Treating and Managing Patients with Opioid and Other Substance Use Disorders Certificate Program

 Summary

This module will introduce the learner to the management of chronic pain with opioid therapy including utilizing various screening tools, prescribing of opioids using evidence-based guidelines, and monitoring for safety and efficacy of treatment regimens while mitigating risk and preventing substance misuse or abuse.

 Module Objectives

Upon completion of this module, you should be able to:

1. Outline recommendations from evidence-based practice guidelines for opioid management for healthcare providers.
2. List components of risk mitigation strategies in the practice of chronic pain management with specific focus on prescription drug monitoring programs, opioid risk assessment tools, and urinary drug screening tests.
3. Recommend appropriate treatment options and monitoring strategies with opioids in chronic pain management including the use of medication for the prevention of substance abuse overdose.

To Do

1. Watch Lectures 1.1-1.6
2. Complete the Module 1 Quiz

Slides

• Lecture 1.1: Risk Mitigation in Chronic Pain Management (1-52)
• Lecture 1.2: Treatment Strategies with Opioids in Chronic Pain Management (53-102)
• Lecture 1.3: Introduction to Opioid Equianalgesic Dosing in Chronic Pain Management (103-134)
• Lecture 1.4: Opioid Monitoring and Managing Common Side Effects (135-170)
• Lecture 1.5: Personalized Medicine in Pain Management (171-198)
• Lecture 1.6: Medical Marijuana and Chronic Pain Management (199-232)

Speakers

Robin M Li Pharm.D., BCACP, NBC-HWC

 Lecture Objectives

Upon completion of this lecture, you should be able to:

1. Outline the 12 recommendations of the CDC Opioid Guidelines and explain which providers these guidelines pertain to and why.
2. List the documentation and evaluation components required by the Florida State Opioid Prescribing Policy.
3. Describe the Pharmacist Corresponding Responsibility in regards to controlled substances.
4. Summarize the main points of House Bill 21 including the following:
   • Opioid Prescribing limits for CII for Acute Pain and what must occur for an acute pain exemption.
   • What must be included on CII prescription for chronic pain management.
   • Mandatory use of PDMP (Eforcse for all prescribing and dispensing of controlled substances).
   • Mandatory CE for all CS prescribers.
5. List components of risk mitigation recommended in the practice of chronic pain management with specific focus on EForcse, UDT, and Opioid Risk Assessment Tools.
6. Explain the components and benefits of a treatment agreement/informed consent and demonstrate proper educational techniques when administering to the patient.
7. Demonstrate proper education techniques when requesting urine drug screens from patients in a clinical practice.
8. Evaluate results of urine drug screen examples to determine if they are appropriate.
9. Describe the interaction between opioids and benzodiazepines and provide appropriate counseling points on this topic to patients.
10. Explain the MOA, available devices, candidates, and education points associated with naloxone.

Presentation

Please allow up to 30 seconds for the video to load.

Speakers

Robin M Li Pharm.D., BCACP, NBC-HWC

 Lecture Objectives

Upon completion of this lecture, you should be able to:

1. Identify if a patient has been appropriately screened based on the VA/DoD Clinical Practice Guidelines for consideration for opioid therapy.
2. Summarize the basics of opioids including brand names, origin, receptor binding, and chemical classification.
3. Identify what opioids have a lower risk of cross-sensitivity in a patient who reports a confirmed allergy to codeine.
4. Explain the general drug interaction and renal impairment considerations for commonly used opioids in chronic pain management.
   
5. Define opioid tolerance and identify patients who are considered opioid tolerant based on current opioid therapy.
   
6. Explain what the REMS program is and how REMS impacts pain management clinical practice.
   
7. List the clinical pearls and dosing, and contraindications of selected opioids used in chronic pain.
   
8. Provide the brand name for specific highlighted opioids commonly used in chronic pain management.
   
9. Outline the details surrounding Xtampza including indication, administration guidance in patients unable to swallow.
   
10. Compare and contrast tramadol and tapentadol based on MOA, metabolism, analgesic activity, and guidance based on renal and hepatic impairment.
    
11. Explain why buprenorphine is unique based on MOA, side effects, and rational behind microdose inductions.
    
12. Explain the unique pharmacokinetic and pharmacodynamics characteristics of methadone including the effects of enzyme inhibitors and enzyme inducers.
    
13. List patients who are good candidates for methadone candidates and provide explanation for why certain patients are not good candidates for methadone therapy.
    
14. Provide the ECG recommendations for methadone based on 2017 VA Methadone recommendations.
    
15. Provide initial methadone dosing recommendations for opioid naïve patients and recommended proper dose titrations and main counseling points
    
16. Outline counseling points for a patient who has been given an initial prescription for transdermal fentanyl including the timeline to reach steady state concentrations.
    
17. Justify the final opioid selection when considering an opioid in a given case.

Pain Management Using the SBIRT Model

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Presentation

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Speakers

Robin M Li Pharm.D., BCACP, NBC-HWC

 Lecture Objectives

Upon completion of this lecture, you should be able to:

1. Explain why opioid conversions are completed in clinical practice.
   
2. List concerns associated with equianalgesic tables and opioid conversions.
   
3. List important data you must gather prior to completing opioid conversions and explain the importance behind this data.
   
4. Calculate the MME of a given opioid regimen and recommend multiple opioid options that can be considered in a given case.
   
5. List the 5 step process to complete an opioid conversion.
   
6. List important patient education points on opioid conversions.
   
7. Explain how breakthrough pain dosing is determined and list important education points regarding proper use of breakthrough pain medications.
   
8. Provide proper monitoring parameters that should be implemented during an opioid conversion process.

Presentation

Please allow up to 30 seconds for the video to load.

Speakers

Robin M Li Pharm.D., BCACP, NBC-HWC

 Lecture Objectives

Upon completion of this lecture, you should be able to:

1. List the monitoring parameters that should be listed when a patient is treated with an opioid and list examples of aberrant drug behavior.
   
2. Provide the most common side effects seen in opioid therapy.
   
3. Explain the proper monitoring parameters for assessing constipation complaints including components of the Rome IV OIC definition and AGA definition of laxative refractory OIC.
   
4. Recommend the appropriate bowel regimen for opioid induced constipation in given cases.
   
5. List the 3 PAMORAs used in OIC and summarize any serious drug-drug interaction concerns.
   
6. State the brand names of each of the targeted opioid antagonists and general class.
   
7. Recall which of the targeted opioid antagonists are suggested by the most recent AGA guidelines for OIC.
   
8. Define Opioid Induced Hyperalgesia.
   
9. Differentiate the responses reported by patients experiencing OIH vs. opioid tolerance when an opioid dose is increased.
   
10. List possible treatment options if OIH is suspected.
    
11. Explain the typical timeline for opioid withdrawal.
    
12. List common symptoms of opioid withdrawal.
    
13. List various reasons why an opioid taper is indicated.
    
14. Define opioid tapering and describe suggested tapering methods/suggestions that are currently used in clinical practice.
    
15. Formulate a general education outline and identify target factors which will be important for the patient during the tapering process.

Presentation

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Speakers

Larisa Cavallari Pharm.D.

 Lecture Objectives

Upon completion of this lecture, you should be able to:

1. Describe how genotypes impact variability in opioid response and influence NSAID exposure.
   
2. Discuss the activity score method to assign CYP2D6 and CYP2C9 phenotypes based on genotype.
   
3. Describe importance of considering use of CYP2D6 inhibitors when assigning CYP2D6 phenotype.
   
4. Summarize CPIC recommendations for opioid and NSAID prescribing.

Presentation

Please allow up to 30 seconds for the video to load.

Speakers

Robin M Li Pharm.D., BCACP, NBC-HWC

 Lecture Objectives

Upon completion of this lecture, you should be able to:

1. List the location and effects of the CB1 and CB2 Receptors.
2. Compare and contrast the clinically relevant properties and effects seen between THC and CBD.
   
3. Explain the different between marijuana and hemp.
   
4. List the commercially available products including the synthetic THC products and plant derived cannabinoids for medical use and indicate approved uses.
   
5. List patients who are NOT proper candidate for medical marijuana based on consensus recommendations.
   
6. Provide recommended initial dosing and titration of CBD and THC products based on current guidelines discussed in lecture.
   
7. Discuss the required steps for obtaining a medical marijuana card in Florida including qualified indications and expected cost of obtaining the card.
   
8. Counsel patients on routes of administration and duration of action of available formulations of medical marijuana.
   
9. Outline the common effects associated with Sativa and Indica and indicate the proper administration time for each chemovar (strain).
   
10. Summarize possible drug interactions and adverse effects that could be clinically relevant with THC and CBD.
    
11. Provide the average detection window for THC in standard urine drug testing based on typical use pattern.
    
12. Provide proper counseling to a patient regarding concerns of completing a UDS when using a CBD product.

Presentation

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After reviewing Module 1, complete the assessment. You must pass the assessment with a 70% or higher to receive credit for this course. This assessment consists of 22 multiple choice questions and is untimed. Questions are displayed one at time, you will not be able to review or change previous answers. Once you begin the assessment, you must complete it in one sitting. You will have three attempts to pass the assessment.

 Summary

This module will introduce the learner to the assessment and management of acute pain. Part 1 will focus on acute non-surgical pain. Part 2 will focus on acute surgical pain and patient controlled analgesia. Additionally, the selection of drug therapy and recommend appropriate efficacy and safety monitoring for opioid and non-opioid therapies used in the management of acute non-surgical and surgical pain will be covered.

 Module Objectives

Upon completion of this module, you should be able to:

1. Explain key differences between acute and chronic pain.
   
2. Identify the types of pain based on a patient’s reports of symptoms.
   
3. Explain the importance of proper assessment in pain management.
   
4. Identify the consequences of untreated pain.
   
5. Explain the concept of multimodal therapy for acute pain.
   
6. List the common therapies used for acute pain.
   
7. Recommend treatment and monitoring plans for patients with varying severities of acute non-surgical pain.
   
8. Describe the monitoring process for acute pain therapies.
   
9. Identify concerns associated with procedural pain control.
   
10. Describe the process of using a PCA in acute pain.

To Do

1. Watch Lectures 2.1-2.2
2. Complete the Module 2 Quiz

Slides

• Lecture 2.1: Acute Pain Management for the Consultant Pharmacist Part 1 - Introduction, assessment, and management of non-surgical pain (1-55)
• Lecture 2.2: Acute Pain Management for the Consultant Pharmacist Part 2 - Management of surgical pain and patient controlled analgesia (PCA) (56-103)

Speakers

Adonice Khoury Pharm.D.

 Lecture Objectives

Upon completion of this lecture, you should be able to:

1. Explain key differences between acute and chronic pain.
   
2. Identify the types of pain based on a patient’s reports of symptoms.
   
3. Explain the importance of proper assessment in pain management.
   
4. Identify the consequences of untreated pain.
   
5. Explain the concept of multimodal therapy for acute pain.
   
6. List the common therapies used for acute pain.
   
7. Recommend treatment and monitoring plans for patients with varying severities of acute non-surgical pain.

Presentation

Please allow up to 30 seconds for the video to load.

Speakers

Adonice Khoury Pharm.D.

 Lecture Objectives

Upon completion of this lecture, you should be able to:

1. List and compare the common multi-modal therapies used in the management of acute peri-operative pain.
   
2. Describe the monitoring process for acute pain therapies.
   
3. Identify concerns associated with procedural pain control.
   
4. Describe the process of using Patient Controlled Analgesia (PCA) in acute pain.

Presentation

Please allow up to 30 seconds for the video to load.

After reviewing Module 2, complete the assessment. You must pass the assessment with a 70% or higher to receive credit for this course. This assessment consists of 30 multiple choice questions and is untimed. Questions are displayed one at time, you will not be able to review or change previous answers. Once you begin the assessment, you must complete it in one sitting. You will have three attempts to pass the assessment.

 Summary

This module will review the CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022.

 Module Objectives

Upon completion of this module, you should be able to:

1. Review the CDC guidelines for prescribing opioids for pain.

To Do

1. Review the Required Reading
2. Complete the Module 3 Quiz

Authors

Deborah Dowell, MD¹; Kathleen R. Ragan, MSPH¹; Christopher M. Jones, PharmD, DrPH²; Grant T. Baldwin, PhD¹; Roger Chou, MD³

Author Affiliations: ¹Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC; ²Office of the Director, National Center for Injury Prevention and Control, CDC; ³Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon

Reading

CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022

After reviewing the required reading, complete the assessment. You must pass the assessment with a 70% or higher to receive credit for this course. This assessment consists of 5 multiple choice questions and is untimed. Questions are displayed one at time, you will not be able to review or change previous answers. Once you begin the assessment, you must complete it in one sitting. You will have three attempts to pass the assessment.