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Pain Treatment Challenge

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Price: $0

Andrew Turner

Requests Medical Marijuana

0.5 hr(s)CME/CE
Goal: Clinicians working in a state where use of marijuana is an option will learn how to determine whether this is an appropriate treatment, provide relevant patient education, and make a recommendation for medical marijuana treatment.
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Activity Steps

Activity Content
Post-Assessments
Certificate

This activity is designed to change: Competence, Performance, Patient Outcomes. 0.5 hr(s)

Overview

Professional Practice Gaps

Educational Objectives:

After completing this activity, participants will be able to:

  • Describe the limited uses of medical marijuana for treating chronic pain
  • Make a referral for medical marijuana to treat pain
  • Provide patient education and facilitate patient decision-making regarding uses, risks, and effectiveness of medical marijuana for pain

Training Activity References

Audience and Accreditation

Audience: Providers

Type Est. Time Released Expires
AMA PRA Category 1 Credit(s)™ 0.5 hrs 03/25/19 03/25/22

Accreditation Statement: Clinical Tools, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA PRA Category 1 Credit™ Designation Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

A letter of completion for 0.5 hour(s) is available for non-physicians.

A score of 70% on the post-test is required to complete the activity.

Participation Requirements

Funding
Initial development of this activity was supported by a grant from the National Institute on Drug Abuse (#1R44DA027245-01).

Authors

As an ACCME accredited provider of continuing medical education, Clinical Tools, Inc.requires everyone who is in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest to the provider. The ACCME defines ‘relevant’ financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Any conflicts of interest are resolved prior to the delivery of the educational activity to the learner. CTI does not permit individuals with financial conflicts of interest to participate in any stage of activity development.

T Bradley Tanner, MD (President, Clinical Tools, Inc.)
Disclosure: Has disclosed no relevant financial relationships. Dr. Tanner is the owner of Clinical Tools.
Read Bio
T. Bradley Tanner, MD is president of Clinical Tools and responsible for the vision of the company. He has received funding via grants and contracts from NIDA, NIAAA, NIMH, NCI, AHRQ, CDC, the Dept of Defense, and NASA to develop medical and health education projects. Dr. Tanner served as principal investigator on 2 NIDA grants to develop the DATA-2000 qualifying buprenorphine training program and clinical practice tools on Bup.ClinicalEncounters.com. He also has a strong background in technology and oversees the development and delivery of all Clinical Tools websites. Dr. Tanner is also a board-certified psychiatrist with experience in inpatient, outpatient, and emergency health settings. He currently treats patients and educates medical students and residents via his role as a Clinical Associate Professor of Psychiatry at the University of North Carolina at Chapel Hill.
Karen Rossie, DDS, PhD (Research Scientist, Clinical Tools, Inc. )
Disclosure: Has disclosed no relevant financial relationships.
Read Bio
Karen Rossie, DDS, PhD, directs projects at Clinical Tools. She majored in biology at Cleveland State University and studied dentistry at Case Western Reserve University followed by completing a Masters in pathology at Ohio State University, and later, a PhD in Psychology from the Institute of Transpersonal Psychology. She taught and practiced oral pathology and oral medicine for 15 years at the Ohio State University and the University of Pittsburgh, doing research in autoimmune disease, bone marrow transplantation, oral cancer, salivary gland disease, candidiasis, and diabetes. She has used this diverse background to lead or contribute to CTI projects related to tobacco cessation, opioid abuse treatment, anxiety, dementia care, alcohol use disorder, screening and brief interventions for substance abuse, obesity, and pain and addiction.

Reviewers

Steve Applegate, MEd, MEd (President, Applegate Consulting, )
Disclosure: Has disclosed no relevant financial relationships.
Read Bio
Mr. Applegate has experience in substance use counseling, state initiatives impacting substance use, and professional training. His prior positions include director of higher education and instructional design at the North Carolina Governor’s Institute on Alcohol and Substance Abuse, project director of the North Carolina Initiative of the Mid-Atlantic Addiction Technology Transfer Center, and program director of the Addiction Sciences Center (an outpatient substance abuse treatment center at the University of Virginia Health Sciences Center). Mr. Applegate works as an on-site consultant and travels to the Clinical Tools (CTI) office on a monthly basis from his office in Richmond, VA. Mr. Applegate helped design the CTI Instructional Manual and works to continue to revise it as we expand our Instructional Design methodology. Mr. Applegate has extensive experience with online education and training, especially in the area of substance abuse. He often pushes the envelope of technology and brainstorms with Clinical Tools how we can utilize new technology in our products. He helped guide the development of the curriculum plan and assessments in Phase I of the current project.

Most Recent Reviews

CTI Content Review: Monday, 03/11/2019
CTI Editorial Review: Tuesday, 03/19/2019

Funding Information Development of this website was funded by grant #1R44DA035042 from the National Institute of Drug Abuse. The website contents are solely the responsibility of the authors and do not necessarily represent the official views of NIDA. The site is maintained by Clinical Tools, Inc. No commercial support is received.
Clinical Tools is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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Participation Requirements

Activity Credit: Obtaining credit for participation in this activity requires that you work through the case simulation and any associated content, complete the post-test with a 70% score, complete post-surveys, and then request credit. At the end of the activity, you will be instructed on how to print out a certificate for your records.

Time Requirement: You will be required to spend a set amount of time in order to claim credit.

Technical Requirement: Our site requires the latest versions of Google Chrome, Safari, Firefox, or Microsoft Edge. The site is not optimized for Internet Explorer and certain functionality will not work with that browser. Please utilize a supported browser when accessing the site.

Training Activity References

Carter GT, Aggarwal SK. Cannabis in the treatment of chronic pain. NABP 2009 Symposium. 2009. Available at: https://www.nabp.net/events/assets/Carter_Aggarwal.pdf Accessed 02/13/2019.

Cherkin DC, Sherman KJ, Balderson, BH, et al. Effect of mindfulness-based stress reduction vs. cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain. A randomized clinical trial. JAMA. 2016; 315(12):1240-1249. Available at: http://jama.jamanetwork.com/article.aspx?articleid=2504811 Accessed 02/13/2019.

Chou R, Fanciullo G, Fine P, et al. Clinical guidelines for the use of chronic opioid therapy in chronic non-cancer pain. J Pain. 2009; 10(2): 113-130. Available at: http://www.jpain.org/article/S1526-5900(08)00831-6/abstract Accessed 02/13/2019.

Drug Enforcement Administration. State Prescription Drug Monitoring Programs. U.S. Department of Justice. 2011. Available at: http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm Accessed 02/13/2019.

Ewing, J.A. Detecting alcoholism: The CAGE questionnaire. JAMA: Journal of the American Medical Association. 1984. 252, 1905–1907. Available at: http://www.ncbi.nlm.nih.gov/pubmed/6471323 Accessed 02/13/2019.

FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013. Available at: https://www.fsmb.org/siteassets/advocacy/policies/model-policy-on-data-2000-and-treatment-of-opioid-addiction-in-the-medical-office.pdf Accessed 02/13/2019.

Hill KP. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems. A clinical review. JAMA. 2015; 313(24): 2474-2483. Available at: https://jamanetwork.com/journals/jama/article-abstract/2338266 Accessed 02/13/2019.

Lucas P, Walsh Z, Crosby K, et al. Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors. Drug Alcohol Rev. 2015; doi:10.1111/dar.12323. Available at: http://onlinelibrary.wiley.com/doi/10.1111/dar.12323/abstract Accessed 02/13/2019.

National Cancer Institute. PDQ® Cannabis and Cannabinoids. Bethesda, MD: National Cancer Institute. Date last modified: 2016. Available at: http://www.cancer.gov/about-cancer/treatment/cam/patient/cannabis-pdq#link/_11 Accessed 02/13/2019.

Physicians for Responsible Opioid Prescribing. Petition to FDA. July 25, 2012. Available at: http://www.citizen.org/documents/2048.pdf Accessed 02/13/2019.

Skinner, HA. The Drug Abuse Screening Test. Addictive Behavior, 1982, 7, 363-371

Thomas DA, Maslin B, Legler A, et al. Role of alternative therapies for chronic pain syndromes. Curr Pain Headache Rep. 20(5): 29. Available at: http://www.ncbi.nlm.nih.gov/pubmed/27038968 Accessed 02/13/2019.

Wang J, Christo PJ. The influence of prescription monitoring programs on chronic pain management. Pain Physician. 2009; 12: 507-515. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19461820 Accessed 02/13/2019.

Ware MA, Wang T, Shapiro S, et al.. Cannabis for the management of pain: Assessment of safety study . J Pain. . Available at: http://www.ncbi.nlm.nih.gov/pubmed/26385201 Accessed 02/13/2019.

Professional Practice Gaps

The incidence of opioid overdose, diversion, and addiction has continued to rise (SAMHSA, 2018; CDC, 2018), suggesting that physicians are not sufficiently following evidence-based guidelines for prescribing opioids to minimize these risks. The parallel rise of the rate of opioid addiction and the number of opioid prescriptions (SAMHSA, 2013a; SAMHSA, 2013b; ) suggests that physicians had not followed guidelines to limit opioid prescribing. Training physicians in the guidelines for safe opioid prescribing would decrease exposure of patients with chronic pain to unnecessary risks of opioids (Dowell, et al., 2016).

Practice Gap References

CDC. “Understanding the Epidemic | Drug Overdose | CDC Injury Center,” December 19, 2018. https://www.cdc.gov/drugoverdose/epidemic/index.html Accessed 02/13/2019.

Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep. 2016; ePub: March 2016: DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1er. Available at: http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm Accessed 02/13/2019.

SAMHSA. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration. 2013a. Available at: http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf Accessed 02/13/2019.

SAMHSA. National Estimates of Drug-Related Emergency Department Visits. Drug Abuse Warning Network, 2011. 2013b. Available at: http://www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf Accessed 02/13/2019.

SAMHSA. Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration., September 2018. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHFFR2017/NSDUHFFR2017.pdf Accessed 02/13/2019.