Opioid Stewardship in Multimorbidity: Balancing Pain, Function, and Polypharmacy
Course #55060 -
- Participation Instructions
- Review the course material online or in print.
- Complete the course evaluation.
- Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
Opioid stewardship in multimorbidity demands clinical sophistication beyond guideline adherence. It requires individualized risk-benefit analysis, mastery of pharmacokinetic principles, commitment to functional rather than purely pain-focused goals, and most critically, interprofessional collaboration. Those caring for complex patients must become comfortable with uncertainty, recognizing that "the right answer" emerges from team-based deliberation rather than algorithmic prescribing. As healthcare systems transition toward value-based care, managing multimorbid patients effectively becomes both a quality imperative and a professional responsibility. Safe opioid prescribing in this population is not about withholding analgesia. It is about providing comprehensive, coordinated pain management that honors patient complexity while minimizing harm.
- INTRODUCTION
- UNDERSTANDING THE MULTIMORBIDITY CHALLENGE
- CRITICAL DRUG-DRUG INTERACTIONS IN OPIOID THERAPY
- ALTERNATIVES TO OPIOIDS IN MULTIMORBID PATIENTS
- WHEN FUNCTION, NOT PAIN ELIMINATION, IS THE GOAL
- INTERPROFESSIONAL COORDINATION: THE KEY TO SAFE PRESCRIBING
- CASE APPLICATION: BRINGING CONCEPTS TOGETHER
- CONCLUSION
- Works Cited
This course is designed for dental professionals involved in the care of patients with multiple chronic conditions and comorbid pain.
The purpose of this course is to provide dental professionals with evidence-based strategies for safe opioid prescribing in patients with multiple chronic conditions and complex medication regimens, improving interprofessional care and patient outcomes.
Upon completion of this course, you should be able to:
- Identify critical drug-drug interactions between opioids and commonly prescribed medications in multimorbid patients.
- Describe evidence-based alternatives to opioids for chronic pain management.
- Implement risk mitigation strategies when opioid therapy is necessary in patients with polypharmacy.
- Articulate the roles of pharmacists and behavioral health professionals in interprofessional opioid stewardship.
Mary Franks, MSN, APRN, FNP-C, is a board-certified Family Nurse Practitioner and NetCE Nurse Planner. She works as a Nurse Division Planner for NetCE and a per diem nurse practitioner in urgent care in Central Illinois. Mary graduated with her Associate’s degree in nursing from Carl Sandburg College, her BSN from OSF Saint Francis Medical Center College of Nursing in 2013, and her MSN with a focus on nursing education from Chamberlain University in 2017. She received a second master's degree in nursing as a Family Nurse Practitioner from Chamberlain University in 2019. She is an adjunct faculty member for a local university in Central Illinois in the MSN FNP program. Her previous nursing experience includes emergency/trauma nursing, critical care nursing, surgery, pediatrics, and urgent care. As a nurse practitioner, she has practiced as a primary care provider for long-term care facilities and school-based health services. She enjoys caring for minor illnesses and injuries, prevention of disease processes, health, and wellness. In her spare time, she stays busy with her two children and husband, coaching baseball, staying active with her own personal fitness journey, and cooking. She is a member of the American Association of Nurse Practitioners and the Illinois Society of Advanced Practice Nursing, for which she is a member of the bylaws committee.
Contributing faculty, Mary Franks, MSN, APRN, FNP-C, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Mark J. Szarejko, DDS, FAGD
The division planner has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Sarah Campbell
The Director of Development and Academic Affairs has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.
Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.
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The role of implicit biases on healthcare outcomes has become a concern, as there is some evidence that implicit biases contribute to health disparities, professionals' attitudes toward and interactions with patients, quality of care, diagnoses, and treatment decisions. This may produce differences in help-seeking, diagnoses, and ultimately treatments and interventions. Implicit biases may also unwittingly produce professional behaviors, attitudes, and interactions that reduce patients' trust and comfort with their provider, leading to earlier termination of visits and/or reduced adherence and follow-up. Disadvantaged groups are marginalized in the healthcare system and vulnerable on multiple levels; health professionals' implicit biases can further exacerbate these existing disadvantages.
Interventions or strategies designed to reduce implicit bias may be categorized as change-based or control-based. Change-based interventions focus on reducing or changing cognitive associations underlying implicit biases. These interventions might include challenging stereotypes. Conversely, control-based interventions involve reducing the effects of the implicit bias on the individual's behaviors. These strategies include increasing awareness of biased thoughts and responses. The two types of interventions are not mutually exclusive and may be used synergistically.