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Expanded Skills in Chronic Opioid Therapy

3 hr(s)CME/CE
Goal: To provide expanded skills training to physicians and other clinicians with respect to reducing the risk of addiction/misuse of opioids and other prescribed controlled substances.
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Activity Steps

Activity Content
Post-Assessments
Certificate

This activity is designed to change: Competence, Performance, Patient Outcomes3 hr(s)

Overview

Professional Practice Gaps

Educational Objectives:

After completing this activity participants will be able to:

  • Monitor patients during ongoing pain treatment for substance use problems
  • Coordinate care of a patient seeing multiple clinicians for chronic pain
  • Utilize appropriate treatment structure and/or referral if a patient with pain develops substance use problems
  • Manage the chronic pain of patients with a high risk of substance misuse
  • Identify and take steps to prevent potential diversion and risk for overdose by patients and their contacts through clinical protocols and practice management

Modules in this Training Activity

Activity Content

Pages Status
1

Minimizing Opioid Diversion and Overdose Risk

2

The High Risk Patient and Opioids

3

Coordinating Pain Treatment with Colleagues

Training Activity References

Audience and Accreditation

Audience: Prescribers of ER/LA opioids and other health professionals who impact patients taking these medications

Type Est. Time Released Expires
AMA PRA Category 1 Credit(s)™ 3 hr(s) 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 3 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 3 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), a contract from the National Institute on Drug Abuse (#HHSN271200800012C).

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: Thursday, 01/05/2017
CTI Editorial Review: Monday, 01/09/2017

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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Clinical Tools, Inc. staff have disclosed no relevant financial relationships.

Unless otherwise noted, individuals pictured are models and are used for illustrative purposes only.
This site is for educational purposes only and medical decisions should not be based solely on its content. This site, its authors, and its consultants do not assume liability for errors or omissions.
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Participation Requirements

Activity Credit: Obtaining credit for participation in this activity requires that you complete the pre-assessments, work through the modules (including all in-module interactive activities), complete the post-assessments with a 70% score on the post-test, 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: Keep track of the amount of time it takes you to complete this activity. You will be required to spend a set amount of time in order to claim credit. You should claim credit only for the time actually spent in the activity.

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

AAPS. Project: Communicate and Cooperate; AAPS 3-Point Plan to Stop the “Drug War on Physicians” & Reduce Prescription Drug Abuse. Association of American Physicians and Surgeons, Inc.. 2009. Available at: http://www.aapsonline.org/painman/cooperate.htm Accessed 02/13/2019.

ACPM . Use, abuse, misuse, and disposal of prescription pain medication clinical reference. American College Preventive Medicine . 2011. Available at: http://www.yuma.usmc-mccs.org/mccsyuma/assets/File/Drug%20Facts%20Sheets/painmedsclinicalreference.pdf Accessed on: 2015-07-07.

Alford DP, Compton P, Samet JH. Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy. Annals of Internal Medicine. 2006; 144(2): 127-134. Available at: http://annals.org/article.aspx?articleid=719514 Accessed 02/13/2019.

American Pain Society in conjunction with the American Academy of Pain Medicine. Guideline for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. Evidence Review. American Pain Society. 2009. Available at: http://americanpainsociety.org/uploads/education/guidelines/chronic-opioid-therapy-cncp.pdf Accessed 02/13/2019.

American Society of Addiction Medicine (ASAM). The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. June 1, 2015. Available at: http://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement1b630f9472bc604ca5b7ff000030b21a.pdf?sfvrsn=0 Accessed 02/13/2019.

American Society of Anesthesiologists. The Management of Pain. 2010. Available at: http://www.asahq.org/ Accessed 02/13/2019.

Baldisseri MR. Impaired healthcare professional. Crit Care Med. 2007; 35(2): S106-16. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17242598 Accessed 02/13/2019.

Ballantyne, JC, Mao, J. Opioid therapy for chronic pain. N Engl J Med. 2003; 349(20): 1943-53. Available at: http://www.nejm.org/doi/full/10.1056/NEJMra025411 Accessed 02/13/2019.

Banta-Green CJ, Merrill JO, Doyle SR, Boudreau DM, Calsyn DA. Opioid use behaviors, mental health and pain-development of a typology of chronic pain patients. Drug Alcohol Depend. In Press Epub. 2009. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716214/ Accessed 02/13/2019.

Brushwood DB. Electronic prescription monitoring programs: a data-reporting tool designed to prevent drug diversion. Emerging Solutions in Pain Knowledge Series III. MediCom Worldwide, Inc. 2007. Available at: http://www.emergingsolutionsinpain.com/index.php?option=com_continued&cat=20&Itemid=267 Accessed 02/13/2019.

Brushwood DB. Maximizing the value of electronic prescription monitoring programs. Journal of Law, Medicine, and Ethics. 2003; 31: 41-54. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1748-720X.2003.tb00058.x/abstract Accessed 02/13/2019.

Califano, JA et al. Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S. The National Center on Addiction and Substance Abuse at Columbia University. 2005. Available at: http://www.centeronaddiction.org/addiction-research/reports/under-the-counter-diversion-abuse-controlled-perscription-drugs Accessed 02/13/2019.

Center for Drug Evaluation and Research (CDER). Abuse-deterrent opioids – evaluation and labeling . U.S Department of Health and Human Services. 2015. Available at: http://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm334743.pdf Accessed 02/13/2019.

Center for Medicare & Medicaid Services (CMS) . What is a prescriber’s role in preventing the diversion of prescription drugs?. Partners in Integrity. 2014. Available at: https://www.pharmacy.umn.edu/sites/pharmacy.umn.edu/files/prescriber_role_in_preventing_diversion.pdf Accessed 02/13/2019.

Center for Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series 42. DHHS Publication No. (SMA) 05-3922. Substance Abuse and Mental Health Services Administration. Substance Abuse Treatment for Persons With Co-Occurring Disorders. 2005. Available at: http://www.ncbi.nlm.nih.gov/books/NBK64197/ Accessed 02/13/2019.

Chou R, Fanciullo G, Fine P, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer 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.

Cicero JT, Dart RC, Inciardi JA, Woody GE, Schnoll S, Munoz A. The Development of a Comprehensive Risk-Management Program for Prescription Opioid Analgesics: Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS). Pain Medicine. 2007; 8(2): 157-169. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17305687 Accessed 02/13/2019.

Cicero TJ, Inciardi JA, Munoz A. Trends in abuse of Oxycontin and other opioid analgesics in the United States: 2002–2004. J Pain. 2005; 6(10): 662–672. Available at: http://www.jpain.org/article/S1526-5900(05)00656-5/abstract Accessed 02/13/2019.

Cole, BE. Recognizing and Preventing Medication Diversion. Family Practice Management. 2001; 8(9): 37-41. Available at: http://www.aafp.org/fpm/2001/1000/p37.html Accessed 02/13/2019.

Cole, E. Recognizing preventing and medication diversion: Don’t let diversion of pain medication hamper your ability to treat chronic pain. Family Practice Management. 2001; 8(2): 37-41. Available at: http://www.aafp.org/fpm/2001/1000/p37.html Accessed 02/13/2019.

Compton P. Should Opioid Abusers be Discharged from Opioid-Analgesic Therapy?. Pain Medicine. 2008; 9(4): 383-390. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18489627 Accessed 02/13/2019.

Compton, Peggy. Substance Abuser with Chronic Pain. QuantiaMD. 2010; courseid=30793: . Available at: http://Quantiamd.com Accessed 02/13/2019.

Coolen, P. Overdose deaths involving prescription opioids among Medicaid enrollees—Washington, 2004-2007. Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR). 2009; 58(42): 1171-75. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5842a1.htm Accessed 02/13/2019.

Cornish MA , Wade NG. Spirituality and religion in group counseling: a literature review with practical guidelines . American Psychological Association. 2010. Available at: http://www.researchgate.net/publication/232591847_Spirituality_and_Religion_in_Group_Counseling_A_Literature_Review_With_Practice_Guidelines Accessed 02/13/2019.

Dart R. Evaluation of ADFs using RADARS system data . RADARS System. 2011.

Dart, RC. Opioid Abuse, Misuse, and Diversion: Strategies for Prevention. Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS). 2009: 11-25. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2006.00259.x/abstract Accessed 02/13/2019.

Dasgupta N . RADARS system subutex & suboxone: how much is prescribed vs. abuse/diversion reports. SAMHSA Meeting on Buprenorphine. 2010. Available at: https://www.radars.org/system/publications/2008_Dasgupta_CSAT.pdf Accessed 02/13/2019.

DEA. Pharmacist’s Manual – an informational outline of the controlled substances act. Office of Diversion Control. 2010. Available at: http://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/index.html Accessed 02/13/2019.

DEA. Schedules of Controlled Substances: Placement of Tramadol Into Schedule IV. DEA Office of Diversion Control Website. 2014; Rules – 2014: 21 CFR Part 1308 Docket No. DEA-351. Available at: http://www.deadiversion.usdoj.gov/fed_regs/rules/2014/fr0702.htm Accessed 02/13/2019.

Deding M , Saidj M , Brännström L. 12-step programs for reducing illicit drug use: protocol for a systematic review. The Campbell Collaboration . 2013. Available at: https://campbellcollaboration.org/library/12-step-programmes-illicit-drug-abuse-reduction.html Accessed 02/13/2019.

Dowell D , Kunins HV, Farley TA. Opioid analgesics – risky drugs, not risky patients. JAMA . 2013; 309(21): . Available at: http://jama.jamanetwork.com/article.aspx?articleid=1686609 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.

Drug Abuse Warning Network (DAWN). Highlights of the 2009 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits. 2010. Available at: http://www.samhsa.gov Accessed 02/13/2019.

Drug and Alcohol Services Information System (DASIS). Characteristics of Primary Prescription and OTC Treatment Admissions: 2002. The DASIS Report, Office of Applied Studies, Substance Abuse and Mental Health Services Administration. 2004. Available at: https://www.scribd.com/document/338523/00141-prescription Accessed 02/13/2019.

Drug Enforcement Administration (DEA). Automation of Reports and Consolidated Orders System (ARCOS). U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control. 2009. Available at: http://www.deadiversion.usdoj.gov/arcos/index.html Accessed 02/13/2019.

Drug Enforcement Administration (DEA). Practitioner’s manual – an informational outline of the controlled substances act. Office of Diversion Control. 2006. Available at: http://www.deadiversion.usdoj.gov/pubs/manuals/pract/pract_manual012508.pdf Accessed 02/13/2019.

Drug Enforcement Administration. State Prescription Drug Monitoring Programs. U.S. Department of Justice. 2009. Available at: http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm Accessed 02/13/2019.

Drug Enforcement Administration. State Prescription Drug Monitoring Programs. U.S. Department of Justice. 2010. Available at: http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm Accessed 02/13/2019.

Dunn KM, Saunders KW, Rutter CM, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Annals of Internal Medicine. 2010; 152(2): 85-92. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000551/ Accessed 02/13/2019.

DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: physicians’ health programs. Journal of Substance Abuse Treatment. 2009; 36: 159-171. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19161896 Accessed 02/13/2019.

Dysvik E , Kvaløy JT , Natvig GK. The effectiveness of an improved multidisciplinary pain management programme: a 6- and 12-month follow-up study. J Adv Nurs. 2012; 68(5): 1061-72. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22050304 Accessed 02/13/2019.

Eccher DF. Maine’s Prescription Monitoring Program: Preventing Prescription Drug Misuse. Department of Health and Human Services, Office of Substance Abuse. 2009. Available at: http://www.maine.gov/dhhs/osa/data/pmp/files/ME_PMP_Intro_20090113.pdf Accessed 02/13/2019.

Eggleston W, Clark KH, Marraffa JM. Loperamide abuse associated with cardiac dysrhythmia and death. Annals of Emergency Medicine. 2016; DOI: http://dx.doi.org/10.1016/j.annemergmed.2016.03.047: . Available at: http://www.annemergmed.com/article/S0196-0644(16)30052-X/fulltext Accessed 02/13/2019.

Emmons K, Rollnick S. Motivational interviewing in health care settings. Opportunities and limitations. Am J Prev Med. 2001; 20(1): 68-74. Available at: http://www.ajpmonline.org/article/S0749-3797(00)00254-3/abstract Accessed 02/13/2019.

FDA. FDA approves first once-monthly buprenorphine injection, a medication-assisted treatment option for opioid use disorder. U.S. Food and Drug Administration Website. 2017; November 30. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm587312.htm Accessed 02/13/2019.

Fine PG. Opioid Rotation. J Pain Symptom Management. 2009. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19735902 Accessed 02/13/2019.

Fingerhut, LA. Increases in poisoning and methadone-related deaths: United States, 1999-2005. National Center for Health Statistics (NCHS). 2008. Available at: http://www.cdc.gov/nchs/data/hestat/poisoning/poisoning.pdf Accessed 02/13/2019.

Fitzgibbon DR, Rathmell JP, Michna E, Stephens LS, Posner KL, Domino KB. Malpractice claims associated with medication management for chronic pain. Anesthesiology. 2010; 112(4): 777-8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20234314 Accessed 02/13/2019.

Frank E, Carrera JS, Elon L, Hertzberg VS. Basic demographics, health practices, and health status of US medical students. American Journal of Preventative Medicine. 2006; 31(6): 499-505. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17169711 Accessed 02/13/2019.

Frank E, Elon L, Naimi T, Brewer R. Alcohol consumption and alcohol counseling behavior among US medical students: cohort study. BMJ. 2008; 337:a2155: 1-10. Available at: http://www.bmj.com/content/337/bmj.a2155 Accessed 02/13/2019.

FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website http://www.fsmb.org. 2013. Available at: https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/2013_model_policy_treatment_opioid_addiction.pdf Accessed 02/13/2019.

Galanter M, Dermatis H, Mansky P, McIntyre J, Perez-Fuentes G. Substance-abusing physicians: monitoring and twelve-step-based treatment. American Journal on Addictions. 2007; 16:2: 117-123.

Gibbs LS and Haddox JD. Lawful Prescribing and the Prevention of Diversion. Journal of Pain & Palliative Care Pharmacotherapy. 2003; 17(1): 5-14. Available at: http://www.ncbi.nlm.nih.gov/pubmed/14640336 Accessed 02/13/2019.

Gibbs LS, Haddox JD. Lawful prescribing and the prevention of diversion. J Pain Palliat Care Pharmacother. 2003. Available at: http://www.ncbi.nlm.nih.gov/pubmed/14640336 Accessed 02/13/2019.

Gilson AM, Joranson DE. U.S. Policies Relevant to the Prescribing of Opioid Analgesics for the Treatment of Pain in Patients with Addictive Disease. The Clinical Journal of Pain. 2002; 18: S91-S98. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12479259 Accessed 02/13/2019.

Giulia N , McDonough CM , Cabral H, et al . Cost-utility of cognitive behavioral therapy for low back pain from the commercial payer perspective. Spine . 2015; 40(10): 725-733. Available at: http://journals.lww.com/spinejournal/Abstract/2015/05150/Cost_Utility_of_Cognitive_Behavioral_Therapy_for.12.aspx Accessed 02/13/2019.

Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: A rational approach to the treatment of chronic pain. Pain Medicine. 2005; 6(2): 107-112. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15773874 Accessed 02/13/2019.

Green TC , Mann MR , Bowman SE , et al . How does use of a prescription monitoring program change medical practice?. Pain Medicine . 2012; 13: 1314-1323. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22845339 Accessed 02/13/2019.

Greenwald MK, Schuh KJ, Hopper JA, Schuster CR, Johanson CE. Effects of buprenorphine sublingual tablet maintenance on opioid drug-seeking behavior by humans. Psychopharmacology (Berl). 2002; 160(4): 344-352. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11919661 Accessed 02/13/2019.

Hall AJ, Logan JE, Toblin RL, et al. Patterns of abuse among inuntentional pharmaceutical overdose fatalities. JAMA. 2008; 300(22): 2613-2620. Available at: http://jama.jamanetwork.com/article.aspx?articleid=183046 Accessed 02/13/2019.

Hall AJ, Logan JE, Toblin RL, et al. Patterns of Abuse Among Unintentional Pharmaceutical Overdose Fatalities. JAMA. 2008; 300(22): 2613-2620. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19066381 Accessed 02/13/2019.

Hall AJ, Paulozzi LJ. Prescription Opioids and Overdose Deaths—Reply. JAMA. 2009; 301(17): 1767-1768. Available at: http://jama.jamanetwork.com/article.aspx?articleid=183831 Accessed 02/13/2019.

Harm Reduction Coalition. Naloxone Kit Materials. Harm Reduction Coalition. Available at: http://harmreduction.org/issues/overdose-prevention/tools-best-practices/od-kit-materials/ Accessed 02/13/2019.

Harned M, Sloan P. Safety concerns with long-term opioid use. Expert Opin Drug Saf. 2016; PMID: 27070052: . Available at: http://www.ncbi.nlm.nih.gov/pubmed/27070052 Accessed 02/13/2019.

Harwood I, Stansfeld S. Doctors and Alcohol Misuse. StudentBMJ . 2006; 14: 265-308. Available at: http://student.bmj.com/student/student-bmj.html Accessed 02/13/2019.

Heit, H. Aberrant behaviors – refer or triage. Emerging Solutions in Pain. Ask the Expert. 2009. Available at: http://www.emergingsolutionsinpain.com/login?return=aW5kZXgucGhwP29wdGlvbj1jb21fbWFtcyZ2aWV3PWFydGljbGUmc2VjaWQ9MTcmYXJ0aWQ9MjM0Jkl0ZW1pZD0yMjA= Accessed 02/13/2019.

Hooten WM , Timming R, Belgrade M, et al. Assessment and management of chronic pain. Institute for Clinical Systems Improvement . 2013. Available at: https://www.opioidprescribing.com/documents/01-pain_assessmentand_management_guideline.pdf Accessed 02/13/2019.

Inciardi JA, Surratt HL, Cicero TJ, et al . Prescription opioid abuse and diversion in an urban community: the results of an ultra-rapid assessment. Pain Med . 2009; 10(3): 537-548. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719877/ Accessed 02/13/2019.

Institute of Medicine (IOM). Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Board on Health Care services. 2006. Available at: http://www.nap.edu/read/11470/chapter/5#78 Accessed 02/13/2019.

Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy Press, Washington, DC. 2001. Available at: http://iom.nationalacademies.org/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx Accessed 02/13/2019.

Institute of Medicine (IOM). Health Professions Education: A Bridge to Quality. National Academies Press, Washington, DC. 2003. Available at: http://www.nap.edu/catalog/10681/health-professions-education-a-bridge-to-quality Accessed 02/13/2019.

Kahan M, Srivastava A, Wilson L, Gourlay D, Midmer D. Misuse of and dependence on opioids: Study of chronic pain patients. Can Fam Physician. 2006; 52(9): 1081-1087. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1783735/ Accessed 02/13/2019.

Kaner E, Rapley T, May C. Seeing through the glass darkly? A qualitative exploration of GPs’ drinking and their alcohol intervention practices. Family Practice. 2006; 23: 481-487. Available at: http://fampra.oxfordjournals.org/content/23/4/481.full.pdf+html Accessed 02/13/2019.

Katz NP, Adams EH, Benneyan JC, Birnbaum HG, Budman SH et al. Foundations of opioid risk management. Clinical Journal of Pain. 2007; 23: 103-118. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17237659 Accessed 02/13/2019.

Keefe FJ. Cognitive behavioral therapy for managing pain. The Clinical Psychologist. 1996; 49(3): 4-5. Available at:  https://www.researchgate.net/publication/267420048_Cognitive_Behavioral_Therapy_for_Managing_Pain Accessed 02/13/2019.

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Professional Practice Gaps

Due to the widespread extent of the opioid epidemic and patients with chronic pain (Volkow et al., 2016; 2018), physicians are seeing a high rate of relatively more challenging problems, such as opioid addiction, drug-related aberrant behavior, and diversion (CDC, 2018; SAMHSA, 2018). After a review of the evidence, the FDA concluded that physicians need training in evidence-based opioid prescribing and provided an outline for the content of the training needed (FDA, 2017).

The AMA and American Association of Medical Colleges, having reviewed the evidence, each concluded that training in clinical skills related to opioids will help address the opioid epidemic (Parks, 2016; AAMC, 2017).

Practice Gap References

AAMC. Training Future Physicians to Address Opioid Crisis. AAMC News, September 19, 2017. https://news.aamc.org/patient-care/article/training-future-physicians-address-opioid-crisis/ Accessed 02/13/2019.

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

Parks, Troy. Opioid Crisis Needs Training Emphasis in GME. American Medical Association, November 17, 2016. https://www.ama-assn.org/delivering-care/opioids/opioid-crisis-needs-training-emphasis-gme Accessed 02/13/2019.

FDA. FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain (May 2017). Available at: https://www.fda.gov/drugs/news-events-human-drugs/fda-education-blueprint-health-care-providers-involved-management-or-support-patients-pain 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.

Volkow, Nora D., and A. Thomas McLellan. Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies. New England Journal of Medicine 374, no. 13 (March 31, 2016): 1253–63. https://doi.org/10.1056/NEJMra1507771 Accessed 02/13/2019.

Volkow, Nora D., Emily B. Jones, Emily B. Einstein, and Eric M. Wargo. Prevention and Treatment of Opioid Misuse and Addiction: A Review. JAMA Psychiatry, December 5, 2018. https://doi.org/10.1001/jamapsychiatry.2018.3126 Accessed 02/13/2019.