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Buprenorphine Training

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Opioid Misuse – 1 Patient

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Opioid Misuse – 1 Patient

0.5 hr out of up to 8.5 CME/CE

Goal: To train providers in distinguishing between undertreated pain and opioid use disorder in patients on chronic opioid therapy and plan best medical management of the chronic pain condition.

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Educational Objectives:

After completing this activity participants will be able to:

  • Interview a patient to obtain a comprehensive history for chronic pain
  • Assess risk for substance use disorder in a patient on chronic opioid therapy
  • Evaluate a patient on chronic opioid therapy for opioid use disorder
  • Recognize and respond to aberrant drug-related behaviors in patients

Choose Another Module:

Buprenorphine for Opioid Use Disorder: Overview course image
Buprenorphine for Opioid Use Disorder: Overview

0.5 Hrs

30 min

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Screening, Detection, and Diagnosis of Opioid Use Disorder course image
Screening, Detection, and Diagnosis of Opioid Use Disorder

1 Hr

60 min

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Assessing Patients for Buprenorphine Treatment course image
Assessing Patients for Buprenorphine Treatment

1 Hr

60 min

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Buprenorphine Treatment Structure course image
Buprenorphine Treatment Structure

0.5 Hrs

30 min

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Understanding Opioid Medications and Buprenorphine Formulations course image
Understanding Opioid Medications and Buprenorphine Formulations

1 Hr

60 min

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Induction – Initiating Buprenorphine Treatment course image
Induction – Initiating Buprenorphine Treatment

1 Hr

60 min

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Prescribing for Pain with Care: 2 Patients course image
Prescribing for Pain with Care: 2 Patients

1 Hr

60 min

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Opioid Misuse – 1 Patient course image
Opioid Misuse – 1 Patient

0.5 Hrs

30 min

View Activity Outline

 
Opioid Use Disorder and Medication Assisted Treatment – 2 Patients course image
Opioid Use Disorder and Medication Assisted Treatment – 2 Patients

0.5 Hrs

30 min

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Opioids and Acute Pain: When and How – 1 Patient course image
Opioids and Acute Pain: When and How – 1 Patient

0.5 Hrs

30 min

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Maintenance and Discontinuation course image
Maintenance and Discontinuation

1 Hr

60 min

View Activity Outline

 

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Activity Content

Interactive Patient Case: Chad Wright
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Pre-Assessments
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Test Your Knowledge
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Post-Assessments
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Pre-Assessments
1 Test
Opioid Misuse: 1 Patient Pre-Test
Interactive Patient Case: Chad Wright
Test Your Knowledge
1 Test
Opioid Misuse: 1 Patient Post-Test
Post-Assessments
Funding Information Development of this website was funded by grant #R44DA12066, contract #HHSN271200655304C, contracts #HHSN271200900003C and Grant #1R44DA027245-01, from the National Institute on Drug Abuse (NIDA) at the National Institutes of Health. The website contents are solely the responsibility of the authors and do not necessarily represent the official views of NIDA. Ongoing development and maintenance is funded by the training fee and 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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Buprenorphine Practice Gaps

Professional practice gaps exist when there is a disparity between educational needs and the ideal or desired level of knowledge, competence, and performance. Despite demonstrated effectiveness of buprenorphine (SAMHSA, 2020), only around 95,000 providers prescribe buprenorphine for office-based treatment of opioid use disorder, which is a small percentage considering that the pool of potential prescribers is well over a million (SAMHSA, 2021). Physicians, nurse practitioners, and physician assistants are likely to encounter patients having this disorder due to the size of the opioid epidemic:

  • 9.5 million people (3.4%) aged 12 or older engaged in misuse of opioids in 2020 (SAMHSA, 2021a). 
  • Many people who need treatment are still not receiving it; in 2019 only 18.1% of those needing it received medication-assisted treatment for opioid use disorder (SAMHSA, 2020a).
  • Practitioners having a DEA registration to prescribe controlled substances can prescribe buprenorphine for opioid use disorder and detoxification (HHS, 2021). Federal law requires practitioners wishing to see more than 30 patients to complete an 8-hour certification training in order to prescribe buprenorphine (SAMHSA, 2020b; HHS, 2021).
  • This training is intended for practitioners who are not required to complete a certification training for a waiver and others who wish to refresh skills or learn more about buprenorphine.

Buprenorphine is a safe and effective treatment for opioid use disorder. Until the exemption for practitioners with DEA registration announced on April 28, 2021 (HHS, 2021), 8 hours of training by an approved organization was required by law in order to prescribe it (SAMHSA, 2020b). Providing information on all aspects of buprenorphine treatment will help address this knowledge need. Moreover, buprenorphine treatment has a protocol for successful outcomes and to minimize risks of overdose, death, and diversion (ASAM, 2020), which validates a need for training for many providers. New, extended-release formulations of buprenorphine have been released over the past several years, resulting in the need to learn new clinic protocols and understanding of patient needs (Compton & Volkow, 2021).

Understanding of clinical protocol and how to apply it will help address this competence need. Experience with interactive case scenarios helps address the performance need of translating competence in following the protocol into actual practice. 

Practice Gap References

ASAM. The ASAM National Practice Guideline For the Treatment of Opioid Use Disorder 2020 Focused Update. 2020.

Compton W & Volkow N. Extended-Release Buprenorphine and Its Evaluation With Patient-Reported Outcomes. JAMA Netw Open. 2021;4(5):e219708. doi:10.1001/jamanetworkopen.2021.9708

Health and Human Services Department. Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder. Fed Regist. April 28, 2021.

Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.; 2020a.

Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.; 2021a.

SAMHSA. Buprenorphine. October 7, 2020b.

SAMHSA. Practitioner and Program Data. SAMHSA.gov. 2021b.

Opiolids Misuse Case References

American Academy of Orthopedic Surgeons. Treatment of Osteoarthritis of the Knee 2nd edition. 2011; Available at: https://www.ncbi.nlm.nih.gov/pubmed/23996988 Accessed 02/14/2019.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC, American Psychiatric Association. 2013 page 541.

PCSS-MAT/APA. Opioid use disorder diagnostic criteria. Reprinted from Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (Copyright 2013) American Psychiatric Association. Available at: https://pcssnow.org/resource/opioid-use-disorder-opioid-addiction/ Accessed 02/14/2019.

Babor TF, de la Fluente JF, Saunders J, Grant M. AUDIT: The Alcohol Use Disorders Identification Test: guidelines for use in primary health care. Generva, Switzerland: World Health Organization. 1992.

Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review. 1988; 8(1):77-100.

Belgrade M, Schamber CD, Lindgren BR. The DIRE score. Predicting outcomes of opioid prescribing for chronic pain. The Journal of Pain. 2006; 7(9): 671-81. Available at: http://www.jpain.org/article/S1526-5900(06)00626-2/abstract. Accessed 02/14/2019.

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

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: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm. Accessed 02/14/2019.

FDA. Drug Safety and Availability – FDA Drug Safety Communication: FDA recommends against the continued use of propoxyphene. https://www.fda.gov/Drugs/DrugSafety/ucm234338.htm. Accessed 02/14/2019.

Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann. Rheum. Dis. 2000;16 (4): 494-502. Available at https://www.ncbi.nlm.nih.gov/pubmed/13498604. 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.

Kumar L, Barker C, Emmanuel A. Opioid-induced constipation: Pathophysiology, clinicial consequences, and management. Gastroenterology Research and Practice. 2014; 2014. Available at: https://www.hindawi.com/journals/grp/2014/141737/ 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.

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.

Pani PP, Vacca R, Troqu E, Amato L, Davoli M. Pharmacological treatment for depression during opioid agonist treatment for opioid dependence. Cochrane Database of Systematic Reviews. 2010; 8(9): CD008373. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008373.pub2/abstract Accessed 02/14/2019.

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.

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

Practice Gaps Opioid Misuse

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).

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.

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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