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Waiver Training for NPs & PAs Part 2: 16 hours SBIRT, Opioids, Pain, and Risk Reduction

Home › Training › Waiver Training for NPs & PAs Part 2: 16 hours SBIRT, Opioids, Pain, and Risk Reduction
As of April 15, 2019, the following activity does not meet the requirement for waiver training and will no longer be offered. The same content is available through individual activities (SBIRT Core Training Activity: Screening, Brief Interventions, and Referral to Treatment / Foundations of Assessing and Treating Pain / Risk Reduction Strategies for ER/LA Opioids / Expanded Skills in Chronic Opioid Therapy), but will not qualify as waiver training and may not be eligible for board-certified continuing education credit.

This activity is designed to change: Competence, Performance. 16 hr(s)

Overview

Goal: This activity aims to:

  1. Train health care providers to apply the clinical skills of screening, brief intervention, and referral to treatment (SBIRT) with patients having substance use problems. Additionally, to train providers in basic motivational interviewing techniques to motivate people having substance use to change behaviors contributing to substance use problems. To adapt these skills according to the substance involved, severity of the substance use problem, and other individual patient needs. (SBIRT Goal – 5 hrs)
  2. Enhance clinical skills of health professionals in treating pain safely and effectively while reducing the risk of addiction/substance abuse/misuse and overdose in patients being treated for pain as well as recognizing and addressing these problems in patients. Specifically:
    • To prepare healthcare professionals who prescribe opioids to fully assess patients before prescribing them, prescribe all opioids carefully and safely, and monitor patients for early detection and prevention of serious adverse events. Further, to become familiar with general and specific drug information on ER/LA opioid analgesics, such as instructions for use, special precautions, adverse effects/side effects, drug interactions, opioid tolerance, the risk of overdose, conversion methods, product safety, dosing, and effect of tolerance.
    • To apply clinical skills with respect to reducing the risk of addiction/misuse of opioids and other prescribed controlled substances, recognizing and addressing drug-related aberrant behavior, urine drug testing and other ongoing monitoring of patients on chronic opioid therapy, coordinating care of these patients with a multidisciplinary team, and assuring adequate pain management in patients with substance use disorders without further contributing to patient substance use problems.

    (Opioids, Pain, Risk Reduction Goal – 11 hrs)

Professional Practice Gaps – SBIRT
Professional Practice Gaps – Opioids, Pain, Risk Reduction

Educational Objectives:

After completing this activity participants will be able to:

SBIRT
  • Select and utilize tobacco, alcohol, and drug use screening tools with patients.
  • Perform brief interventions for tobacco and substance use problems with patients.
  • To use basic motivational interviewing techniques to motivate patients having substance use problems to change behaviors in order to improve health.
  • Refer patients to the appropriate type of substance abuse treatment center and/or specialist
  • Follow-up with and reassess patients who receive treatment for substance abuse or tobacco use
  • Apply the SBIRT approach to substance use problems at a comprehensive and integrated level by individualizing screening, brief interventions, and referral for different patients.
Opioids, Pain, Risk Reduction
  • Review basic pain history, assessment, and diagnosis
  • Describe the main pharmacological and non-pharmacological categories of pain treatments used as first-line treatment for different categories of pain and common pain conditions
  • Collaborate with colleagues in a multi-dimensional/multidisciplinary approach to pain management with a medical “home”
  • Recognize when opioid therapy is indicated based on pain severity, functioning, and risk of addiction or abuse, and potential harm from side effects
  • Develop an opioid medication treatment plan that minimizes risk of addiction, misuse, overdose, and side effects

Modules in this Training Activity

SBIRT
  • SBIRT: Brief and Effective Screening for Hazardous Substance Use
  • SBIRT: Brief Intervention and Other Treatments
  • SBIRT: Referral to Treatment & Follow-up Care
  • SBIRT: In Practice
  • Motivational Interviewing for Primary Care
Opioid Risk
  • Assessing Pain
  • Treatment of Pain
  • Opioids and Pain: Assessment and Treatment Planning Prior to Prescribing (ER/LA Opioids)
  • Opioids and Pain: Understanding ER/LA Opioids
  • Opioids and Pain: Weighing Risks and Benefits (ER/LA Opioids)
  • Opioids and Pain: Initiating, Monitoring, and Terminating Opioid Treatment (ER/LA Opioids)
  • Opioids and Pain: Identifying, Assessing and Responding to an Aberrant Behavior
  • Expanded Skills: Minimizing Opioid Diversion and Overdose Risk
  • Expanded Skills: The High Risk Patient and Opioids
  • Expanded Skills: Coordinating Pain Treatment with Colleagues
  • Cases to Assess Understanding – Barbara and Olivia

Training Activity References – SBIRT
Training Activity References – Opioids, Pain, Risk Reduction

Audience and Accreditation

Audience: Health care professional clinical level students, interns, and residents

Type Est. Time Released Expires
FAPA 16 hr(s) 4/16/18 4/15/21
DCBN 16 hr(s) 4/16/18 4/15/21

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

FAPA Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 16 hour(s) of FAPA credit. Providers and other health professionals should claim only the credit commensurate with the extent of their participation in the activity.

DCBN Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 16 hour(s) of DCBN credit. Clinical Tools, Inc. is an approved provider by the District of Columbia Board of Nursing and is registered with CE Broker, Provider #50-1942.

A letter of completion for up to 16 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), a contract from the National Institute on Drug Abuse (#HHSN271200900003C).

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 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 a Clinical Associate Professor of Psychiatry at the University of North Carolina 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 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 within our products. He helped guide development of the curriculum plan and assessments in Phase I of the current project.

Opioids, Pain, Risk Reduction only:

Barbara St Marie, RN (RN, PhD candidate, University of Wisconsin)
Disclosure: Has disclosed no relevant financial relationships.
Teresa Holt, MD (Dr. Teresa Holt, MD, )
Disclosure: Has disclosed no relevant financial relationships.
Read Bio
Dr. Teresa Holt is a physician that specializes in family medicine, and works in a private practice.

Most Recent Reviews: SBIRT

CTI Content Review: Thu, 11/21/2018
CTI Editorial Review: Mon, 11/29/2018

Most Recent Reviews: Opioids, Pain, Risk Reduction

CTI Content Review: Thu, 1/5/2017
CTI Editorial Review: Mon, 1/9/2017

Next »
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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Training Activity References

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United States Department of Health and Human Services. Screening for drug use in general medical settings: Resource guide. . 2010. Available at: https://www.drugabuse.gov/sites/default/files/resource_guide.pdf Accessed on: 2015-06-16.

United States Department of Labor. Counselors: Occupational Outlook Handbook, 2010-11 Edition. US DOL. 2009. Available at: https://www.bls.gov/ooh/Community-and-Social-Service/School-and-career-counselors.htm Accessed on: 2010-07-07.

University of Wisconsin Center for Tobacco Research & Intervention (UW-CTRI). International Classification of Diseases (ICD) – 10 Codes Tobacco/Nicotine Dependence, and Secondhand Smoke Exposure Effective October 1, 2015. . 2015. Available at: http://www.ctri.wisc.edu/documents/icd10.pdf Accessed on: 2015-10-05.

USDA. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. . 2015. Available at: https://health.gov/dietaryguidelines/2015-scientific-report/pdfs/scientific-report-of-the-2015-dietary-guidelines-advisory-committee.pdf Accessed on: 2015-11-21.

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 on: 2016-11-17.

van der Wouden JC, Rietmeijer C. Motivational Interviewing in the Medical Care Setting. Patient Education Counseling . 2014; 96(1): 142. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24856448 Accessed on: 2015-09-29.

Wagner C, Conners W. Interaction techniques. Mid-Atlantic Addiction Technology Transfer Center. 2003c. Available at: http://www.ourdailybreadmissions.org/Philosophy%20of%20MI.htm Accessed on: 2005-08-22.

Wagner C, Conners W. Motivational interviewing principles. Motivational Interviewing Website. 2003b. Available at: http://www.ourdailybreadmissions.org/Philosophy%20of%20MI.htm Accessed on: 2005-08-22.

Waldron HB, Turner CW. Evidence-based psychosocial treatments for adolescent substance abuse. Journal of Clinical Child & Adolescent Psychology. 2008; 37: 238-261. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18444060 Accessed on: 2015-06-17.

Washington State Department of Health (WSDH). Substance abuse during pregnancy: guidelines for screening and management . Office of Healthy Communities . 2015. Available at: http://here.doh.wa.gov/materials/guidelines-substance-abuse-pregnancy Accessed on: 2015-07-24.

Weddle M, Kokotailo P. Adolescent substance abuse. Confidentiality and consent.. The Pediatric Clinics of North America. 2002; 49(2): 301-315. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11993284 Accessed on: 2013-10-24.

Weisleder P. The right of minors to confidentiality and informed consent. Journal of Child Neurology. 2004; 19(2): 145-148. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15072109 Accessed on: 2013-10-24.

Westar HA , Aviram A. Core Skills in Motivational Interviewing. Psychotherapy (Chic). 2013; 50(3): 273-8. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24000834 Accessed on: 2015-09-29.

Westra HA. Motivational interviewing in the treatment of anxiety . The Guilford Press. 2012. Available at: https://www.guilford.com/books/Motivational-Interviewing-in-the-Treatment-of-Anxiety/Henny-Westra/9781462525997 Accessed on: 2015-06-25.

WHO ASSIST Working Group. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction. 2002; 97: 1183-1194. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12199834 Accessed on: 2015-06-02.

Williams JF, Smith VC, Committee on Substance Abuse. Fetal Alcohol Spectrum Disorders. American Academy of Pediatrics. 2015; 136: 5: 1395-1406. Available at: http://pediatrics.aappublications.org/content/early/2015/10/13/peds.2015-3113 Accessed on: 2015-10-22.

Winzelberg A, Humphreys K. Should patients’ religiosity influence clinicians’ referral to 12-step self-help groups? Evidence from a study of 3,018 male substance abuse patients. J Consult Clin Psychol. 1999; 67(5): 790-4. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10535246 Accessed on: 2013-10-24.

World Health Organization. ASSIST V3.0. World Health Organization. 2004. Available at: http://www.who.int/substance_abuse/activities/assist_v3_english.pdfAccessed on: 2011-04-08.

World Health Organization. The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. . 2013. Available at: http://www.who.int/substance_abuse/terminology/ICD10ClinicalDiagnosis.pdf Accessed on: 2015-06-10.

Yudko E, Lozhkina O, Fouts A, et al. A comprehensive review of the psychometric properties of the drug abuse screening test. Journal of Substance Abuse Treatment. 2007; 32(2): 189-198. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17306727

Professional Practice Gaps

Chronic pain is common, affecting a substantial number of people. For example, the National Health Interview from 2016 found that approximately 18% of adults have pain most days or every day, as well as an estimated 42% of adults have pain some days, indicating a high need for pain management (CDC, 2017). Common musculoskeletal pain conditions, such as arthritis, back problems, or frequent and severe headaches, affect around 43% of U.S. adults (Tsang et al., 2008).

Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain to reduce risk of addiction, other substance misuse, and overdose were developed by the American Pain Society and the American Academy of Pain Medicine, based on an extensive review of the literature by a multidisciplinary panel (Chou et al., 2009). More recent evidence-based guidelines by the CDC on opioid prescribing were even stronger in a number of these recommendations, such as recommending urine drug testing at baseline and periodically during chronic opioid therapy as well as checking prescription drug monitoring data bases regularly (Dowell, et al., 2016).

An opioid misuse epidemic continues: 12.5 million Americans or 4.7% of the American population age twelve or older reported misuse of pain relievers in the past year, with misuse defined as meaning use other than as recommended by a doctor (Hughes et al., 2016). Of those people, only 63% said that their opioid misuse was to relieve pain. Another part of the problem is that the rate of overdose deaths is steadily increasing. In 2015, over 22,000 deaths involved prescription opioids, an increase from 19,000 in 2014, which is nearly a 16% increase (CDC, 2016).

Despite these problems and the guidelines which recommend only 3 day initial prescriptions when opioids are needed to manage pain, providers continue to prescribe opioids at a high rate, enough for a bottle for everyone in the U.S. per year (Dowell, et al., 2016). According to national surveys, physicians do not follow key elements of the plan recommended by evidence-based opioid prescribing guidelines including screening for risk of addiction/misuse, assessing substance misuse, communicating effectively about opioid use and risks, and reducing the risk of prescriptions drug overdose and persion (CASA, July 2005, p. 53, p. 54, p. 7; Adams, et al. 2001).

On the other hand, pain is not recognized or adequately treated in other instances, especially for members of racial and ethnic minority groups, women, elderly, people with cognitive impairment, cancer pain, and end of life pain (Dowell, et al., 2016). Chronic pain, especially when inadequately treated, diminishes the quality of life.

The need for education/skills training in order to be able to follow the guidelines in pain management and safe opioid prescribing is evident from national physician surveys (CASA, July 2005, pp. 6, 90-91; CASA, April 2000, p. ii; Morley-Forster, et al. 2003). Based on the overall results of their physician survey on the problem of drug persion, CASA concluded that physicians should receive more continuing medical education related to prescribing and administering controlled substances and identifying, diagnosing, and treating substance misuse and addiction (CASA, July 2005, p. 100).

Practice Gap References

Adams NJ, Plane MB, Fleming MF, et al. Opioids and the Treatment of Chronic Pain in a Primary Care Sample. J Pain Symptom Manage. 2001; 22: 791-796. Accessed on: 2015-09-21.

Califano, JA et al. Under the Counter: The persion 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-persion-abuse-controlled-perscription-drugs Accessed on: 2013-09-13.

CDC. Opioid Data Analysis. Centers for Disease Control and Prevention. 2016. Available at: https://www.cdc.gov/drugoverdose/data/analysis.html Accessed on: 2017-03-27.

Centers for Disease Control and Prevention. QuickStats: Age-Adjusted Percentage of Adults Aged ≥18 Years Who Were Never in Pain, in Pain Some Days, or in Pain Most Days or Every Day in the Past 6 Months, by Employment Status — National Health Interview Survey, United States, 2016. Morbidity and Mortality Weekly Report . 2017; 66: 796. Available at: https://www.cdc.gov/mmwr/volumes/66/wr/mm6629a8.htm?s_cid=mm6629a8_e Accessed on: 2017-08-01.

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

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 on: 2016-03-16.

Hughes A, Williams MR, Lipari RN, et al. Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health. SAMHSA. 2016. Available at: http://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm Accessed on: 2016-09-13.

Morley-Forster PK, Clark AJ, Speechley M, et al. Attitudes Toward Opioid Use for Chronic Pain: A Canadian Physician Survey. Pain Res Manage. 2003; 8: 189-94. Accessed on: 2015-09-21.

Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. J Pain. 2015; 16(8): . Available at: https://www.ncbi.nlm.nih.gov/pubmed/26028573 Accessed on: 2017-03-27.

The National Center on Addiction and Substance Abuse (CASA). Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse. The National Center on Addiction and Substance Abuse at Columbia University, Survey Research Laboratory. Chicago, IL: University of Illinois at Chicago. 2000. Available at: http://www.centeronaddiction.org/addiction-research/reports/national-survey-primary-care-physicians-patients-substance-abuse Accessed on: 2014-04-28.

Tsang A, Von Korf M, Lee S, et al. Common chronic pain conditions in developed and developing. J Pain. 2008; 9(10): 883-91. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18602869 Accessed on: 2017-03-27.

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