31
  Speaker 1: of healthcare administrators have to understand and take a closer
• 31:36
  Speaker 1: look to the current medical training and education being provided
• 31:43
  Speaker 1: to the clinicians because a lot of times, what I
• 31:47
  Speaker 1: realize and noticed over the years is there is education provided,
• 31:53
  Speaker 1: but they're not in depth when it comes to opiate management.
• 31:59
  Speaker 1: That's a general weakness for a lot of folks. And
• 32:03
  Speaker 1: when they see like some weird dosing it, it's hard
• 32:07
  Speaker 1: for a lot of people to compartmentalize what's really going on.
• 32:12
  Speaker 1: A lot of times they just end up getting like
• 32:13
  Speaker 1: an ivy morphine two milligram when they're.
• 32:16
  Speaker 2: On like a very high dose opioid.
• 32:19
  Speaker 1: And so that tells me that the foundation for the
• 32:25
  Speaker 1: education and training in pay management is not a lot
• 32:27
  Speaker 1: And when we think about the bigger picture of the
• 32:31
  Speaker 1: current movements and the initiatives that target you know, having
• 32:38
  Speaker 1: better access to builpri north in having better maybe like
• 32:43
  Speaker 1: opiate stewardship, you cannot achieve any of those targets if
• 32:49
  Speaker 1: you do not even have a solid foundation of opioid management.
• 32:53
  Speaker 1: And so who are who are the experts in opiate
• 32:56
  Speaker 1: management pain vibusis right.
• 32:58
  Speaker 2: Or any or are yeah?
• 33:02
  Speaker 1: And of course like people who have done dedicated training
• 33:06
  Speaker 1: in pain management or hospice like those are the people
• 33:10
  Speaker 1: that we need to invest in.
• 33:13
  Speaker 2: Because if we.
• 33:13
  Speaker 1: Think about in terms of you know, if we think
• 33:16
  Speaker 1: about like dollar sign or ROI in in the you know,
• 33:21
  Speaker 1: in the healthcare administrator lingo is that we have to
• 33:26
  Speaker 1: understand that one extra length of stay in the hospital
• 33:31
  Speaker 1: is very expensive.
• 33:32
  Speaker 2: And if you and people who have.
• 33:34
  Speaker 1: Pain and ou d maybe like a small amount, but
• 33:38
  Speaker 1: if you target better like a shorter length of stay
• 33:43
  Speaker 1: and a reduction in re emission because you refine your process,
• 33:49
  Speaker 1: you have someone to take a look at the pain
• 33:51
  Speaker 1: regiment before it's faster into something that there's now it's
• 33:55
  Speaker 1: it's very hard to course correct. Those are all dollars
• 33:59
  Speaker 1: says that they may they just may not be aware.
• 34:03
  Speaker 4: Yes, absolutely, So it's a it's huge, it's it's being proactive.
• 34:08
  Speaker 4: It's you know, it's an inch to save a foot
• 34:12
  Speaker 4: along the way. And you know, I think i'd even
• 34:15
  Speaker 4: add in the you know a lot of times leadership
• 34:20
  Speaker 4: in important ways, we'll look at even patient satisfactions. Course well,
• 34:24
  Speaker 4: what more efficient and impactful way to affect those even
• 34:28
  Speaker 4: would be preventing one's patient's pain and concurrently preventing their
• 34:33
  Speaker 4: side effects that they don't no one would want. It's
• 34:36
  Speaker 4: pretty direct, right, I mean, that's part of where we
• 34:39
  Speaker 4: go into that. So very well put, it's a I
• 34:42
  Speaker 4: don't know if anybody's listening, it sounds like there should
• 34:45
  Speaker 4: be some even more jobs. They've certainly been growing along
• 34:48
  Speaker 4: the way here. So well along those lines, one last uh,
• 34:52
  Speaker 4: clinical pearl, perhaps not really clinical, but a pearl in general.
• 34:57
  Speaker 4: I mean, everybody talks about this these days, good old
• 34:59
  Speaker 4: a artificial intelligence. Right, So what's your thoughts though, you
• 35:04
  Speaker 4: think AI is going to replace us pain pharmacists.
• 35:07
  Speaker 1: Oh, you know, I feel like AI is getting very
• 35:11
  Speaker 1: very creative. When I was asking this question myself three
• 35:15
  Speaker 1: months ago, I'll be I'm very confident now three months later,
• 35:19
  Speaker 1: and then when we start to see humanoids and we're
• 35:22
  Speaker 1: starting to question so, I do not think so. And
• 35:29
  Speaker 1: partly I think there's a timeline to when our job
• 35:35
  Speaker 1: will still be safe in the next five to ten years.
• 35:41
  Speaker 1: The if we think that AI is going to completely
• 35:46
  Speaker 1: replace pain pharmacists in dosing opiate medication, I think that's
• 35:51
  Speaker 1: very challenging, just really because the guideline in terms of
• 36:00
  Speaker 1: opiate dosing it's still very general. Like if you see
• 36:04
  Speaker 1: things on the CPC or even the Opiate Conversion Book
• 36:10
  Speaker 1: from doctor Lynn McPherson, it's general. It you know, things
• 36:15
  Speaker 1: moved up and down twenty to fifty percent if you're aggressive,
• 36:19
  Speaker 1: and that's pretty much the guidance that we have and
• 36:22
  Speaker 1: the rest of and the rest of it is really
• 36:25
  Speaker 1: coming from gathering the gathering the story from the patient
• 36:31
  Speaker 1: to really to really come up with a plan. So
• 36:37
  Speaker 1: I feel like until the day we have all these
• 36:41
  Speaker 1: data points from enough patients, maybe then AI will be
• 36:47
  Speaker 1: smart enough to really detail a very specific plan, plan
• 36:51
  Speaker 1: A and plan B to allow physicians to choose which
• 36:55
  Speaker 1: way to go. But I think really the most vas
• 37:00
  Speaker 1: valuable thing that we provide is that because we are
• 37:05
  Speaker 1: such experts and the pay medications, and because humans are
• 37:12
  Speaker 1: also social animals, it's hard for it's hard for me
• 37:17
  Speaker 1: to fathom that a machine will replace the human interaction
• 37:23
  Speaker 1: from a pain pharmacist who know what we're talking about.
• 37:26
  Speaker 1: And the fact that we're able to doill down a
• 37:31
  Speaker 1: very complex idea to something that's palatable to patients and
• 37:37
  Speaker 1: provide them solace in that regard, I think that's one
• 37:41
  Speaker 1: of the highest value that we provide. It's it's beyond
• 37:46
  Speaker 1: it's it's beyond just just the dosing. It combines the
• 37:51
  Speaker 1: humanistic part of human interaction, the communication, and the mastery
• 37:59
  Speaker 1: of the medication. That combination itself is very hard for
• 38:06
  Speaker 1: like for machinery to replace.
• 38:09
  Speaker 4: Absolutely that that's you know, and I really strongly believe
• 38:15
  Speaker 4: that your explanation there, the humanistic part of it, the explanation,
• 38:19
  Speaker 4: the compassion that that's that's synonymous well outside of pain
• 38:24
  Speaker 4: pharmacists as well too. That's actually even outside of healthcare.
• 38:28
  Speaker 4: Quite frankly, it's so incredibly important along the way and technology,
• 38:33
  Speaker 4: there's been major technological advances. I mean, we made to
• 38:36
  Speaker 4: the moon that we made and basically a garbage can
• 38:39
  Speaker 4: we originally and you know, made the Internet, and there's
• 38:44
  Speaker 4: then other things. There's always been this perceived or talked
• 38:47
  Speaker 4: about threat of like, oh, it's going to replace everybody.
• 38:49
  Speaker 4: It's like there's a lot of compliments that come along
• 38:52
  Speaker 4: the way. In fact, AI, as far as I'm concerned,
• 38:56
  Speaker 4: is one of the best you know, students to have
• 38:59
  Speaker 4: in a you know, US pharmacist, US healthcare professionals really
• 39:03
  Speaker 4: need to be there along the way in training and
• 39:06
  Speaker 4: that whole machine learning thing and helping with that to
• 39:09
  Speaker 4: ensure that the information that is out there that will
• 39:11
  Speaker 4: be readily accessible by the lay public is correct, whereas
• 39:15
  Speaker 4: at least as correct as possible. Of course, so lots
• 39:18
  Speaker 4: of educational opportunities there as well too, you know, working
• 39:21
  Speaker 4: with things not it's not a David Goliath, it's you know,
• 39:25
  Speaker 4: everybody at the table in the end, So I thank
• 39:28
  Speaker 4: you for that though. It's really bringing that humanistic standpoint
• 39:31
  Speaker 4: along the way. All right, before I forget those sing ping,
• 39:35
  Speaker 4: we're gonna wrap things up. But I ask every pain
• 39:38
  Speaker 4: podcast this. It's usually two things, but I'll put them
• 39:41
  Speaker 4: in one big picture. How do you and you know
• 39:46
  Speaker 4: it's scinct or verboth or whatever you want, but how
• 39:49
  Speaker 4: do you define pain? And what do you think your
• 39:52
  Speaker 4: favorite or most interesting pain medication is?
• 39:55
  Speaker 1: How do I define pain? How do I see pain?
• 40:02
  Speaker 1: I've been thinking about this question a lot. I would
• 40:05
  Speaker 1: provide you the answer being thirty three, and I'm sure
• 40:09
  Speaker 1: the answer if I were to go back and have
• 40:12
  Speaker 1: a discussion in five years or ten years, I do
• 40:16
  Speaker 1: want to see if my answer would have changed by then.
• 40:19
  Speaker 2: Cool, because because the more.
• 40:22
  Speaker 1: The more, the more I learn, the less I feel
• 40:25
  Speaker 1: like I know and and I guess there's more to
• 40:30
  Speaker 1: know or master mh and so so far, how I
• 40:36
  Speaker 1: would outline this giant, you know subject? I think the
• 40:42
  Speaker 1: best way I can do is to kind of outline it,
• 40:45
  Speaker 1: so then you can see how I see this picture
• 40:49
  Speaker 1: and from a personal From a personal level.
• 40:54
  Speaker 2: I think pain is very debilitating.
• 41:00
  Speaker 1: And the fact that if pain is very severe, it
• 41:05
  Speaker 1: really prevents people from doing things that they want or
• 41:10
  Speaker 1: you know, things that they love. Something that kind of
• 41:15
  Speaker 1: hit me now that I'm visiting my parents and I
• 41:20
  Speaker 1: can see that my mom is aging and she definitely
• 41:24
  Speaker 1: has pain, and I can see that pain is something
• 41:28
  Speaker 1: that's bothering her, and so I I witness it how
• 41:33
  Speaker 1: pain is really limiting someone's ability to do things and
• 41:38
  Speaker 1: enjoy their life.
• 41:39
  Speaker 2: So that's that's on a personal level, and.
• 41:42
  Speaker 1: In a spiritual In a spiritual level, pain also has
• 41:51
  Speaker 1: to do with that because we know that, you know,
• 41:56
  Speaker 1: with depression and other psychiatric conditions, pain can really interfere
• 42:04
  Speaker 1: that that mental health, that mental well being, and they're
• 42:07
  Speaker 1: just all connected. So it's it's beyond so from a
• 42:14
  Speaker 1: personal and physical level and from a spiritual and mental level,
• 42:18
  Speaker 1: that's it. Really pain is already spanning two levels of mankind, right,
• 42:27
  Speaker 1: And then if we think about how pain it's impacting
• 42:33
  Speaker 1: other aspects of a human life, like financial Like if
• 42:37
  Speaker 1: someone is a father or like a parent and then
• 42:41
  Speaker 1: they have pain, like how can they continue to work
• 42:45
  Speaker 1: and support their kids and and and not being stressed
• 42:49
  Speaker 1: out by that, right you know, again you know it's
• 42:52
  Speaker 1: it's financial and somewhat somewhat spiritual because you know it
• 42:56
  Speaker 1: has to do with stress. And then there's also the
• 42:59
  Speaker 1: interperson you know. Part of pain, like I was saying,
• 43:04
  Speaker 1: is that when when pain is so bad to a
• 43:07
  Speaker 1: point that maybe your world just reduced down to just
• 43:12
  Speaker 1: fixing the pain. And then I've seen cases where your
• 43:16
  Speaker 1: interpersonal life and circle just reduce down to nothing. But
• 43:22
  Speaker 1: fixing the pain is like your big goals. So really,
• 43:27
  Speaker 1: pain itself, I wish there's a one liner I can
• 43:31
  Speaker 1: define it.
• 43:31
  Speaker 2: I can't, But.
• 43:33
  Speaker 4: You're not alone. No worries right now.
• 43:37
  Speaker 1: Being having practice for a few years now, and what
• 43:42
  Speaker 1: I realized is pain is highly complex.
• 43:46
  Speaker 2: It's not easy. It's a very sensitive subject.
• 43:50
  Speaker 4: Absolutely, and it's always interesting, you know, you know, and
• 43:54
  Speaker 4: being our pain pod post here and asking many people
• 43:57
  Speaker 4: that question, and by the way, little little offshoot here,
• 44:02
  Speaker 4: I actually will ask patients that as well too. I
• 44:04
  Speaker 4: find that it helps, you know, set goals to be like,
• 44:07
  Speaker 4: how do you define it? What's it matter to you
• 44:10
  Speaker 4: as a patient? Of course helps for goal setting along
• 44:13
  Speaker 4: the way and getting to know somebody like, hey, what
• 44:15
  Speaker 4: what do we here for other than hey, reduce pain,
• 44:17
  Speaker 4: improved function. Right, it's complicated and it's pain. It sucks,
• 44:23
  Speaker 4: so you know it's and that's not it. That's not
• 44:26
  Speaker 4: a definition by any means. So thank you for diving
• 44:29
  Speaker 4: deeper into that of course too as well. So and
• 44:32
  Speaker 4: any particular most interesting or favorite or however you want
• 44:37
  Speaker 4: to word it or look at it pain medication.
• 44:39
  Speaker 1: Or yeah, I I was thinking about that very hard too.
• 44:46
  Speaker 1: Out of so many things, you know, I could have
• 44:48
  Speaker 1: I could have choose maybe like metado and because I
• 44:51
  Speaker 1: feel like that's one of the things that I love dosing.
• 44:53
  Speaker 1: But I think I think as of right now, I
• 44:57
  Speaker 1: would say it's super northing. And I also have two
• 45:00
  Speaker 1: reasons for that. On on a on a professional level,
• 45:08
  Speaker 1: I remember when I first started my job right after
• 45:12
  Speaker 1: PGY two residency, Bill was the medication that helped me
• 45:23
  Speaker 1: that that helped me connect with the hospitalist in the
• 45:28
  Speaker 1: institute because at the time I was just starting out
• 45:33
  Speaker 1: my position, I noticed that the knowledge in Bilpernorphine wasn't
• 45:39
  Speaker 1: the strongest at the time. A few years back, and
• 45:44
  Speaker 1: I vividly remember the first time I started a patient
• 45:51
  Speaker 1: on the box zone, I did micro induction too, and
• 45:54
  Speaker 1: and that was and that was very cutting edge. Like
• 45:58
  Speaker 1: at the time when at first went when when there
• 46:00
  Speaker 1: isn't anyone doing Bill per Northie at all to use
• 46:04
  Speaker 1: you being a pain management pharmacist taking the drivers, taking
• 46:08
  Speaker 1: the driver's see and you do micro induction.
• 46:11
  Speaker 2: That that's cutting edge, very kind of edge.
• 46:14
  Speaker 1: Yeah. And since that, since that experience and then it
• 46:23
  Speaker 1: really helped me establish the rapport with with the with
• 46:30
  Speaker 1: the hospitals. And then since then I start to have
• 46:34
  Speaker 1: a stop physicians start to utilize me and then and
• 46:39
  Speaker 1: that's something that I'm very grateful for. And I really
• 46:42
  Speaker 1: have to thank Bill Perry because, like I'm like we
• 46:46
  Speaker 1: were talking earlier, not not every hospital has in patient
• 46:52
  Speaker 1: pay management pharmacist or even pay management pharmacists. So when
• 46:55
  Speaker 1: you all of a sudden hire a pay management pharmacist,
• 46:58
  Speaker 1: some people don't even know what to expect, what you
• 47:02
  Speaker 1: can what you can actually offer until you until you
• 47:06
  Speaker 1: show up and tell people what you got. But when
• 47:09
  Speaker 1: you do, then they were start to utilize you. So again,
• 47:13
  Speaker 1: you know, I'm very thankful that buper nor the really
• 47:15
  Speaker 1: helped me develop my my professional route and on a
• 47:21
  Speaker 1: on a healthcare level, I've also seen that patients who
• 47:29
  Speaker 1: have your disorder and when they start buper northen and
• 47:37
  Speaker 1: they finally break the cycle and they're able and and
• 47:43
  Speaker 1: they're able to function and and and live a life
• 47:47
  Speaker 1: that they consider me more meaningful. It's it's it's very
• 47:52
  Speaker 1: it's very gratifying to see because because you you are
• 47:58
  Speaker 1: offering people an option, right because for some people maybe
• 48:03
  Speaker 1: what they know is methadone, and they just don't want
• 48:07
  Speaker 1: to go to methadone clinic every day and be seen.
• 48:11
  Speaker 1: There's so many concerns about that. And then when you
• 48:16
  Speaker 1: offer them an option that can help them break the cycle.
• 48:21
  Speaker 1: And I think that's and not even just for oud
• 48:23
  Speaker 1: and even for patients who have been on opiate for
• 48:27
  Speaker 1: a really long time. That's also another opiod for opiate rotation.
• 48:31
  Speaker 1: And I think having being the person who who can
• 48:37
  Speaker 1: offer the option to patients and so they can live
• 48:41
  Speaker 1: a better life, that's also very gratifying. And I think
• 48:45
  Speaker 1: bullpri Norphine does that for me and my patients. So
• 48:49
  Speaker 1: if there's one favorite drug bill, priorpine so far, Yes, awesome.
• 48:55
  Speaker 4: Well, I think I've said it a few times, but
• 48:57
  Speaker 4: you're not about on that one. That's come up for
• 48:59
  Speaker 4: a lot a lot of different pharmacists and healthcare professionals
• 49:02
  Speaker 4: as well too, and that's but also kind of devils
• 49:04
  Speaker 4: into that whole most interesting and I appreciate your background
• 49:08
  Speaker 4: even professionally on that as well too, So thank you
• 49:11
  Speaker 4: very much, sir. And you know we're gonna we're gonna
• 49:14
  Speaker 4: call that a rap for this episode here of the
• 49:16
  Speaker 4: Pain Pod, But I really really want to thank you
• 49:19
  Speaker 4: for your time and expertise and thoughts here today, Singping's
• 49:24
  Speaker 4: It's been a pleasure, and I know we will be
• 49:26
  Speaker 4: keeping in touch for many collaborations in the future. But folks,
• 49:29
  Speaker 4: I highly recommend you, you know, of course, check out
• 49:34
  Speaker 4: the career adventures, the endeavors of Singping you got of course,
• 49:38
  Speaker 4: the pain RX consulting, working as a pharmacist at the VA,
• 49:43
  Speaker 4: lots of different things, so if you're in the pain landscape,
• 49:46
  Speaker 4: definitely need to connect as well too. But thank you
• 49:49
  Speaker 4: very much today, Singping, and look forward to many things
• 49:52
  Speaker 4: in the future as well too.
• 49:53
  Speaker 2: Thank you so much for having me today.
• 49:55
  Speaker 4: Oh you're welcome, sir, and Pain Pod Nation. That's a
• 49:58
  Speaker 4: wrap on another one. I certainly look forward to our
• 50:01
  Speaker 4: next episode of the Pain Pod, but until then, thank
• 50:05
  Speaker 4: you for your time. It's the most valuable resource we
• 50:08
  Speaker 4: have and as always, have a great day every day.
• 50:12
  Speaker 3: If you'd like to join Mark on the Pain Pod,
• 50:15
  Speaker 3: send us an email to publish you're at pharmacypodcast dot
• 50:19
  Speaker 3: com and make sure to share the show and subscribe
• 50:23
  Speaker 3: on your favorite podcast directory. Thanks for listening.