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medication-assisted treatment for substance use disorders

Clinical Challenges in Prescribing Controlled Drugs:
Prescribing Opioids for Chronic Pain

Purpose of the Courses

Each year, millions of patients are treated for a variety of serious medical conditions with prescription drugs whose therapeutic benefits are accompanied by psychoactive effects. This is particularly true of the management of chronic pain, which often involves potent opioid analgesics.

Recent indicators present troubling evidence that the misuse and abuse of prescription opioids is on the rise. Physicians and other health care professionals thus face the challenge of minimizing the potential for misuse of these important medications without impeding patients' access to needed medical care.

The CME courses described here provide specific knowledge and skills associated with safe prescribing of opioids for chronic pain. Course faculty and accompanying resource materials address practice management, legal and regulatory issues, opioid pharmacology, and clinical strategies for managing challenging patient situations.

Primary care physicians constitute the principal audience for the courses, although physician extenders such as independent nurse practitioners and physician assistants also are welcomed.

Educational Objectives

  • Identify clinical situations in which opioids are indicated and contraindicated for the treatment of chronic pain.
  • Select patients who are appropriate candidates for long-term therapy with opioids, including methadone.
  • Educate patients about methadone's unique pharmacologic properties, such as its long duration of action and absence of euphoric effect (lack of knowledge of these characteristics on the part of physicians and patients has contributed to inadvertent overdoses and fatalities).
  • Understand the difference between drug-induced dependence and addiction.
  • Follow a careful, evidence-based protocol for starting patients on long-term opioid therapy, whether from a drug-naive state or in transition from another analgesic.
  • Perform careful patient monitoring and take other appropriate steps to minimize the potential for opioid diversion, abuse, or addiction.

Continuing Medical Education Credits

This educational activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through joint sponsorship with the local host organizations and the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration.

Course sponsors must be accredited by the ACCME to provide continuing medical education for physicians. The local sponsor designates this educational activity for an appropriate number of Category 1 credit(s) in the Physician Recognition Program™ of the American Medical Association.

Typical Program

The course can be delivered in as little as 90 minutes or as much as six hours. At least three hours is recommended to allow adequate time for audience-faculty interaction. The following example is based on a presentation lasting four and half hours.

1:00 pm Introduction and overview of the program; statement of purpose
1:05 Common problems seen in patients who are prescribed opioids for persistent pain
1:35 Case presentation
1:50 Deciding whether or not to prescribe an opioid
2:40 pm Break
2:50 Steps to take if you decide to prescribe an opioid for the treatment of persistent pain
3:35 Steps to take if you decide NOT to prescribe an opioid for the treatment of persistent pain
4:05 Revisit the case
4:20 pm Break
4:30 The practical side of patient monitoring
4:50 When, why and how to stop prescribing opioids and manage the patient with another treatment approach
5:10 Revisit the case and closing Q&A
5:30 pm Adjournment

FY 2012 CME COURSES ON PRESCRIBING OPIOIDS FOR CHRONIC PAIN *

All courses are sponsored by local medical organizations and state agencies, with support from the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration.

Date:September 21, 2011
Site: Ft. Belvoir Army Medical Center, Virginia
Sponsor/Co-Sponsor: UCLA Medical Center, Dept. of Medicine and Dept. of Psychiatry (S); California Society of Addiction Medicine (CS) (attendance: 32 plus faculty)
Faculty: Ted Parran, Jr., MD, Tony Dekker, DO
CME Credits: 6.5
   
Date: September 27, 2011
Site: Waterbury, Connecticut
Sponsor/Co-Sponsor: CT State Medical Society (S); CT Chapter, American College of Physicians (CS); CT Dept. of Mental Health and Addiction Services (CS); CAB Health & Recovery Services (CS); CT Pain Society (CS) (attendance: 107 plus faculty)
Faculty: Ted Parran, Jr., MD, Dan Alford, MD, Steve Wyatt, DO
CME Credits: 6.5
   
Date: Intermittent dates
Site: Los Angeles, California
Sponsor/Co-Sponsor: UCLA Medical Center, Dept. of Emergency Medicine (Grand Rounds) (attendance: average 50 plus faculty)
Faculty: Karen Miotto, MD
CME Credits: 2.0
   
Date: January 17, 2012
Site: Fargo, Big Sky Conference(regional)
Sponsor/Co-Sponsor: North Dakota Academy of Family Physicians (S); for family physicians in North and South Dakota, Idaho and Montana (attendance: 175 plus faculty)
Faculty: Ted Parran, Jr., MD
CME Credits: 6.5
   
Date: March 31, 2012
Site: Asheville, North Carolina
Sponsor/Co-Sponsor: NC Governor's Institute on Alcohol and Substance Abuse (attendance: 83 plus faculty)
Faculty: James W. Finch, M.D., Mark Fuehrer, M.D.
CME Credits: 4.0
   
Date: June 2, 2012
Site: Austin, Texas
Sponsor/Co-Sponsor: Seton HealthCare Family (Seton Shoal Creek Hospital) (S); Univ. of Texas Southwestern Medical Center (CS); Texas Society of Addiction Medicine (CS)
Faculty: Ted Parran, Jr., MD, James W. Finch, MD, Jane C. Maxwell, PhD, Carlos Tirado, MD
Contact: Reenie Collins, Director of Community Outreach, Seton Shoal Creek Hospital, at 512-324-2063 or rhcollins@seton.org
CME Credits: 6.5
   
Date: July (date TBD)
Site: Martinsburg, West Virginia
Sponsor/Co-Sponsor: WV Medical Association (S); WV Board of Medical Licensure (CS)
Faculty: Ted Parran, Jr., MD, John Hopper, MD
CME Credits: 6.5
   
Date: July-August (date TBD)
Site: Bethesda, Maryland
Sponsor/Co-Sponsor: Uniform Services University of the Health Sciences (S)
Faculty: Ted Parran, MD, Dan Alford, MD, Tony Dekker, DO
CME Credits: 6.5
   
Date: August(date TBD)
Site: Portland metro area, Oregon (also marketed to Washington)
Sponsor/Co-Sponsor: Oregon University of Health Sciences (S); Oregon Medical Association (CS); perhaps Washington State Medical Society (CS)
Faculty: Ted Parran, MD, John Hopper, MD, Rick Ries, MD
CME Credits: 6.5
   
Date: September(date TBD)
Site: Lewisburg, West Virginia (with telemedicine broadcast to remote sites)
Sponsor/Co-Sponsor: WV School of Osteopathic Medicine (S); WV Board of Osteopathic Medical Licensure (CS)
Faculty: Ted Parran, Jr., MD, James W. Finch, MD, Steve Wyatt, DO
Contact: Jim Nemitz, Ph.D., Vice Dean for xxx, West Virginia School of Osteopathic Medicine, at 512-324-2063 or rhcollins@seton.org
CME Credits: 6.5
   
Date: Sept. 8, 2012
Site: Hyannis, Massachusetts
Sponsor/Co-Sponsor: Cape Cod Symposium on Addictive Disorders (S)
Faculty: Stephen Wyatt, DO
Contact: Dee McGraw, Director of Education, CCSAD, at 616-475-4210 or deemcgraw@ameritech.net
CME Credits: 4.0
   
Date: Available 24/7; no fee
Site: Accessible from anywhere in US on the Web
Sponsor/Co-Sponsor: Boston University School of Medicine (S); Massachusetts Board of Medical Licensure (CS) www.opioidprescribing.com
Faculty: Dan Alford, MD, John Renner, MD
CME Credits: 4 modules; 1 credit per module
   

_______________________________________________________________________________________________ * as of April 15, 2012; additional courses may be scheduled

For more information about these courses, contact:

  • Alina Salvatore, RPh, MS
    Public Health Advisor
    Division of Pharmacologic Therapies
    Center for Substance Abuse Treatment
    SAMHSA
    1 Choke Cherry Rd., Room No 2-1090
    Rockville, MD 20857
    (Overnight: 20850)
    alina.salvatore@samhsa.hhs.gov
    Phone: 240 276-2755
    Fax: 240 276-2710

Acknowledgements

Support for the development of the prescribing courses has been provided by JBS International, Inc., under contract 270-2003-0001-0006 with the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration. Kenneth Hoffman, M.D., M.P.H., and Jennifer Fan, Pharm.D., J.D., both of the Division of Pharmacologic Therapies of the Center for Substance Abuse Treatment, served as Government Project Officers. Robert Lubran, M.S., M.P.A., Director of the Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, provided valuable guidance, as did other experts within government agencies and private sector organizations.

Bonnie B. Wilford, M.S., Director of the Center for Health Services & Outcomes Research, serves as Project Director. Gail Jara is the Project's Education Coordinator. The following individuals made significant contributions to the development of this continuing medical education program, and their contributions are acknowledged with gratitude:

  • Edward C. Covington, M.D., Director, Chronic Pain Rehabilitation Program, Cleveland Clinic Foundation, Cleveland, Ohio
  • Scott Fishman, M.D., Professor and Chief, Division of Pain Medicine, Department of Anesthesia and Pain Medicine, University of California/Davis School of Medicine
  • G. Douglas Gourlay, M.D., FASAM, Wasser Pain Management Centre, Toronto, Ontario, Canada
  • William L. Harp, M.D., Executive Director, Virginia Board of Medicine, Richmond, VA
  • Margaret K. Kotz, D.O., Director, Addiction Recovery Services, Department of Psychiatry, and Associate Professor, Case Western Reserve University School of Medicine, Cleveland, OH
  • Joyce Lowinson, M.D., Professor Emerita, New York University School of Medicine, New York City, and Executive Director, International Society for Pain and Chemical Dependency
  • William Marcus, J.D., Assistant Attorney General for the State of California (retired), Los Angeles, CA
  • Judith Martin, M.D., East Bay Recovery Project and the 14th Street Clinic, Oakland, CA
  • Robert Morrow, M.D., Montefiore Medical Center, New York, NY
  • Michael H. Moskowitz, M.D., Assistant Professor, Department of Anesthesia and Pain Medicine, University of California/Davis School of Medicine, Davis, CA
  • Theodore V. Parran, Jr., M.D., Associate Clinical Professor, Case Western Reserve University School of Medicine, Cleveland, OH
  • Norman Wetterau, M.D., FAAFP, FASAM, Tricounty Family Medicine, Danville, NY, and the New York State Academy of Family Physicians

Appreciation also is expressed to Lisa Robin of the Federation of State Medical Boards for assistance in providing educational resources.

Disclaimer

The views expressed in this course and related materials do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
 
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