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Buprenorphine Training

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Screening, Detection, and Diagnosis of Opioid Use Disorder

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Screening, Detection, and Diagnosis of Opioid Use Disorder

1 hr out of up to 8.5 CME/CE

Goal: To prepare providers to screen for and diagnose opioid use disorder and motivate patients to make related health behavior changes.

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Educational Objectives:

After completing this activity participants will be able to:

  • Screen for opioid use disorder through patient interviews and use of standardized screening instruments
  • Use motivational interviewing skills to optimize patient outcomes in buprenorphine treatment
  • Assess patients for signs and symptoms of opioid use disorder

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

View Activity Outline

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

1 Hr

60 min

View Activity Outline

 
Buprenorphine Treatment Structure course image
Buprenorphine Treatment Structure

0.5 Hrs

30 min

View Activity Outline

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

1 Hr

60 min

View Activity Outline

 
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

View Activity Outline

 
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

View Activity Outline

 
Maintenance and Discontinuation course image
Maintenance and Discontinuation

1 Hr

60 min

View Activity Outline

 

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Activity Content

Pre-Assessments
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Post-Assessments
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Test Your Knowledge
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Screening, Detection, and Diagnosis of Opioid Use Disorder
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Pre-Assessments
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Screening, Detection, and Diagnosis of Opioid Use Disorder Pre-Test
Screening, Detection, and Diagnosis of Opioid Use Disorder
Test Your Knowledge
1 Test
Screening, Detection, and Diagnosis of Opioid Use Disorder 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.

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.

Screening Practice Gaps

Providers need to learn how to screen patients for opioid use disorder and risk and to make the diagnosis. The U. S. Preventive Services Task Force guidelines recommend screening all patients over 18 for drug use by asking questions about unhealthy drug use.1

Treatment starts with proper diagnosis of opioid use disorder followed by assessment of the appropriateness of office-based buprenorphine treatment. Original guidelines, such as SAMHSA’s TIP 40, Chapter 3, on Patient Assessment, as well as more recent guidelines, such as ASAM’s 2020 National Practice Guideline For the Treatment of Opioid Use Disorder, underscore the importance of providers being skilled in the diagnosis of opioid use disorder2–4. The FSMB Model policy also describes diagnosis of opioid use disorder as a critical patient assessment5.

Knowledge gaps are among the main barriers associated with low utilization of OUD medications, and this module aims to help address those gaps.6

References

  1. U.S. Preventive Services Task Force. Unhealthy Drug Use: Screening. June 9, 2020.
  2. SAMHSA/CSAT. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. 2004. PMID: 22514846.
  3. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.
  4. ASAM. The ASAM National Practice Guideline For the Treatment of Opioid Use Disorder 2020 Focused Update. 2020.
  5. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013.
  6. Mackey K, Veazie S, Anderson J, Bourne D, Peterson K. Barriers and Facilitators to the Use of Medications for Opioid Use Disorder: A Rapid Review. J Gen Intern Med. December 2020;35(Suppl 3):954-963. doi:10.1007/s11606-020-06257-4. PMCID: PMC7728943. PMID: 33145687.
Training Activity References

Screening, Detection, and Diagnosis of Opioid Use Disorder

  1. U.S. Preventive Services Task Force. Unhealthy Drug Use: Screening. June 9, 2020.

  2. SAMHSA/CSAT. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. 2004. PMID: 22514846.

  3. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.

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

  5. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013.

  6. Mackey K, Veazie S, Anderson J, Bourne D, Peterson K. Barriers and Facilitators to the Use of Medications for Opioid Use Disorder: A Rapid Review. J Gen Intern Med. December 2020;35(Suppl 3):954-963. doi:10.1007/s11606-020-06257-4. PMCID: PMC7728943. PMID: 33145687.

  7. NIDA. Screening for Substance Use. Natl Inst Drug Abuse. 2020.

  8. Walden G. Text – H.R.6 – 115th Congress (2017-2018): SUPPORT for Patients and Communities Act. October 4, 2018.

  9. American Psychiatric Association. Substance-Related and Addictive Disorders. APA. 2013.

  10. Shah M, Huecker MR. Opioid Withdrawal. In: StatPearls. Vol Treasure Island (FL): StatPearls Publishing; 2020. PMID: 30252268.

  11. Greene MS, Chambers RA. Pseudoaddiction: Fact or Fiction? An Investigation of the Medical Literature. Curr Addict Rep. 2015;2(4):310-317. doi:10.1007/s40429-015-0074-7. PMCID: PMC4628053. PMID: 26550549.

  12. Chou R, Fanciullo GJ, Fine PG, et al. Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. J Pain Off J Am Pain Soc. February 2009;10(2):113-130. doi:10.1016/j.jpain.2008.10.008. PMCID: PMC4043401. PMID: 19187889.

  13. Smith P, Schmidt S, Allensworth-Davies D, et al. A Single-Question Screening Test for Drug Use in Primary Care. Arch Intern Med. 2010;170(13):1155-1160. PMCID: PMC2911954. PMID: 20625025.

  14. UMBCtube. SBIRT: Screen for Substance Use – Negative Screen. UMBCtube; 2011.

  15. McNeely J, Wu L-T, Subramaniam G, et al. Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for Substance Use Screening in Primary Care Patients. Ann Intern Med. November 15, 2016;165(10):690. doi:10.7326/M16-0317.

  16. Mdege N, Lang J. Screening Instruments for Detecting Illicit Drug Use Abuse That Could Be Useful in General Hospital Wards: A Systematic Review. Addict Behav. 2011;36:1111-1119. PMID: 21821364.

  17. Brown R, Leonard T, Saunders L, et al. The Prevalence and Detection of Substance Use Disorder among Inpatients Ages 18 to 49: An Opportunity for Prevention. Prev Med. 1998;27:101-110. PMID: 9465360.

  18. Babor T, Higgins-Biddle J, Saunders J, et al. AUDIT: The Alcohol Use Disorders Identification Test Guidelines for Use in Primary Care. Vol Second edition. World Health Organization, Department of Mental Health and Substance Dependence; 2001.

  19. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Vol 5th edition. Washington, DC: Author; 2013.

  20. Trachtenberg A, Fleming M. Diagnosis and Treatment of Drug Abuse in Family Practice. 1994.

  21. Sullivan J, Sykora K, Schneiderman J, et al. Assessment of Alcohol Withdrawal: The Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar). Br J Addict. 1989;84(11):1353-1357. PMID: 2597811.

  22. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change, 3rd Edition. Vol 3rd edition. New York, NY: The Guilford Press; September 7, 2012.

  23. Lundahl B, Moleni T, Burke B, et al. Motivational Interviewing in Medical Care Settings: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. 93. 2013;2:157-168. PMID: 24001658.

  24. Miller W, Rollnick S. An Overview of Motivational Interviewing. 2011.

  25. Magill M, Stout R, Apodaca T. Therapist Focus on Ambivalence and Commitment: A Longitudinal Analysis of Motivational Interviewing Treatment Ingredients. Psychol Addict Behav. 2013;27:754-762.

  26. Clinical Tools, Inc. Motivational Interviewing: Managing Challenging Patient Behavior. Chapel Hill, NC: Clinical Tools, Inc.; 2016.

  27. Schulz JE, Parran T Jr. Principles of Identification and Intervention. In: Principles of Addiction Medicine. Vol 2nd ed. Chevy Chase, Md.: American Society of Addiction Medicine; 1998:250-251.

  28. SAMHSA. Screening, Brief Intervention, and Referral to Treatment (SBIRT). 2014.

  29. SAMHSA. Talking with Your Adult Patients about Alcohol, Drug, and/or Mental Health Problems. Publ Digit Prod. August 2010.

  30. Pickett M, Rogers P, Cavanaugh Jr R. Screening for alcohol, tobacco, and drug use in children and adolescents. In: In: Graham AW, Schultz TK, Mayo-Smith MF, Ries RK, Wilford BB, Eds. Principles of Addiction Medicine. Vol Third Edition. Chevy Chase, Md: American Society of Addiction Medicine; 2003.

  31. American Academy of Pediatrics. Alcohol Use by Youth and Adolescents: A Pediatric Concern. Pediatrics. 2010;125(5):1078-1087.

  32. Kaul P, Coupey S. Clinical Evaluation of Substance Abuse. Pediatr Rev. March 2002;23(3):85-94. PMID: 11875181.

  33. Knight J, Shrier L, Bravender T, et al. A New Brief Screen for Adolescent Substance Abuse. Arch Pediatr Adolesc Med. 1999;153(6):591-596.

  34. Marshal MP, Molina BSG, Pelham WE. Childhood ADHD and Adolescent Substance Use: An Examination of Deviant Peer Group Affiliation as a Risk Factor. Psychol Addict Behav J Soc Psychol Addict Behav. December 2003;17(4):293-302. doi:10.1037/0893-164X.17.4.293. PMCID: PMC3652274. PMID: 14640825.

  35. Al-Tayyib A, Rice E, Rhoades H, et al. Association between Prescription Drug Misuse and Injection among Runaway Homeless Youth. Drug Alcohol Depend. 2013;134:406-409. PMCID: PMC3886282. PMID: 24300900.

  36. Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT). A Guide to Substance Abuse Services for Primary Care Clinicians. Rockville, Md: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration; 2008.

  37. Tamm L, Trello-Rishel K, Riggs P, et al. Predictors of Treatment Response in Adolescents with Comorbid Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder. Subst Abuse Treat. 2013;44(2):224-230. PMCID: PMC3499678. PMID: 22889694.

  38. Warden D, Riggs PD, Min S-J, et al. Major Depression and Treatment Response in Adolescents with ADHD and Substance Use Disorder. Drug Alcohol Depend. August 31, 2011;120(1-3):214-219. PMCID: PMC3245790. PMID: 21885210.

  39. Cirone S. Brief Intervention: Adolescent with Prescription Opioid Use Disorder. 2013.

  40. Dowell D, Haegerich T, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep. 2016;65(1):1-49. doi:10.15585/mmwr.rr6501e1er.

  41. Madras B, Wilson M, Avula D, et al. Screening, Brief Interventions, Referral to Treatment (SBIRT) for Illicit Drug and Alcohol Use at Multiple Healthcare Sites: Comparison at Intake and Six Months. Drug Alcohol Depend. 2010;99(1-3):280-295. PMCID: PMC2760304. PMID: 18929451.

  42. Food and Drug Administration (FDA). Buprenorphine-containing Transmucosal products for Opioid Dependence (BTOD) Risk Evaluation and Mitigation Strategy (REMS). Initial REMS / , updated 6/2015 2013.

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