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Risk Reduction Strategies for Opioids (Including ER/LA Opioids)

5 hr(s)CME/CE
Goal: To prepare health care professionals who prescribe opioids to fully assess patients before prescribing them, prescribe them carefully and safely, and to continue to monitor patients for early detection and prevention of serious adverse events.
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Activity Steps

Activity Content
Post-Assessments
Certificate

This activity is designed to change: Competence, Performance, Patient Outcomes. 5 hr(s)

Overview

Professional Practice Gaps

Educational Objectives:

After completing this activity participants will be able to:

  • Assess for risk of substance use disorders in patients being considered for treatment with opioids (including ER/LA opioids).
  • Become knowledgeable about the general and specific characteristics of opioids including the effect of tolerance on prescribing for patients and learn differences with ER/LA opioids before prescribing them.
  • Safely and effectively initiate treatment using opioids, only when it is indicated, based on a complete history and physical examination and assessment of patient pain and functioning.
  • Use effective communication techniques with patients and their caregivers when opioids are prescribed for chronic pain to support their safe use at the minimum dose needed and help prevent adverse effects and diversion.
  • Monitor patients on chronic opioid therapy, make appropriate referrals and safely discontinue medication use when indicated.

Modules in this Training Activity

Activity Content

Pages Status
1

Identifying, Assessing, and Responding to an Aberrant Behavior

2

Initiating, Monitoring, and Terminating Opioid Treatment (Including ER/LA Opioids)

3

Weighing Risks and Benefits of Opioids (Including ER/LA Opioids)

4

Understanding Opioids (Including ER/LA Opioids)

5

Assessment and Treatment Planning Prior to Prescribing Opioids (ER/LA Opioids)

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)™ 5 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 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 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), 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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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.

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Training Activity References

AAPI. Use of Opioids for the Treatment of Chronic Pain, A statement from the American Academy of Pain Medicine. The American Academy of Chronic Pain. 2013. Available at: https://painmed.org/clinician-resources/tools-for-practice Accessed 02/14/2019.

Adams et al. Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients. J Pain Symptom Manage. 2004; 27: 440-459. Available at: http://www.jpsmjournal.com/article/S0885-3924(04)00101-0/abstract Accessed 02/14/2019.

Adams LL, Gatchel RJ, Robinson RC, et al. Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients. J Pain Symptom Manage. 2004; 27: 440-459. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15120773 Accessed 02/14/2019.

Agency Medical Directors’ Group. Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain: An educational aid to improve care and safety with opioid therapy. Washington State Agency Medical Directors Group. 2010. Available at: http://www.agencymeddirectors.wa.gov/Files/OpioidGdline.pdf Accessed 02/14/2019.

Aggarwal A, Kumar R, Sharma RC, Sharma DD. Persistent dystonia following opioid withdrawal. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2011; 35(2): 640. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20685372 Accessed 02/14/2019.

AMA. Promote safe storage and disposal of opioids and all medications. AMA-ASSN.org. 2017. Available at: https://www.aafp.org/dam/AAFP/documents/patient_care/pain_management/safe-storage.pdf Accessed 02/14/2019.

American Academy of Pain Medicine, American Pain Society and American Society of Addiction Medicine. Definitions related to the use of opioids for the treatment of pain. 2001. Available at: https://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2011/12/15/definitions-related-to-the-use-of-opioids-for-the-treatment-of-pain-consensus-statement Accessed 02/14/2019.

American Academy of Pain Medicine. Long-term Controlled Substances Therapy for Chronic Pain Sample Agreement. American Academy of Pain Medicine. 2001. Available at: https://www.nhms.org/sites/default/files/Pdfs/Opioid-Tx-Agreement-AAPM2001.pdf Accessed 02/14/2019.

American Geriatrics Society. Pharmacological management of persistent pain in older persons. Journal of the American Geriatrics Society. 2009; 57(8): 1331-1346. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19573219 Accessed 02/14/2019.

American Pain Foundation. Target Chronic Pain Notebook. American Pain Foundation. 2004; updated 2008. Available at: http://www.emergingsolutionsinpain.com/content/tools/apf_resources/TargetCard.pdf Accessed 02/14/2019.

American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. 5th ed. 2013. Available at: https://www.amazon.com/Diagnostic-Statistical-Manual-Mental-Disorders/dp/0890425558/ref=sr_1_1?s=books&ie=UTF8&qid=1492003452&sr=1-1&keywords=dsm+5 Accessed 02/14/2019.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). American Psychiatric Association. 2013; 5. Available at: http://www.appi.org/products/dsm-manual-of-mental-disorders Accessed 02/14/2019.

American Psychological Association. Patient Health Questionnaire (PHQ-9 & PHQ-2). APA.com. 2013. Available at: http://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/patient-health.aspx Accessed 02/14/2019.

Antoin H, Beasley RD. Opioids for chronic noncancer pain: tailoring the therapy to fit the patient and the pain. Postgrad Med. 2004; 116(3): 37-40, 43-44. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15460088 Accessed 02/14/2019.

Avouac J, Gossec L, Dougados M. Efficacy and safety of opioids for osteoarthritis: a meta-analysis of randomized controlled trials. Osteoarthritis Cartilage. 2007; 15(8): 957-65.

Bair MJ, Polshuck EL, Wu J, Krebs EK, Damush TM, Tu W, Kroenke K. Anxiety but not social stressors predict 12-month depression and pain severity. The Clinical Journal of Pain. 2013; 29: 95-101. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23183264 Accessed 02/14/2019.

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 02/14/2019.

Belgrade MJ, Schamber CD, Lindgren BR . The DIRE score: predicting outcomes of opioid prescribing for chronic pain. J Pain. 2006; 7: 671-81. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16942953 Accessed 02/14/2019.

Bennetto L, Patel NK, Fuller G. Trigeminal neuralgia and its management. BMJ. 2007; 334: 201-205. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1782012/ Accessed 02/14/2019.

Benyamin R, et al. Opioid Complications and Side Effects. Pain Physician. 2008; 11: 105-120. Available at: http://www.painphysicianjournal.com Accessed 02/14/2019.

Berland, D, Rodgers P. Use of opioids for management of chronic nonterminal pain. Am Fam Physician. 2012; 86(3): 252-258. Available at: http://www.aafp.org/afp/2012/0801/p252.html Accessed 02/14/2019.

BMJ Publishing Group. Opioid overdose. http://bestpractice.bmj.com/best-practice/verify-user-north-american-access.html. 2011; October 27. Available at: http://bestpractice.bmj.com/best-practice/monograph/339/treatment/step-by-step.html Accessed 02/14/2019.

Boscarino JA, Rukstalis MR, Hoffman SN, et al. Prevalence of prescription opioid-use disorder among chronic pain patients: comparison of the DSM-5 vs. DSM-4 diagnostic criteria. J Addict Dis. 2011; 30(3): 185-94. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21745041 Accessed 02/14/2019.

Briley M, Moret C. Treatment of comorbid pain with serotonin norepinephrine reuptake inhibitors. CNS Spectr. 2008; 13(7): 22-26.

Brown KS. Integrating Risk Assessment in Opioid Prescribing for Persistent Pain Management. Integrative Pain Center, Tripler Army Medical Center. 2009. Available at: https://division-rehabpsych.squarespace.com/ Accessed 02/14/2019.

Brown RL, Rounds LA. Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wis Med J. 1995; 94: 135-40. Available at: http://www.ncbi.nlm.nih.gov/pubmed/7778330 Accessed 02/14/2019.

Butler SF , Budman SH, Fernandez KC, et al. Cross-validation of a screener to predict opioid misuse in chronic pain patients (SOAPP-R). J Addict Med . 2010. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2712300/ Accessed 02/14/2019.

Butler SF, Budman SH, Fernandez KC, et al. Development and validation of the current opioid misuse measure. Pain. 2007; 130(1-2): 144-156. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1950245/ Accessed 02/14/2019.

Butler SF, Fernandez K, Benoit C, et al. Validation of the Revised Screener and Opioid Assessment for Patients in Pain (SOAPP-R). J Pain. 2008; 9: 360-372.

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 02/14/2019.

CASA. National Survey of American Attitudes on Substance Abuse XIII: Teens and Parents. National Center on Addiction and Substance Abuse. 2008. Available at: http://www.centeronaddiction.org/addiction-research/reports/national-survey-american-attitudes-substance-abuse-teens-parents-2008 Accessed 02/14/2019.

CDC. Unintentional Drug Poisoning in the United States . CDC. 2010; July. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5605a1.htm Accessed 02/14/2019.

Center for Disease Control. Prescription Painkiller Overdoses, Use and Abuse of Methadone as a Painkiller. CDC Vital Signs. 2012. Available at: http://www.cdc.gov/vitalsigns/MethadoneOverdoses/ Accessed 02/14/2019.

Chabal C, Erjavec MK, Jacobson L, Mariano A, Chaney E. Prescription opiate abuse in chronic pain patients: clinical criteria, incidence and predictors. Clin J Pain. 1997; 13(2): 150-155. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9186022 Accessed 02/14/2019.

Chan B, Tam LK, Wat CY, et al. Opioids in chronic non-cancer pain. Expert Opinion on Pharmacotherapy. 2011; 12(5): 705-720. Available at: http://informahealthcare.com/doi/abs/10.1517/14656566.2011.536335?journalCode=eop Accessed 02/14/2019.

Chou R, Ballantyne J, Fanciullo G, et al. Research Gaps on Use of Opioids for Chronic Noncancer Pain: Findings From a Review of the Evidence for an American Pain Society and American Academy of Pain Medicine Clinical Practice Guideline. J Pain. 2009b; 10(2): 147-159.

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 02/14/2019.

Chou R, Fanciullo GJ, Fine PG, et al. Opioids for chronic noncancer pain: prediction and identification of aberrant drug-related behaviors: a review of evidence for an American Pain Society and American Academy of Pain Medicine Clinical Practice Guideline. J Pain. 2009a; 10(2): 131-146. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19187890 Accessed 02/14/2019.

CMS. Calendar Year (CY) 2016 Clinical Laboratory Fee Schedule (CLFS) Preliminary Determinations. 2016. Available at: https://www.nila-usa.org/images/nila/!CY2016-CLFS-Codes-Final-Determinations%20-%20Copy.pdf Accessed 02/14/2019.

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 02/14/2019.

Compton P, Darakjian J, Miotto K. Screening for addiction in patients with chronic pain and “problematic” substance use: evaluation of a pilot assessment tool. J Pain Symptom Manage. 1998; 16: 355-363. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9879160 Accessed 02/14/2019.

Compton P, Wu SM, Schieffer B, Pham Q, Naliboff BD. Introduction to a self-report version of the Prescription Drug Use Questionnaire and relationship to medication agreement noncompliance. J Pain Symptom Manage. 2008; 36: 383-395. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630195/ Accessed 02/14/2019.

Compton P. The role of urine toxicology in chronic opioid analgesic therapy. Pain Manag Nurs. 2007; 8(4): 166-172. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18036504 Accessed 02/14/2019.

Compton P. Urine toxicology screening: a case study. Emerging Solutions in Pain. 2009. Available at: http://www.emergingsolutionsinpain.com Accessed 02/14/2019.

Cone et al. Urine drug testing of chronic pain patients: licit and illicit drug patterns. J Anal Toxicol. 2008; 32: 530-543. Available at: http://jat.oxfordjournals.org/content/32/8/530.long Accessed 02/14/2019.

Couper FJ, Logan BK. NHTSA Drugs and Human Performance Fact Sheets (rev 2014). 2014. Available at: https://www.wsp.wa.gov/breathtest/docs/webdms/DRE_Forms/Publications/drug/Human_Performance_Drug_Fact_Sheets-NHTSA.pdf Accessed 02/14/2019.

Covidien. EXALGO(TM) Risk Evaluation & Mitigation Strategy. EXALGO(TM) Risk Evaluation & Mitigation Strategy. 2011.

Dahan A, et. al.. Incidence, Reversal, and Prevention of Opioid-induced Respiratory Depression. Anesthesiology. 2010; 112: 226-238. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20010421 Accessed 02/14/2019.

Dais J, Khosia A, Doulatram G. The successful treatment of opioid withdrawal-induced refractory muscle spasms with 5-HTP in a patient intolerant to clonidine. Pain Physician. 2015; 18: E417-E420. Available at: http://www.painphysicianjournal.com/ Accessed 02/14/2019.

De Gregori S, De Gregori M, Ranzani GN, et al. Morphine metabolism, transport and brain disposition. Metabolic Brain Disease. 2012; 27(1): 1-5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22193538 Accessed 02/14/2019.

Deyo RA, Von Korff M, Duhrkoop D. Opioids for low back pain. The British Medical Journal. 2015; 350: g6380. Available at: http://www.bmj.com/content/350/bmj.g6380 Accessed 02/14/2019.

Donahue KE, Gartlehner G, Jonas DE. Systematic review: comparative effectiveness and harms of disease-modifying medications for rheumatoid arthritis. Ann Intern Med. 2008; 148: 124-134.

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 02/14/2019.

Dowling LS, Gatchel RJ, Adams LL, Stowell AW, Bernstein D. An evaluation of the predictive validity of the Pain Medication Questionnaire with a heterogeneous group of patients with chronic pain. J Opioid Manag. 2007; 3: 257-266. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18181380 Accessed 02/14/2019.

Drug Enforcement Administration (DEA). State Prescription Drug Monitoring Programs: Questions & Answers. U.S. Department of Justice. 2008. Available at: http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm Accessed 02/14/2019.

Drugs.com. Naloxone. FDA Professional Drug Information. Copyright 2000-2015; Last updated Jan-Feb, 2015: . Available at: http://www.drugs.com/pro/naloxone.html Accessed 02/14/2019.

Dublin S, Walker RL, Jackson ML, Nelson JC , Weiss NS , Von Korff M, Jackson LA. Use of Opioids or Benzodiazepines and Risk of Pneumonia in Older Adults: A Population-Based Case-Control Study. J Am Geriatr Soc.. 2011; 59. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223721/ Accessed 02/14/2019.

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 02/14/2019.

FDA. Blueprint for Prescriber Continuing Education Program 2011 (rev 2013). Available at: http://www.accessdata.fda.gov/drugsatfda_docs/rems/ERLA%20Opioids_2014-12-29_FDA%20BLUEPRINT%20FOR%20PRESCRIBER%20EDUCATION.pdf Accessed 02/14/2019.

FDA. ER/LA Opioid Analgesic Class Labeling Changes and Postmarket Requirements. New Safety Measures Announced for Extended-release and Long-acting Opioids. 2013. Available at: http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM367697.pdf Accessed 02/14/2019.

FDA. New Safety Measures Announced for Extended-release and Long-acting Opioids. FDA Website. 2013. Available at: https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm363722.htm Accessed 02/14/2019.

FDA. FDA Drug Safety Communication: FDA warns about several safety issues with opioid pain medicines; requires label changes. 3/22/2016. Available at: http://www.fda.gov/Drugs/DrugSafety/ucm489676.htm Accessed 02/14/2019.

Federation of State Medical Boards of the United States. Model policy for the use of controlled substances for the treatment of pain. Federation of State Medical Boards of the United States, Inc. 2004. Available at: http://www.fsmb.org/ Accessed 02/14/2019.

Ferri CM. Defining Opioid Tolerance and Dependency. Journal of Pain and Palliative Care Pharmacotherapy. 2013; 27: 392-393. Available at: http://informahealthcare.com/doi/abs/10.3109/15360288.2013.847518?journalCode=ppc Accessed 02/14/2019.

Fine PG. Opioid Rotation. J Pain Symptom Management. 2009. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19735902 Accessed 02/14/2019.

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 02/14/2019.

Fishbain DA, Cole B, Lewis J, Rosomoff HL, Rosomoff RS. What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Pain Med. 2008; 9(4): 444-59. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18489635 Accessed 02/14/2019.

Fishman SM, Bandman TB, Edwards A, Borsook D. The opioid contract in the management of chronic pain. J Pain Symptom Manage. 1999; 18(1): 6-8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10439570 Accessed 02/14/2019.

Florida Legislature. Health Professions and Occupations: General Provisions. Online Sunshine. 2013. Available at: http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0456/0456.html Accessed 02/14/2019.

Freynhagen R, Geisslinger G, Schug SA. Opioids for chronic non-cancer pain. British Medical Journal. 2013; 346: . Available at: http://www.bmj.com/content/346/bmj.f2937 Accessed 02/14/2019.

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 02/14/2019.

Galvez R, Perez C. Is morphine still the best reference opioid?. Future Medicine. 2012; 2(1): 33-45. Available at: http://www.futuremedicine.com/doi/abs/10.2217/pmt.11.78 Accessed 02/14/2019.

Garra G, Singer AJ, Taira BR, et al. Validation of the Wong-Baker FACES pain rating scale in pediatric emergency department patients. Academic Emergency Medicine. 2010; 17: 50-54. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20003121 Accessed 02/14/2019.

Goli V, Webster LR, Lamson MJ, et al. Effects of concurrent intravenous morphine sulfate and naltrexone hydrochloride on end-tidal carbon dioxide. Harm Reduction Journal. 2012; 9(13): . Available at: http://www.ncbi.nlm.nih.gov/pubmed/22420453 Accessed 02/14/2019.

Gourlay DL, Heit HA , Caplan YH , et al. Urine drug testing in clinical practice: the art and science of patient care. John Hopkins Medicine. 2012; 5. Available at: https://www.remitigate.com/wp-content/uploads/2015/11/Urine-Drug-Testing-in-Clinical-Practice-Ed6_2015-08.pdf Accessed 02/14/2019.

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 02/14/2019.

Gourlay DL, Heit HA. Compliance monitoring in chronic pain management. In SM Fishman, JC Ballantyne, JP Rathmell (eds). Bonica’s Management of Pain, Fourth Edition Philadelphia: Lippincott Williams & Wilkins. 2010. Available at: http://www.amazon.com/Bonicas-Management-Pain-Fishman/dp/0781768276 Accessed 02/14/2019.

Gourlay DL, Heit HA. Universal Precautions Revisited: Managing the Inherited Pain Patient. Pain Medicine. 2009; 10(S2): S115-S123. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19691682 Accessed 02/14/2019.

Gourlay DL, Howard HA, Yale CH. Urine Drug Testing in Clinical Practice: Dispelling the Myths & Designing Strategies. California Academy of Family Physicians and PharamCom Group, Inc. 2006: Edition 3. Available at:  https://www.coursehero.com/file/5867154/171-UDT-2006/ Accessed 02/14/2019.

Gupta DK, Avram MJ. Rational Opioid Dosing in the Elderly: Dose and Dosing Interval When Initiating Opioid Therapy. Clinical Pharmacology & Therapeutics. 2012; 91(2): 339-343. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22205194 Accessed 02/14/2019.

Harm Reduction Coalition. Naloxone Kit Materials. Harm Reduction Coalition. . Available at: http://harmreduction.org/issues/overdose-prevention/tools-best-practices/od-kit-materials/ Accessed 02/14/2019.

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 02/14/2019.

Heit HA, Gourlay DL. Urine drug testing in pain medicine. J Pain Symptom Manage. 2004; 27(3): 260-267. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15010104 Accessed 02/14/2019.

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 02/14/2019.

Holmes CP, Gatchel RJ, Adams LL, Stowell AW, et al. An opioid screening instrument: long-term evaluation of the utility of Pain Medication Questionnaire. Pain Pract. 2006; 6: 74-88. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17309714 Accessed 02/14/2019.

Hooten WM , Timming R, Belgrade M, et al. Assessment and management of chronic pain. Institute for Clinical Systems Improvement . 2013. Available at: https://www.icsi.org/guideline/pain/ Accessed 02/14/2019.

Hospice Palliative Care. Principles of Opioid Management. Hospice Palliative Care Program. 2006. Available at: https://web.archive.org/web/20170829012200/https://www.fraserhealth.ca/media/16FHSymptomGuidelinesOpioid.pdf Accessed 02/14/2019.

Huang AR, Mallet L. Prescribing opioids in older people. Maturitas. 2013; 74: 123-129. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23201325 Accessed 02/14/2019.

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 02/14/2019.

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 02/14/2019.

Irwin RS, Rippe JM. Irwin and Rippe’s Intensive Care Medicine. Lippincott Williams & Wilkins. 2012. Available at: https://www.amazon.com/Irwin-Rippes-Intensive-Care-Medicine/dp/160831183X Accessed 02/14/2019.

Jaine R, Jaine S. Antidepressants in the treatment of chronic pain. Practical Pain Management. 2011. Available at: http://www.practicalpainmanagement.com/treatments/pharmacological/non-opioids/antidepressants-treatment-chronic-pain?page=0,0 Accessed 02/14/2019.

Jarzyna D, et. al.. American Society of Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Sedation and Respiratory Depression. Pain Management Nursing . 2011; 12: 118-145. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21893302 Accessed 02/14/2019.

Katz N, Fanciullo GJ. Role of urine toxicology testing in the management of chronic opioid therapy. Clin J Pain. 2002; 19(4): S76-S82. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12479257 Accessed 02/14/2019.

Ko TM, Wong CS, Wu JY, et al. Pharmacogenomics for personalized pain medicine. Acta Anaesthesiologica Taiwanica. 2016; 1: 24-30. Available at: http://www.e-aat.com/article/S1875-4597(15)30027-8/fulltext Accessed 02/14/2019.

Krantz MJ, Kutinsky IB, Robertson AD, et al. Dose-related effects of methadone on QT prolongation in a series of patients with torsade de pointes. Pharmacotherapy. 2003; 23: 802-05. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12820821 Accessed 02/14/2019.

Krebs EE, Lorenz KA, Bair MJ. Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. J Gen Intern Med. 2009; 24(6): 733-738. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686775/ Accessed 02/14/2019.

Lipman AG. Understanding Opioid Tolerance A Seriously Overestimated Phenomenon. Journal of Pain and Palliative Care Pharmacotherapy. 2013; 27: 318-319. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24303831 Accessed 02/14/2019.

Manchikanti L, et. al.. American Society of Interventional Physicians (ASIPP) Guidelines for Responsible Opioid Prescribing in Chronic Non-Cancer Pain: Part 2 – Guidance . Pain Physician. 2012; 15: 67-116. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22786449 Accessed 02/14/2019.

Marshall, PS. Physical Functional Ability Questionnaire (FAQ5). In: Assessment and Management of Chronic Pain, 5th edition. Institute for Clinical Systems Improvement. 2011; 14: Appendix C:99. Available at: http://www.generationsprimarycare.com/assets/pain-contract.pdf Accessed 02/14/2019.

Martin DP, Bhalla T, Beltran R, et al. The safety of prescribing opioids in pediatrics. Expert opinion in drug safety. 2014; 13(1): 93-101. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24073760 Accessed 02/14/2019.

McCabe SE, Boyd CJ, Cranford JA, Teter CJ. Motives for nonmedical use of prescription opioids among high school seniors in the United States: Self-treatment and beyond. Archives of Pediatrics & Adolescent Medicine. 2009; 163(8): 739-744.

McCulloch, DK. Chronic Opioid Therapy Safety Guideline for Patients With Chronic Non-Cancer Pain. Group Health. 2010, rev. 2012. Available at: https://wa.kaiserpermanente.org/static/pdf/public/guidelines/opioid.pdf Accessed 02/14/2019.

McNicol ED, Midbari A, Eisenberg E. Opioids for neuropathic pain. Cochrane Database System of Reviews. 2013; 8(8): CD006146. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23986501 Accessed 02/14/2019.

Mdege ND, Lang J . Screening instruments for detecting illicit drug use/abuse that could be useful in general hospital wards: a systematic review. Addictive Behaviors. 2011; 36(12): 1111-1119. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21821364 Accessed 02/14/2019.

Meissner K, Avram MJ, Yermolenka V, et al. Cyclosporine-inhibitable Blood-Brain Barrier Drug Transport Influences Clinical Morphine Pharmacodynamics. Anesthesiology. 2013; 119(4): 941-953. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23851346 Accessed 02/14/2019.

Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975; 1: 277-299. Available at: http://www.ncbi.nlm.nih.gov/pubmed/1235985 Accessed 02/14/2019.

Merrill JO, Von Korff M, Banta-Green CJ, et al. Prescribed opioid difficulties, depression and opioid dose among chronic opioid therapy patients. General Hospital Psychiatry. 2012; 34: 581-587. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22959422 Accessed 02/14/2019.

Middleton P, Pollard H. Are chronic low back pain outcomes improved with co-management of concurrent depression?. Chiro Osteopat. 2005; 13(1). Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182702/ Accessed 02/14/2019.

Moore TM , Jones T , Browder JH, et al. A comparison of common screening methods for predicting aberrant drug-related behavior among patients receiving opioids for chronic pain management. Pain Medicine. 2009; 10(8): 1426-1433. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2009.00743.x/abstract Accessed 02/14/2019.

NAABT.org. Physical Dependence and Addiction An Important Distinction. The National Alliance of Advocates for Buprenorphine Treatment. 2014. Available at: http://www.naabt.org/addiction_physical-dependence.cfm Accessed 02/14/2019.

Nafziger AN, Bertino JS. Utility and application of urine drug testing in chronic pain management with opioids. Clinical Journal of Pain. 2009; 25(1): 73-79. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19158549 Accessed 02/14/2019.

Nalamachu SR. Opioid Rotation in Clinical Practice. Advances in Therapy. 2012; 29(10): 849-863. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23054690 Accessed 02/14/2019.

NaloxoneInfo.org. Naloxone Information. NaloxoneInfo.org. . Available at: https://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone  Accessed 02/14/2019.

National Center for Complementary and Integrative Health. NIH Analysis Shows Americans are in Pain. National Institute of Health. 2015. Available at: https://nccih.nih.gov/news/press/08112015?nav=pin Accessed 02/14/2019.

National Pain Foundation. Migraine Headache. National Pain Foundation, Inc. 2009. Available at: https://uspainfoundation.org/tag/migraine/ Accessed 02/14/2019.

Nicholson B. Benefits of extended-release opioid analgesic formulations in the treatment of chronic pain.. Pain Practice. 2009; 9: 71-81. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19019047 Accessed 02/14/2019.

Noble M, Treadwell JR, Tregear SJ, Coates VH, Wiffen PJ, Akafomo C, Schoelles KM. Long-term opioid management for chronic non-cancer pain. Cochrane Database of Systematic Reviews. 2010; 1: . Available at: http://www.ncbi.nlm.nih.gov/pubmed/20091598 Accessed 02/14/2019.

Office of National Drug Control Policy (ONDCP). Proper Disposal of Prescription Drugs. White House Drug Policy. 2009. Available at: http://www.whitehouse.gov/ondcp Accessed 02/14/2019.

Overdyk FJ. Initiatives in Safe Patient Care: Postoperative Respiratory Depression and Opioids. Saxe Healthcare Communications. 2009; 1-8: . Available at: http://files.sld.cu/anestesiologia/files/2012/01/postoperative-respiratory-depression-opioids.pdf Accessed 02/14/2019.

Pasero C, McCoffery M. Reversing Respiratory Depression with Naloxone. The American Journal of Nursing. 2003; 100: 26. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10683639 Accessed 02/14/2019.

Passik S. Moment of truth and techniques needed to manage the patient with chronic pain. Available at: http://www.medscape.org/viewarticle/587118 Accessed 02/14/2019.

Passik S. Psychiatric and pain characteristics of prescription drug abusers entering drug rehabilitation. Journal of Pain and Palliative Care Pharmacotherapy. 2006; 20(2): 5-13.

Passik SD, Kirsh KL, Casper D. Addiction-related assessment tools and pain management: instruments for screening, treatment planning and monitoring compliance. Pain Med. 2008; 9: S145-S166.

Passik SD, Kirsh KL, Webster L. Pseudoaddiction revisited: a commentary on clinical and historical considerations. Pain Management. 2011; 1(3): 239-248. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24646390 Accessed 02/14/2019.

Passik SD, Schein JR, Dodd SL, et al. A new tool to assess and document pain outcomes in chronic pain patients receiving opioid therapy. Clin Ther. 2004; 26(4): 552-61. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15189752 Accessed 02/14/2019.

Passik SD, Weinreb HJ. Managing chronic nonmalignant pain: Overcoming obstacles to the use of opioids. Adv Ther. 2000; 17: 70-83.

Pawasauskas J, Stevens B, Youssef R, Kelley M. Predictors of naloxone use for respiratory depression and oversedation in hospitalized adults. American Journal of Health-System Pharmacy. 2014; 71(9): 746-750. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24733138 Accessed 02/14/2019.

Peppin JF, Passik SD, Couto JE, et al. Recommendations for urine drug monitoring as a component of opioid therapy in the treatment of chronic pain. Pain Medicine. 2012; June early e-publications: 1-11. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2012.01414.x/abstract Accessed 02/14/2019.

Pergolizzi J, Böger RH, Budd K, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract. 2008; 8(4): 287-313. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18503626 Accessed 02/14/2019.

Physicians for Responsible Opioid Prescribing (PROP). Cautious Evidence Based Opioid Prescribing. Physicians for Responsible Opioid Prescribing. 2011. Available at: http://www.supportprop.org/wp-content/uploads/2014/01/PROP_OpioidPrescribing.pdf Accessed 02/14/2019.

Portenoy RK, Ahmed E. Principles of Opioid Use in Cancer Pain. Journal of Clinical Oncology. 2014; 32(16): 1662-1670. Available at: http://jco.ascopubs.org/content/early/2014/05/05/JCO.2013.52.5188.abstract Accessed 02/14/2019.

Pritham UA, McKay L. Safe Management of Chronic Pain in Pregnancy in an Era of Opioid Misuse and Abuse. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2014; 43(5): 554-567. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25123962 Accessed 02/14/2019.

Reisfield GM, Salazar E, Bertholf RL. Review: rational use and interpretation of urine drug testing in chronic opioid therapy. Ann Clin Lab Sci. 2007; 37(4): 301-314. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18000286 Accessed 02/14/2019.

Risser A, Donovan D, Heintzman J, Page T. NSAID prescribing precautions. Am Fam Physician. 2009; 80(12): 1371-8. Available at: http://www.aafp.org/afp/2009/1215/p1371.html Accessed 02/14/2019.

Rudd RA. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR. Morbidity and Mortality Weekly Report. 2016; 65. Available at: http://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm Accessed 02/14/2019.

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. 2013. Available at: http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf Accessed 02/14/2019.

SAMHSA. SAMHSA opioid overdose prevention toolkit. 2014. Available at: https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4742.pdf Accessed 02/14/2019.

Savage SD, Kirsh KL, Passik, SD. Challenges in using opioids to treat pain in persons with substance use disorders. Addiction Science & Clinical Practice. 2008. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797112/ Accessed 02/14/2019.

Schafer, M. Guide to Pain Management in Low-Resource Settings, Chapter 7 Opioids in Pain Medicine. International Association for the Study of Pain. 2010. Available at: http://www.iasp-pain.org/files/Content/ContentFolders/Publications2/FreeBooks/Guide_to_Pain_Management_in_Low-Resource_Settings.pdf Accessed 02/14/2019.

Schechter Neil L. Pediatric Pain Management and Opioids: the baby and the bathwater. JAMA Pediatrics. 2014; 168(11): 987-988. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25200481 Accessed 02/14/2019.

Schnoll, Sidney H., Finch, James. Medical Education for Pain and Addiction: Making Progress Toward Answering a Need. The Journal of Law, Medicine & Ethics. 1994. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1748-720X.1994.tb01303.x/abstract Accessed 02/14/2019.

Shah A, Hayes CJ, Martin BC, et al. Characteristics of initial prescription episodes and likelihood of long-term opioid use — United States, 2006–2015. MMWR. 2017; 66(10): 265-269. Available at: https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm?s_cid=mm6610a1_w Accessed 02/14/2019.

Shi Y, Weingarten TN, Hooten WM, Maintilla CB, Warner DO. Smoking and pain: pathophysiology and clinical implications. Anesthesiology. 2010; 113(4): 977-992. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20864835 Accessed 02/14/2019.

Silverman SM. Opioid induced hyperalgesia: Clinical implications for the pain practitioner. Pain Physician. 2009; 12(3): 679-694. Available at: http://www.painphysicianjournal.com/ Accessed 02/14/2019.

Solanki DR, Koyyalagunta D, Shah RV, Silverman S, Manchikanti L. Monitoring opioid adherence in chronic pain patients: Assessment of risk of substance misuse. Pain Physician. 2011; 14: E119-E131. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21412377 Accessed 02/14/2019.

Solomon DH, Furst DE, Romain PL. Patient information: Nonsteroidal anti-inflammatory drugs (NSAIDs). UpToDate. 2014. Available at: http://www.uptodate.com/contents/nonsteroidal-antiinflammatory-drugs-nsaids-beyond-the-basics Accessed 02/14/2019.

Stagnitti MN. Trends in Prescribed Outpatient Opioid Use and Expenses in the U.S. Civilian Noninstitutionalized Population, 2002-2012. Statistical Brief. AHRQ. 2015. Available at: http://meps.ahrq.gov/mepsweb/data_files/publications/st478/stat478.shtml Accessed 02/14/2019.

Stein DJ, Ipser JC, Seedat S. Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database Systematic Reviews. 2006; 1. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16437445 Accessed 02/14/2019.

Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2008 National Survey on Drug Use and Health: National Findings. Office of Applied Studies, NSDUH Series H-36, HHS Publication No. SMA 09-4434. Rockville, MD. 2009.

Substance Abuse and Mental Health Services Administration. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 40, USDHHS Publication (SMA) 04-3939. 2004. Available at: http://www.ncbi.nlm.nih.gov/books/NBK64766/ Accessed 02/14/2019.

Substance Abuse and Mental Health Services Administration. Opioid Overdose Toolkit. SAMHSA. Available at:  https://store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit/SMA18-4742 Accessed 02/14/2019.

Tennant F. Using objective signs of severe pain to guide opioid prescribing. Pain Treatment Topics. 2008.

The American Academy of Pain Medicine. The American Society of Addiction Medicine. Consensus document. The American Pain Society. 2001. Available at: https://www.asam.org/Quality-Science/publications/magazine/read/article/2017/07/11/asam-releases-consensus-document-outlining-appropriate-use-of-drug-testing Accessed 02/14/2019.

Trescot A, Glaser S, Hansen H, et al. Effectiveness of opioids in the treatment of chronic non-cancer pain. Pain Physician. 2008a; 11: S181-S200. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18443639 Accessed 02/14/2019.

Trescot A, Helm S, Hansen H, et al. Opioids in the management of chronic non-cancer pain: an update of American Society of the Interventional Pain Physicians’ (ASIPP) guidelines. Pain Physician. 2008b; 11: S5-S62.

Turner JA, Saunders K, Shortreed SM, et al. Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results. J Gen Intern Med. 2014; 29(12): 1663-1671. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25217208 Accessed 02/14/2019.

U.S. Preventive Services Task Force. Final Recommendation Statement – Depression in Adults: Screening. U.S. Preventive Services Task Force Website. 2016. Available at: http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/depression-in-adults-screening1 Accessed 02/14/2019.

USDHHS. Facing Addiction in America. The Surgeon General’s Report on Alcohol, Drugs, and Health. Surgeon General Reports. 2016. Available at: https://addiction.surgeongeneral.gov/ Accessed 02/14/2019.

VA/DoD. Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain. VA/DoD. 2010. Available at: https://www.healthquality.va.gov/guidelines/Pain/cot/VADoDOTCPG022717.pdf Accessed 02/14/2019.

VA/DoD. Tapering and Discontinuing Opioids. 2010 VA/DoD Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain. 2010. Available at: https://www.healthquality.va.gov/guidelines/Pain/cot/VADoDOTCPG022717.pdf Accessed 02/14/2019.

VA/DoD. VA/DoD Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain. VA/DoC. 2003. Available at: http://www.ihs.gov/nc4/index.cfm Accessed 02/14/2019.

van Ojik AL, Jansen PAF, Brouwers J, et al. Treatment of Chronic Pain in Older People. Drugs & Aging. 2012; 29(8): 615-625. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22765848 Accessed 02/14/2019.

Vissers KCP, Besse K, Hans G, Devulder J, Morlion B. Opioid Rotation in the Management of Chronic Pain: Where Is the Evidence?. Pain Practice. 2010; 10(2): 85-93. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1533-2500.2009.00335.x/pdf Accessed 02/14/2019.

Vowles KE, McEntee ML, Julnes PS, et al. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015; 156(4): 569-576. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25785523 Accessed 02/14/2019.

Walsh S. FDA approves new hand-held auto-injector to reverse opioid overdose: First naloxone treatment specifically designed to be given by a family members or caregivers. FDA.gov. 2014. Available at: https://www.fda.gov/Drugs/DrugSafety/ucm391449.htm Accessed 02/14/2019.

Warner EA. Opioids for the Treatment of Chronic Noncancer Pain. The American Journal of Medicine. 2012; 125(12): 1155-1161. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18443640 Accessed 02/14/2019.

Warner M, Chen LH, Makuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999-2006. NCHS Data Brief, no. 22. Hyattsville, MD: National Center for Health Statistics. 2009. Available at: http://www.cdc.gov/nchs/data/databriefs/db22.pdf Accessed 02/14/2019.

Washington State Department of Health. Washington State Department of Health: Pain Management. Washington State Department of Health. 2010. Available at: http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/PainManagement Accessed 02/14/2019.

Webster LR, Fine PG. Overdose deaths demand a new paradigm for opioid rotation. Pain Med. 2012; 13(4): 571-4. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22458858 Accessed 02/14/2019.

Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the Opioid Risk Tool. Pain Medicine. 2005; 6(6): 432-442. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16336480 Accessed 02/14/2019.

Webster LR. Methadone-related deaths. Pain Med. 2011; 1(4): 211-7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21668754 Accessed 02/14/2019.

Weissman DE, Haddox JD. Opioid pseudoaddiction—An iatrogenic syndrome. J Pain. 1989; 36(3): 363-366. Available at: http://www.ncbi.nlm.nih.gov/pubmed/2710565 Accessed 02/14/2019.

World Health Organization (WHO). WHO’s pain relief ladder. World Health Organization: Programmes and projects: Cancer. 2010. Available at: http://www.who.int/cancer/palliative/painladder/en/ Accessed 02/14/2019.

Wu SM, Compton P, Bolus R, et al. The Addiction Behaviors Checklist: validation of a new clinician-based measure of inappropriate opioid use in chronic pain. J Pain Symptom Manage. 2006; 32: 342-351. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17000351 Accessed 02/14/2019.

Zacharoff, KL, Pujol LM, Corsini E. Managing Chronic Pain With Opioids in Primary Care. The PainEDU.org Manual. 2010; 2nd ed. Available at: http://www.bookwire.com/book/USA/Managing-Chronic-Pain-with-Opioids-in-Primary-Care-9780982529805-Zacharoff-Kevin-L-28531238 Accessed 02/14/2019.

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.