Taking Healthcare by Storm: Industry Insights with Mark Garofoli

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Mark Garofoli, PharmD, MBA, BCGP, CPE, CTTS, a  board-certified geriatric pharmacist, certified pain educator, nationally recognized expert in pain management and substance use education, and host of the Pain Pod.

Mark shares how mentors, patient experiences, and his work in practice and education led him into pain management and substance use education. He reflects on the 2016 CDC opioid guideline’s intent versus real-world consequences and highlights the need for interprofessional care, expanded pharmacist roles, more non-opioid options, better access to opioid use disorder medications, and improved insurance coverage for pain treatments.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

The views and opinions expressed by the host and guests are their own and do not necessarily reflect the views, positions, or policies of Quality Insights. Publication number QI-040326-GK

Transcript

 Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

Hi everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical director here at Quality Insights, and today's guest is Dr.

Mark Garofoli, DMBA, board certified geriatric pharmacist, certified pain educator, and nationally recognized expert in pain management and substance. Use education. Dr. Garofoli has spent his career at the intersection of pharmacy practice public health. Policy and education with a particular focus on helping clinicians manage pain safely, effectively, and compassionately.

I still don't think we are there, but maybe we're getting closer. Mark is a clinical assistant professor and director of experiential learning at the West Virginia. School of Pharmacy, a clinical pain management pharmacist at the WVU Medicine Center for Integrative Pain Management, and a member of the WVU School of Medicine Pain Fellowship faculty.

He also played a central role in developing West Virginia's safe and effective management of pain guidelines and is served as a CDC grant reviewer, expert, witness, and advisor on pain and substance use. Issues nationwide, and he has his own podcast called Pain Pod, which I highly recommend. I've been listening to it for a long time, so I encourage you to check it out.

In this conversation we'll explore the evolution of opioid prescribing the current state of the opioid crisis. Is it still going on? Has it stopped? Is it resolved? The role pharmacists should play in pain management, emerging therapies, and what the future of pain care. Could look like if we truly centered patients evidence and collaboration.

Dr. Mark Garofoli, thank you so very much for joining us today. It is an absolute pleasure. Thank you very much. Boy, man. What an intro. You start wondering, uh, maybe you've done a few things in life when you listen to these things. Yeah. So you've worn many hats, as I stated. Community, pharmacist, managed care leader, educator, pain specialist.

What moments or experiences most shaped your path into pain management and substance use? Education. That's, that's a getting to it. Hey, we went over all that info. What this guy's done and um, I'd also like to say, Hey, it's wonderful to have a listener of my own podcast, the Pain Pod and the pharmacy podcast network you know, ending up, uh, on their podcast.

Kind of cool. I must say it's. Now, I love your thoughts here on the, like, hey, who influenced you here? And, you know, we're all gonna  have to give a shout out to our, our parents, our family overall, of course, back in the day. I'll take a step further. I'll even go back, you know, my wife and I have two relatively young boys, so maybe we're just a little bit more attuned to the elementary years and, you know, the, the non-college years.

But my high school chemistry teacher. You know, the main one, it was, uh, he just went by Mr. Luke. It really, it was Lucas Savage, but we all called him Mr. Luke. And, uh, for those that really know me, no, we did not name our first born after him, Luke. But he was influential nonetheless.  You know, at that point of deciding should I be a pharmacist or something else?

Who knows? Along the way just, you know, was really there.  I think we often in society take for granted what our educators. Do for us in addition to learning, just being there to listen and, kind of help guide along the way. Having been there before with many students prior, so Mr.

Mr. Luke was pretty paramount.  It wasn't just the stuff we were making or blown up in chem lab, it was went far beyond that. Throughout my career, you know, you mentioned a whole heck of a lot of career adventures. Quite frankly, pain and addiction, they weren't always in the title, but, they were always there.

And it was very easy to realize just how misunderstood they are, the topics and, understanding. It's really like an art form, quite frankly, beyond what they say, like, oh, the arts of medicine. No. Beyond that even  individual patients, I'd say I, I'm not one for remembering names.

It's a, it's a fatal flaw, but faces I'll never forget. Individual patients that I, you know, got to, uh, work with and collaborate with and hopefully help, uh, whether it was a community setting or even managed care setting or MTM settings, they were influencing me and others.  Day in, day out, you name it.

there's nothing. Better than just helping someone with their pain. Don't get me wrong, you wanna prevent heart attacks too. Quite important.  But you know, in a society of click the button, I want to receive it within a day or two, and that's how I shop. You know, helping folks and, and particularly in pain management is more akin to that and the big picture beyond the clinical practice side.

 I truly never. Ever thought I'd be an educator for crying out loud, I didn't even keep my Form D regalia, which I and some colleagues have laughed about many a times over, uh, because once I was hired as a faculty member, um, in our West University School of Pharmacy  it was actually right before that year's graduation.

They're like, oh yeah, we'll have you on stage. And I'm like. Hey, side note, I don't have my regalia. And they're like, what do you mean you don't have it? Who doesn't keep theirs? I'm like, I never thought I'd need it. Good golly. Probably gave it the goodwill or something, you know? Uh, who knows who's wearing that thing around and where.

Anyways. All that being said, I love it daily 'cause when we're helping patients, we're educating them. So why not pay it forward, indirectly affect more patients by educating other clinicians along the way. Just loving it daily really. Yeah. And, and it's so very important, especially in, in West Virginia, and I wanna kind of bring it back to kind of when opioids.

Maybe we're a huge issue started becoming a huge, maybe they were a huge issue for a long time, but the CDC 2016 opioid prescribing guideline, I'd love to hear what your thoughts are. I know at the time I was actually practicing in West Virginia, I was just doing nursing home medicine and saw that over half the patients in the nursing home were getting an opioid prescription, and we didn't have to really follow those.

Those guidelines because we were exempt being in the nursing home. So I had a lot of thoughts around it at the time. So what do you think, what, what did it get right? Those guideline. That guideline, and where did it create unintended consequences for patients and clinicians, especially in West Virginia.

We are jumping pretty quick to the elephant in the room. You go online, I mean, there's a lot of polarity and different, uh, personal facts. My, uh, one sister-in-law calls opinions that I love it.  There's more points of view when it comes to many things, but particularly the CDC, either the original, the OG chronic pain opioid guidelines, or the update from, you know, just a couple years back.

A lot of viewpoints. But one thing I've never noticed in all the different media coverage, and quite frankly even within healthcare. Was looking at the big picture, folks were quick to point the blame and say, oh, it's not us in healthcare, or, yeah, it was those, those folks in healthcare  if you're looking at limited data, you're gonna have a limited perspective.

And regardless of what your outcome is, it's, it's just flawed. It's how it is. Um, I believe that's how statistics works, but I'm a pharmacist, not a statistician. So anybody listen out there, shout out to you if you love working the numbers.  Accountants do, I guess, but I, you know. There were something I actually did and I, I have a couple charts available on my website.

Uh, it's PGA us  basically it was too cheap to do the.com I guess, but anyways, you can contact me on there anytime. If you message me on PGA US, it literally will ring my phone  vibrated anyway. But anyways, there's some charts I put on there of looking at. You know, the, be the, during, the before and the current as far as this overall opioid crisis here too, right?

 I, you know, there were many more prescription opioids prescribed and dispensed around the turn of the century or so than, than if you looked in decades past. Like by far, there's really, the facts are facts, right? Um, however, on individual patient levels that could be good or bad.  It's, and those numbers in the totality were drastically impacted, uh, by what were eventually determined to be illegal pill mills, whether it was prescribing or dispensing.

But you know, it, those skewing numbers, major numbers there. You know, I, I would beg folks to consider, were those folks actually healthcare professionals to begin with. You know, the, the ones that were substantiated as pill mills, right?  So it's tough to extract those numbers 'cause we don't have a lot of granularity there.

I think the, the second part of what you asked there, um, was, you know, unintended consequences, things like that. So, I've spoken with many have actually who worked for the CDC, A lot of folks have talked with them before, but a lot of the authors, the primary authors  Dr. Dalby and the primary one  but you know, they repeatedly stated in the opening act, I'll say it's like paragraph one or two of the OG guideline from 2016.

 they literally just stated, don't apply this. to things outside of, chronic pain, primary care overall essentially don't apply this to, uh, patients with cancer pain, sickle cell disease, so on and so forth along the way. They stated that. That's one inside the coin.  No one lives under a rock either.

Uh, you know, we gotta be real already, even though you're stating it, you know how these things are gonna be applied. I mean, come on, let's just be real. Uh, so it, you know, there's instances of ultra high risk opioids being utilized overall for patients in pain.  And that's a pharmacological and a general patient care concern, really.

Uh, and it needs to be mitigated. But Yes, with the knowledge and skills and expertise, but also with empathy and compassion along the way. And that that's, you know, as far as unintended consequences, we, we perhaps, potentially lost some of that empathy and compassion along the way. We're human, we're going to have these errors, but, you know, things reflecting back is always easiest.

Yeah. Yeah. We all know that West Virginia has been described as ground zero for the opioid epidemic. Do you believe we're still in an opioid epidemic? Has the problem evolved into something different? Is it more complex now? Oh, things always evolved, so I'm not gonna pick on your, your words here, but, you know, I'm never too comfy with the term epidemic in this realm.

Yeah. Um, I'm more of a fan of crisis. Tomato to model. I, you know, to the heart of your question of what really matters here, um, the healthcare supply chain  prescribers, dispensers, patients, I even others like, uh, wholesale distributors, the industry manufacturers, those coming up with guidelines, you name it.

The whole kit and caboodle within the healthcare supply chain  has settled down.  And if anything things are going to the other side of opioid phobia or opioid phobia, depending on how you wanna say that. The illicit drug supply chain, conversely completely different, un obviously unregulated.

It's illicit, illegal, uh, that's proliferated, uh, to account for entirely too many lost heartbeats. Every time we see those numbers of, uh, lost lives, it's. It's, it  each one of those is a lost heartbeat. You know, we went from, um, something like 111,000, I think about two years ago, lost heartbeats to drug overdoses in our country.

We're down to about 70,000. That's an appreciable decrease overall, I'm, I don't know about you, but I don't think we should be happy with still having 70,000 lost heartbeats in this accord.  But I, you know, it is substantiated. Now, the two thirds of those come from. Directly from illegal drugs. So the kidney punches to healthcare, you know, it's not  it, that's not a thing necessarily in the majority right now, but it doesn't mean that it, it didn't exist in the past.

So we all, you know, gotta put our thick skin on and work together in this as well too. Of course. In the bigger picture. So we have great strides, great, uh, success Recently. We've, we've got more effort in the horizon though. the bottom line of our drug supply these days, uh, compared to say decades past is that little moment of being asked if you'd like a pill, a drug.

You name it, you know the little decision of yes or no. Uh, it's potentially a lethal decision anymore, unlike the times of your, when I was faced with decisions like that back in the day, I, it, you know, things might go bad. But it wasn't really a concern for something being lethal. If one of my sons is faced with that win, one of my sons, if not both, will be faced with that question soon.

It's a much different ball game and that's really something  to be recognized and appreciated by everyone in society, not just healthcare Really. Yeah, really interesting. And, you know, something I touched on at the beginning about  nursing home, and I'm just gonna say, you know, I, I know you were talking about do you want a pill, you know, and you were talking about it maybe recreationally, you know, not in the healthcare setting.

My, my big pet peeve is when in a nursing home or hospital, a nurse says to a patient. Do you want a pain pill, right? Mm-hmm. I'm like, that's, that's not a good question. It's not a good question. We always say we want smart goals. I'm not gonna go through the whole acronym, but, uh  the measurable, timely, achievable, yeah.

Things like that. Um, you know, that might hit some of them, but, uh, yeah, the bigger picture of the word smart is not gonna work out in that regard. So, yeah.  You know, pain is treated differently depending on the setting, whether it's a. You know, the outpatient clinic, hospital, nursing home. So should prescribers be thinking differently about pain in these environments?

So there, there's certainly commonalities in pain or pain management overall.  Particularly the patient experience and you know, their expectations along the way.  You believe, you mentioned nursing homes, of course. Um, that involves patients. Um, well, in my opinion anyway, my view, they police place.

Complete trust in their care providers. I mean, it, it healthcare decisions and everything. You're, you are in someone else's building their world really. And really, clinicians have to put their best foot forward. Of course  general clinics, your outpatient AM care. You know, will often involve  shared decision making.

It's a relatively novel term or concept, but really provokes clinicians to think and strategize, uh, differently overall.  You know, asking someone, Hey, do you want a pain medication is not necessarily a shared decision making strategy. It, it's, you know, it's putting it out there, but, uh, you gotta go over the risks and the benefits as well too.

So, I, you know, that, that left, left us, I believe with health, um, hospital settings. The acute demand clinicians being at the top of their game at all times, balancing the protocols that are out there, yet hearing, actually actively listening to the patient out, to provide the best patient care possible.

It, it is another art form. So there's commonalities of, the patient experience overall. 'cause in the end it is pain. But there's some uniqueness here and there, of course, depending on the setting, like many other things in life as well too. Yeah. So I'm I'm guessing there are, there's a role for pharmacists.

You see a role for pharmacists in all of those SA pain settings and all of those healthcare settings. So, and you've been a strong advocate for pharmacists and pain management. What role should pharmacists be playing that where underutilized or overlooking in these settings? Good golly, there's so many, uh, so much under utilization.

So I've actually been thinking about this recently and, um call it, uh, reading the room for the, what's been going on recently, um, for traditions. But  there's Groundhog Day, right? That Varant, he's around every day. But, uh, we pay attention one day and doesn't necessarily mean it's the greatest guidance.

I believe it's like a 25% or something like that, rate of accuracy. But anyways, I digress.  I, I'm gonna throw this out there, and I don't know if my colleagues would agree, but  it's kinda like us, uh, pharmacists we're like the groundhogs of healthcare. Specifically a good old punk satani fill in, punk satani.

Actually, I've been there once. Recommend the experience to everybody. Do it once you're good to go for your life. But anyways, there's actually, uh, they have like little, uh, fills, uh  the groundhogs, like statues, uh, the size of an adult, um, all around town. And there was a pharmacist one go figure. But anyways, I think that's what propelled my thoughts here, but, uh, us pharmacists we're, we're there every day.

We're casting a shadow, we're creating an impact that dives deep into people's lives. Yet it's about once a year that others actually notice how much we can help with the overall system. It certainly doesn't help that we've provided guidance, uh, pretty much for free for centuries. It's kind of what we always did.

that's helpful, gives that warm feeling. But, there's not a cost, cost associated with something, uh. And there's no value associated either, and it's all about the value.   I can give an example. Even I say you have a patient and they're, um, what they're explaining and is, is basically some neuropathic pain symptoms.

You know, that's shooting lightning like pain. Okay? They get a workup from multiple of our healthcare team and. They just get fed up. 'cause no one's figuring it out.  Like many healthcare situations, medical conditions, it's, you know, we have that whole show on tv house of trying to figure things out.

I know there's a lot more going on in that drama, but, you know, is figuring things out in the big picture. Then one of us groundhogs walks up, talks with them and realizes, hey, patient's got diabetes. They're taking a very common medication for that called metformin. Zara, the, uh, that medication is decreasing, the absorption of their vitamin B12 from their diet or even vitamin.

And that's, that deficiency is actually gonna lead to lightning shooting. Like pain. I, I tell you, if I had a nickel for every time that came up, I'd have value. That's what comes down to really, all that being said, by the way I'm, I'm even more of a fan of interprofessional care, so yay pharmacists and groundhogs.

But why limit to, uh, one or two healthcare professionals? Let's have everybody hands on deck. I work in Utopia. We're a completely interprofessional team. We happen to get along, uh, but we're there for every patient, whoever is needed along the way. And it's wonderful that way to have a, a really diverse treatment plan for our patients.

Yeah, I will say you've mentioned Punit fil there is one, there is a groundhog in West Virginia, right? I can't remember his name. There's a whole bunch of different, uh, groundhog like things these days. Um, in West Virginia we've got a lot of other things like, uh, cryptids going down a different road here, but there's actually, even in our town in Morgantown, it's uh, where WVU is, uh, centralized.

The, there's a Crypted Mini golf.  Our oldest son loves it. We do too. Of just the different crypted. It's kinda like spooky, like figures if you haven't heard that term before. Yeah. So there's lots of different things. Moth man is one of the famous ones, of course. But yes. So you mentioned you're in a utopia, so maybe, maybe this will make this question easy for you to answer.

Who is getting pain management? Right? Whether it's a system. A program or a model and what are they doing differently? You mentioned interdisciplinary input  where you are, so maybe that's part of it. It's certainly gonna factor in  that's, and you know, we don't, uh, live and work and thrive in isolation here.

There's really many groups that are getting it right. It's just getting that message out there. You know, in clinical practice we talk about if, if, uh, when it comes to the care of a patient, if it's not documented, it didn't happen. It's the same thing for getting the word out of what different practices or groups are doing if it's not advertised.

Talked about that, no one's gonna know. So there's not really one group that's hitting the nail on the head is there's many. So, um, you know, there's enough of the opposite to go around as well too, of course. It's really one of those tougher questions to tackle. So the biggest thing really is, and I think this hits home a little bit more for patients.

And by the way, is a little quick, subtle reminder. Patience, as in, Hey, that's us too. Okay. All of us. When we are a patient, I often hear, oh, well man, that doc was great and I, I want to like, as kindly as possible say what made them great. Oh, they told me what I wanted to hear. Really? Like, is that, why, is that how we're defining it?

You know, just diving a little bit deeper, word of mouth only gets one so far. Okay.  And this goes, you know, whether you're talking about a mechanic, a plumber, or a healthcare professional, you name it. We all know this. But, we hear as far as recommendations these days, like, oh, well, you know, talk to your doctor  and, um, you know, see what they say.

Heck no. I'm not saying don't talk to your doctor. I'm not saying don't talk to your pharmacist for that matter, or nurse or whoever, but one human being should not dictate what another human being does in totality. What about, you know, do they have certifications? Are they recognized by their peers as experts in the field?

Even then, there's still one person. So what is an organized group of professionals who are recognized by everybody in the field? Say the people pumping out the guidelines, for instance. That's really, uh, and that goes well beyond pain management, of course. Sure. Folks come up with a couple topics in their head these days.

But  honing it in here, even for pain, it's like, well, what  who's involved with guiding others? Then, you know, you're getting some unbiased. Experienced, skilled folks  along the way, sharing their expertise overall. So it, it's really important to have, that in mind in the big picture.

Yeah, I, I agree. So I'm very excited about the new non-opioid pain medication, and maybe you're gonna tell me I shouldn't be that excited. So this is Suzette Regine. Where do you see this fitting into the future pain management landscape? Is it going to solve all our opioid related problems? That one, uh, that one's made a splash, that's for sure.

Yeah. Um, it was actually pretty interesting. I always like to, um, whenever I'm teaching or talking or whatever, uh, I like to respect the mic. I don't wanna give you any of my opinions and give you the, the facts, all the sides, and you, y'all figure it out for yourself. Okay? That medication is a novel non-opioid  pain medication that is already helping a lot of people in pain.

Does that mean it helps everybody? Absolutely not. That's just the art of medicine. I mean, for anything. But boy, it, it's making a splash and, right out of the gate that the concept of its availability in our country was covered in the general news more than I've seen for a medication sans A GLP, the weight loss things.

Okay. It was just everywhere. And it really caught my eye of like, wow, like everyone's covering this outside of healthcare, if anything more than in healthcare.  It was pretty remarkable. That being said though  there, uh, there has yet to be a holy grail of pain management, meaning something with absolute pain relief and function improvement.

Kind of big on that. It's not just about reducing the pain number, it's can you function? That's the important thing.  Without. Concerning side effects. I, you know, all medications have their baggage. So something not having side effects is, is, is more utopic than where I get to work.  But the more options, the better.

Not only do we want an interprofessional care team, but we want as many options in the treatment bucket as possible, whether they are non-pharmacological. Or pharmacological or interventional, you name it.  Along the way it, it's gonna come down to what's recommended for particular conditions through guidelines and whatnot.

But the more you know, options we have, the better in the big picture. Yeah, I love options. Most definitely. If you were appointed Healthcare Czar tomorrow, this is my, one of my favorite questions, which is why I went right for it. What would be the future of pain management in the United States and what would you change first?

Whew, man.  Well, I've actually had the pleasure of hanging out with, uh, one of our recent drug czars, uh, Dr. Ru Gupta.  It, you know, these are cabinet positions that are appointed. So all politics aside, wow, what an amazing professional. So, uh, first and foremost, there's no way on earth I'd end up in a role like that.

All right. We got that disclaimer and reality outta the way, but, let's see. I, one of the, one of the first things I'd probably change is, um, the incredible consternation just stemming from an imbalance of supply and demand for medications, for opioid use disorder medications that we've used to treat opioid addiction.

Okay. We have numerous efforts out there to increase  the respective prescribing. Even most recently, actually by pharmacists, we had a federal law passed for us to be able to prescribe these medications.  You know, things like buprenorphine naltrexone and methadone. Uh, those are the, the three heavy hammers there.

 But the supply level at the pharmacy is just stymied by wholesale distributor thresholds and limits, whatever you wanna call 'em. Based on what was agreed upon in settlements from the opioid crisis, the national opioid settlement, you could actually literally go to national opioids settlement.com, hold up before you type it.

It's a lot of long. Lawyer like documents. So I'll let you decide if they're boring or not. But you know, on out of 800 pages for one document, there's about three pages that really matter for clinicians. I love to talk about them all the time.  I know that, you know, in the big picture that might be a little bit outside of pain management.

I, yeah, so why not? Um, and quite frankly, the drugs are, would be more, uh, apropos to, to that realm anyway  next up since, well, I'm on a roll here, apparently  would be insurance coverage of pain treatments, you name it, medications, non medications, any whatever.  If you don't want to utilize an opioid, then the other stuff's gotta be covered with a reasonable copay.

I don't know how long those two goals would take, but that would be the big ones. Well, let's hope you get there. That would be fantastic. So last question, we, we talked, we mentioned your podcast in the introduction, you host the pain pod. I said it's a, it's wonderful. I listen to it all the time. What's been your favorite or most surprising conversation so far, and what topic do you secretly love nerding out about the most?

Oh, that last one's the easiest thing.  The nerding out part, uh, tell folks if you made it this far, just stick with me here.  Probably urine drug monitoring.  I'm decently sure I'm one of the very few people on this planet, or at least within healthcare, uh, that enjoy talking about urine for hours, upon hours.

 And even compared to endocrinologists, urologists, you name it  it just seems to be this very. Either misunderstood or less taught topic that's out there. We use urine drug testing for employment. We use it for patient care, and it's kind of like everybody's just roaming around wondering what's going on there.

 You know the difference between a urine drug screening, the relatively cheap little cup, and a test with the relatively and realistic, very expensive machinery. The test holds up in clinic, in court. The screening is, starts a convo. It ends there, really. Um, yet we use it for employment or all across our country.

Go figure. All right, so I'm not gonna dive into like a talk on urine drug monitoring, but that would be the nerding off part, that, that was extremely low hanging fruit and easy. Um, as far as favorite conversations, um, one or two come to mind. The, the first one would be, um, actually one of my first episodes, uh, I was with, uh, Dan Schneider.

Y'all might know him as the pharmacist, the Netflix documentary.  If you haven't watched that yet. I don't know Ayyy. But check it out. It's still in that library somewhere in Netflix. But  yeah, he, uh, quite a riveting story.  It was a pleasure to get to become friends with Dan and, um, you know, record episode.

Yes. But  the other one that stood out was with, uh, another episode from probably about two years ago. Was with Dr. Joshi. I'll put it in a nutshell that it was a conversation talking about when his medical practice was rated by folks holding AK 40 sevens. Hmm. I'll leave it there. Wow. Interesting. So if people wanna, I think you plugged your website.

Let's plug that again and then tell us all the places people can find you on the interwebs. Well folks keep in touch. there's certainly hope. Hope you check out the Pain Pod on the Pharmacy podcast network.  Biggest picture in the umbrella though you could always feel free to head on over to my website.

 Www.paingy.us. Pain guide us a lot of career adventures on there. But the main things are really the headlines tab. So any of the the hot buzz things. You wanna know anything about acetaminophen from 2025, check 'em out. There's also a resources tab. My goal there is to be the one stop shop for all things pain, addiction, diversion, and beyond.

Basically all the guidelines and where all the meat and potatoes are, uh, so headlines and resources. You could also contact me directly on there. Um, I think I mentioned that earlier. If you message through Pain guide us, it literally buzzes my phone.  It doesn't mean I'm gonna respond in like three seconds, it's, we're baseball family, that season's coming up, folks, um, for the little guys and the big ones too.

so feel free to reach out anytime.  I love connecting with people.  And I look forward to those times. Yeah, I'm gonna say you have so much great information on your website. I encourage everybody who's interested to check it out. Dr. Mark Garofoli, thank you so very much for joining me today.

This is a really interesting  great conversation. Pleasure's mine. Thank you very much and look forward to meeting your listeners in person whenever our foot pads cross. Thank you very much.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.