7Ps: An Organized Approach to Opioid Management for Patients with OUD and Painful Serious Illness

Outcomes 1. Organize considerations for weighing risks and benefits of opioid treatment options using the 7P framework in a patient with OUD and painful serious illness.2. Analyze benefits and limitations of different MOUD options in treating patients with complex pain, OUD, and serious illness. Key Message Safely navigating pain management for patients with opioid use disorder (OUD) and serious illness is complex. This session reviews evidence to guide opioid management for patients with serious illness and OUD/misuse. Presenters will use case-based discussion to introduce and illustrate a practical clinical tool to organize risks and benefits of opioids and inform opioid prescribing in hospice and palliative care. Abstract Safely navigating pain management for patients with opioid use disorder (OUD) and serious illness is complex. Balancing the risks and harms of opioid prescribing are even more complex in the context of the escalating drug overdose epidemic, insufficient and inequitable access to OUD treatment, prevalence of chronic pain before serious illness diagnosis, and gaps in primary addiction medicine skills training for hospice and palliative care (HPC) clinicians. Long-term exposure to opioids increases risk for developing unhealthy opioid use or even an OUD. Despite this, there is limited guidance in the literature on treating cancer pain with opioids when there is concern for OUD. These challenges are only expected to grow as patients survive longer with advances in disease-directed treatments.What factors should HPC specialists consider when caring for patients with OUD and painful serious illness? How do we weigh the risks and benefits of full-agonist opioid versus partial-agonist opioid treatment? When should HPC assume responsibility for prescribing methadone when there is OUD? This session will present the multi-dimensional 7P framework (pain characteristics, prognosis, physical function/ performance status, patterns of substance use, psychosocial factors, partnerships, and parity in care to consider biases in pain and OUD treatment) as a tool to organize risks and benefits to opioid treatment decisions when there is concern for addiction or non-prescribed substance use. Led by clinicians dually board-certified in both HPC and addiction medicine, this interactive, case-based session will describe the model to guide medical decision making, summarize available evidence behind management recommendations, and practice its application in ambulatory, inpatient, and hospice case studies. Participants will leave the session with a practical, clinically useful tool to craft more comprehensive, evidence-based, and equitable approaches to opioid prescribing in challenging cases of pain, substance use/ misuse/ use disorder, and serious illness. Keywords Disease specific management / Pharmacotherapeutics / Pharmacopalliation