Clinical Resources

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Academy of Managed Care Pharmacy (AMCP)
American Academy of Family Physicians (AAFP)
American Association for the Treatment of Opioid Use Disorder, Inc. (AATOD)
American Chronic Pain Association (ACPA)
American Chronic Pain Association (ACPA) Resource Guide to Chronic Pain Medication and Treatment (2013 Edition)
American Congress of Obstetricians and Gynecologists (ACOG) and American Society of Addiction Medicine (ASAM)
An Opioid Screening Instrument: Long-Term Evaluation of the Utility of the Pain Medication Questionnaire
Annals of Internal Medicine: Federal Plan for Prescriber Education on Opioids Misses Opportunities
Attention Prescribers: FDA seeks your help in curtailing the U.S. opioid epidemic
Brochure: The Facts About Naltrexone

The Subtance Abuse and Mental Health Services Administration (SAMHSA) released this brochure for physicians to give to patients being treated for opioid use disorder with Naltrexone.

Case: Opioid Agonist Treatment Considerations in HIV-Infected and HIV/HCV-Coinfected Patients

GO TO CASE

Presenters: Jeanette M. Tetrault, MD, FACP; David A. Fiellin, MD

Case Description: Opioid use disorder is a chronic, relapsing medical disorder with available and effective treatment options. Opioid agonist treatment combined with counseling is the most effective therapy, and newer medications have revolutionized the treatment landscape for this disorder. This Cases on the Web (COW) activity reviews considerations for the initiation and maintenance of opioid agonist treatment in patients with HIV infection or HIV/hepatitis C virus (HCV) coinfection.

On completion of this activity, participants will be able to:

 Assess patients with HIV infection or HIV/HCV coinfection for the presence and severity of opioid use disorder
 Counsel patients on appropriate treatment options for opioid use disorder, focusing on opioid agonist treatments
 Describe potential drug interactions and monitoring parameters for patients receiving pharmacologic treatments for opioid use disorder, HIV infection, or HCV infection
Visit www.iasusa.org/content/opioid-agonist-treatment-considerations-hiv-infected-and-hivhcv-coinfected-patients to start learning from this new COW activity now!

CONTINUING EDUCATION CREDITS

CME Credits
The International Antiviral Society–USA (IAS–USA) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The IAS–USA designates this live activity for a maximum of 1.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This CME activity is offered from October 21, 2015, to October 21, 2016. Physicians (MDs, DOs, and international equivalents) who successfully complete the activity posttest and submit the evaluation and registration forms are eligible to receive CME credit. Other health care practitioners will receive a Certificate of Participation.

Nursing Credits
Educational Review Systems is an approved approver of continuing nursing education by the Alabama State Nursing Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Provider # 5-115. This program is approved for 1.5 hours of continuing nursing education.
Educational Review Systems is also approved for nursing continuing education by the state of California, the state of Florida and the District of Columbia.
Program expires 10/9/2017.

Pharmacy Credits
Educational Review Systems is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program is approved for 1.5 hours (0.15 CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the posttest. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit.
UAN # 0761-9999-15-283-H02-P
Program expires 10/9/2017.

2015 GRANT SUPPORT
This activity is part of the IAS–USA national educational effort that is funded, in part, by charitable contributions from commercial companies. Per IAS–USA policy, any effort that uses commercial grants must receive grants from several companies with competing products. Funds are pooled and distributed to activities at the sole discretion of the IAS–USA. Grantors have no input into any activity, including its content, development, or selection of topics or speakers. Generous support for this activity has been received from the following contributors:

For our HIV effort:
Platinum Supporters
Gilead Sciences, Inc
ViiV Healthcare
Gold Supporters
Bristol-Myers Squibb
Janssen Therapeutics
Merck & Co, Inc
Additional support for select activity types in this national program is provided by:
AbbVie
For our viral hepatitis effort:
Gold Supporters
AbbVie
Bristol-Myers Squibb
Gilead Sciences, Inc
Silver Supporter
Merck & Co, Inc

CDC Opioid Prescribing Guidelines

View guidelines.

Fact sheet.

Podcast: Listen to the podcast now! (iTunes account required)
No iTunes account? You can also listen to the podcast here and on Youtube.

Centers for Medicare & Medicaid Services (CMS) Opioid Misuse Strategy 2016
Checklist for prescribing opioids for chronic pain

Click the link below to see the CDC’s checklist for prescribing opioids for chronic pain: cdc_38025_DS1

Childbirth, Breastfeeding and Infant Care: Methadone and Buprenorphine

Childbirth, Breastfeeding and Infant Care: Methadone and Buprenorphine provides guidance for patients on opiate agonist treatment on what to expect during labor and delivery, postpartum, and breast feeding. It was developed by experts in the treatment of pregnant women with opioid dependence.  Please feel free to print out and share with patients. View Brochure.

 

Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain
CN Opioid Guidelines
College of Psychiatric and Neurologic Pharmcists
Common Elements in Guidelines for Prescribing Opioids for Chronic Pain

CDC document outlining common recommendations from a variety of sources, including the American Pain Society, Veterans Affairs, Canadian Guidelines on Prescribing Opioids for Treatment of Pain, and others. Access document here.

Counseling Patients on Side Effects and Driving When Starting Opioids
Decisions in Recovery: Treatment for Opioid Use Disorder
Drug Interactions of Clinical Importance with Methadone and Buprenorphine
Drug–Drug Interactions In Opioid Therapy A Focus On Buprenorphine & Methadone
Drug–drug Interactions in Opioid Therapy: A Focus on Buprenorphine & Methadone
Note:Also available as a phone app
Educating Drug Courts on Medication Assisted Treatment

The National Drug Court Institute, with funding from the Office of National Drug Control Policy of the White House,
in collaboration with the American Academy of Addiction Psychiatry, has developed an online training curriculum
designed to educate drug court professionals on medication assisted treatment for substance use disorders, with a
major focus on opioid use disorders. Nine modules were developed and are available on in the National Drug Court Research Center. 

FDA News Release: FDA Introduces New Safety Measures for Extended-release and Long-acting Opioid Medications
HealthCare Chaplaincy Network

More Resources

A nonprofit healthcare organization that helps people faced with the distress of illness and suffering to find comfort and meaning.

Help and Healing: Resources for Depression Care and Recovery

Part of integrating primary and behavioral health care is learning how to talk about health conditions in a holistic way. Sample scripts can help guide providers and patients alike in making communication seamless – from addressing specific health topics to explaining what integrated care is and keeping team members informed. View resource.

How to Dispose of Unused Medicines
How to Prevent Opioid Overdose and Overdose-Related Death
Important Information for those who Prescribe Long-Acting Opiates

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A Risk Evaluation and Mitigation Strategy (REMS) is a strategy to manage known or potential serious risks associated with a drug product and is required by the Food and Drug Administration (FDA) to ensure that the benefits of a drug outweigh its risks. The FDA has required a REMS for extended-release and long-acting (ER/LA) opioid analgesics.

Under the conditions specified in this REMS, prescribers of ER/LA opioid analgesics are strongly encouraged to do all of the following:

  • Train (Educate Yourself)
  • Counsel Your Patients
  • Emphasize Patient and Caregiver Understanding of the Medication Guide
  • Consider Using Other Tools

More

Indicators of Buprenorphine and Methadone Use and Abuse: What Do We Know?
Integration of Buprenorphine into HIV Primary Care Settings
International Prevention
Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders
Mayo Clinic
Medication-Assisted Treatment: The best therapy for opioid use disorder video

Video created by The Pew Charitable Trusts.

Medscape News: Understanding Opioids: Part 2
Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain July 2013
Motivational Interviewing: Informative Links

1.)  Introduction to Motivational Interviewing – Bill Matulich, PhD

In this slide presentation, Dr. Matulich talks about the basic concepts of Motivational Interviewing (MI). After a brief definition, topics include: the Spirit of MI, the four basic OARS skills, and the “processes” of MI.

2.)  Motivational Interviewing: Brief Explanation

3.)  Core Clinician Skills: Introducing OARS – National Heart Foundation of Australia

  • Develop an understanding of the fundamental spirit and principles of motivational interviewing.
  • Gain up-to-date information regarding the research and evidence of motivational interviewing.
  • Develop an understanding of empathic counselling skills, central to using the technique.
  • Learn when and how to use advice and other more directive elements of motivational interviewing.
  • Observe elements of motivational interviewing, including how motivational interviewing can be used to roll with resistance, resolve ambivalence , encourage change and commitment talk, and help people carry through changes to health behaviors.

4.)  Motivational Interviewing – TheIRETAchannel 

Alan Lyme, LCSW, ICADC, ICCS, MINT, is the Clinical Supervisor for the Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant program at the Medical Center of Central Georgia. Mr. Lyme has provided trainings nationally on Motivational Interviewing, clinical supervision, and skills on working with men. He is a MINT (Motivational Interviewing Network of Trainers) recognized MI trainer, an Internationally Certified Clinical Supervisor, and an Internationally Certified Alcohol and Drug Counselor.

5.)  Motivational Interviewing: Facilitating Change Across Boundaries – Teachers College, Columbia University with William R. Miller, PhD 

6.)  Motivational Interviewing: Brief Therapy for Addictions – PsychotherapyNet with William R. Miller, PhD

MI founder William Miller talks about how Motivational Interviewing helps people resolve their ambivalence about changing addictive behaviors. Watch the full video here.

7.)  Increasing Importance in Motivational Interviewing – PsychotherapyNet with Cathy Cole, LCSW

Learn how Motivation Interviewing is applied to working with addictions in this video with Motivational Interviewing expert and trainer Cathy Cole, LCSW. Watch the full video here.

8.)  Substance Abuse (Marijuana): Motivational Interviewing OARS Skills Case Presentation

This video role-play is part of an online training for which EUs are available for re-credentialing CASACs and members of NASW. You can register for the training at the www.bestpracticetrainers.org website. In the role-play, the therapist is using Motivational Interviewing OARS skills with a client who is using marijuana.

National Center for Complementary and Alternative Medicine (NCCAM)
National Institute on Drug Abuse (NIDA)

More Resources

  • Community Epidemiology Workgroup (CEWG) : Regional Trends in Substance Abuse
  • Mental and Health Professionals
  • ATTC and NIDA Motivational Interviewing: This conference took place on July 13, 2012 in the Baltimore-Washington Metro area. It was sponsored by the Central East Addiction Technology Transfer Center (a program of the Danya Institute), and the Mid-Atlantic Node Clinical Trials Network. It featured presentations on the Blending Products which are a collaborative effort of the The National Drug Abuse Treatment Clinical Trials Network and the National Institute of Drug Abuse/Substance Abuse and Mental Health Services Administrations Blending Initiative to disseminate treatment and training products based on results conducted by the NIDA Clinical Trials Network. See below for the recordings taken from the meeting.

Part 1: Using the ATTC/NIDA Blending Products to Affect Change
Maxine Stitzer, PhD, principal investigator of the Mid-Atlantic Node, explains the mission of the Clinical Trials Network to disseminate research-based drug abuse treatment into clinical practice. Dr. Stitzer shares with the audience how clinicians, scientists, and experienced trainers who are part of this NIDA/SAMSHA blending initiative have worked to create user-friendly treatment tools and products to facilitate evidence-based practices in front-line clinical settings.

Part 2: Using the ATTC/NIDA Blending Products to Affect Change
Christine Higgins, MA, Dissemination Specialist for the Mid-Atlantic Node of the Clinical Trials Network provides an overview of the NIDA Blending Products.

Part 3: Using the ATTC/NIDA Blending Products to Affect Change – MIA:Step
Christine Higgins, MA, Dissemination Specialist for the Mid-Atlantic Node of the Clinical Trials Network provides an introduction to MIA:Step (Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency).

Part 4: Using the ATTC/NIDA Blending Products to Affect Change
Pat Stabile, Director of HARBEL in Baltimore City speaks about the positive aspects of Clinical Trials Network studies conducted at her site. She explains how challenging it can be at times when researchers and clinicians might have different objectives and different language, but the overarching common goal to improve substance use disorder treatment makes such collaboration worth the effort.

Part 5: Using the ATTC/NIDA Blending Products to Affect Change – PAMI by Melissa Wesner

Part 6: Using the ATTC/NIDA Blending Products to Affect Change – MI:Presto
Lori Peterson, Program Director of the Lane Treatment Center presents an Overview of MI:Presto (Motivational Incentives: Positive Reinforcers to Enhance Successful Treatment Outcomes).

Part 7: Using the ATTC/NIDA Blending Products to Affect Change
Amy Pearce, LCSW-C, Clinical Director of Glenwood Life present “The Perspective from the Clinical Side.”

National Institutes of Health (NIH)

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11 Tips for Better Opioid Prescribing

Editor’s Note: As part of its effort to facilitate responsible opioid prescribing, the American Academy of Addiction Psychiatry (AAAP) hosts a listserv where clinicians can submit clinical questions and receive responses from a rotating panel of pain experts. In conjunction with the AAAP, Medscape has selected 10 of the most common questions or topics related to opioid use that have been submitted, and asked Charles E. Argoff, MD, Director of the Comprehensive Pain Management Center at Albany Medical Center, and Roger Chou, MD, Professor of Medicine and Medical Informatics & Clinical Epidemiology at Oregon Health & Science University in Portland, to provide responses. For additional resources on appropriate opioid prescribing and opioid addiction treatment, please see the AAAP’s PCSS-O and PCSS-MAT programs, which provide guidance on the safe and effective use of opioid medications and on the treatment of opioid addiction.

To access the complete article, please click here.*

*A Medscape account is required to view this article. If you do not have a Medscape account, you can create one for free.

Neonatal Abstinence Syndrome Resources
The National Center on Substance Abuse and Child Welfare (NCSACW) is highlighting resources on best practices in the treatment of opioid use disorders and Neonatal Abstinence Syndrome. NCSACW is a national resource center providing information, expert consultation, training and technical assistance to child welfare, dependency court, and substance abuse treatment professionals to improve the safety, permanency, well-being, and recovery outcomes for children, parents, and families.
New England Journal of Medicine

More Resources

  • Tackling the Opioid-Overdose Epidemic: In response to the opioid overdose epidemic, medication assisted therapies are available to clinicians for patients with opioid addiction, but research has found that they are significantly underutilized. Read the New England Journal of Medicine article.
New Hampshire Medical Society Opioid Prescribing Resource
Office of National Drug Control Policy (ONDCP) Announcement to Medical Community
Opioid Prescribing: Safe Practice, Changing Lives

This CME activity from Medscape Education Neurology & Neurosurgery is intended for neurologists, primary care physicians, other physicians, nurses (including advanced practice nurses), physician assistants, pharmacists, dentists, podiatrists, optometrists and other clinicians who may be involved in the treatment of patients who are receiving opioid therapy.

The goal of this activity is to provide education on the safe use of extended-release, long-acting opioid analgesics.

Upon completion of this activity, participants will be able to:

  1. Describe appropriate patient assessment for treatment with ER/LA opioid analgesics
  2. Evaluate the risks and potential benefits of ER/LA opioid analgesics
  3. Summarize the key components of safe use of ER/LA opioid analgesics
  4. Demonstrate accurate knowledge about how to initiate and manage therapy with ER/LA opioid analgesics, including appropriate monitoring for adverse effects and possible misuse

Continue to activity.

Opioid Risk Tool

The Opioid Risk Tool (ORT) is a brief, self-report screening tool designed for use with adult patients in primary care settings to assess risk for opioid abuse among individuals prescribed opioids for treatment of chronic pain. Patients categorized as high-risk are at increased likelihood of future abusive drug-related behavior. The ORT can be administered and scored in
less than 1 minute and has been validated in both male and female patients, but not in non-pain populations. Access Opioid Risk Tool.

Also of interest is this study:

Predicting Aberrant Behaviors in Opioid-Treated Patients: Preliminary Validation of the Opioid Risk Tool

Opioid-Use Treatment

From the New England Journal of Medicine: A primer on treating opioid use disorder. Read article.

Physicians for Responsible Opioid Prescribing (PROP)
Pregnancy: Methadone and Buprenorphine

Pregnancy: Methadone and Buprenorphine provides a brief explanation on the treatment of opioid dependence during pregnancy. It is intended for patient education and was developed by experts in the treatment of pregnant women with opioid dependence. Please feel free to print out and share with patients. View Brochure .

Prescription Painkiller Overdoses: Use and Abuse of Methadone as a Painkiller
Primer on Antagonist-Based Treatment of Opioid Use Disorder in the Office Setting

This training was originally presented by Adam Bisaga, MD, during the American Academy of Addiction Psychiatry 26th Annual Meeting in 2015. View training.

Publications: Complementary and Alternative Medicine

Resources

  • Jordan JB (2006) Acupuncture for the treatment of opiate addiction: a systematic review.  Journal of Substance Abuse Treatment30: 309-314
  • Khanna S and Greeson JM (2013) A narrative review of yoga and mindfulness as complementary therapies for addiction. Complementary Therapies in Medicine21: 244-252.
  • Lin J-G, Chan Y-Y and Chen Y-H (2012) Acupuncture for the treatment of opiate addiction. Evidence-Based Complementary and Alternative Medicine2012: 1-10.
  • Lu L, Zhu W, Shi J, Liu Y, Ling W, Kosten TR (2009) Traditional medicine in the treatment of drug addiction. The American Journal of Drug and Alcohol Abuse35: 1-11.
  • Meade CS, Lukas SE, McDonald LJ, et al. (2010) A randomized trial of transcutaneous electric acupoint stimulation as adjunctive treatment for opioid detoxification. Journal of Substance Abuse Treatment38: 12–21.
QT Interval Screening in Methadone Maintenance Treatment: Report of a SAMHSA Expert Panel
QTc Interval Screening in Methadone Treatment
Questions and Answers: FDA approves a Risk Evaluation and Mitigation Strategy (REMS) for Extended-Release and Long-Acting (ER/LA) Opioid Analgesics
r-Methadone Versus Racemic Methadone: What is Best for Patient Care?
Resources on Narcan Prevention Kits
Substance Abuse and Mental Health Services Administration (SAMHSA)

More Resources

OPIOID USE DISORDER RESOURCES

  • Opioid Treatment Program Locator
  • Opioid Overdose Toolkit: Equips communities and local governments with material to develop policies and practices to help prevent opioid-related overdoses and deaths. Addresses issues for first responders, treatment providers, and those recovering from opioid overdose.

BUPRENORPHINE RESOURCES

NALTREXONE RESOURCES

SAMHSA Report: Clinical Advances in Non-Agonist Therapies: in an effort to continue the exploration of treatment options for people with OUD, SAMHSA/CSAT, in partnership with NIDA, held a Clinical Advances in Non-Agonist Therapies Meeting at the SAMHSA headquarters on May 11, 2016. This report is the result of that meeting.

SBIRT RESOURCES

ADDITIONAL RESOURCES

The American Society of Addiction Medicine (ASAM): Advancing Access to Addiction Medications
The Joint Commission Sentinel Event Alert: Safe Use of Opioids in Hospitals
The Joint Commission: Sentinel Event Alert
The Mental Health & Substance Use Disorder Parity Task Force – Final Report
The Opiate Epidemic – Free Access Article Collection
The Power of Language and Portrayals: What We Hear, What We See

“SAMHSA’s Center for Substance Abuse Treatment is producing a webcast series, The Power of Language and Portrayals: What We Hear, What We See, to help change the way we talk about and portray substance use in news and entertainment.” Read more.

TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction
TIP 53: Addressing Viral hepatitis in People with Substance Use Disorders
TIP 54 Managing Chronic Pain in Adults with or in Recovery From Substance Use Disorders
Transforming Opioid Prescribing in Primary Care (TOPCARE)

More Resources

A team of researchers at Boston Medical Center who propose a novel system change in delivery of primary care services to decrease misuse of and addiction to prescription opioids for patients with chronic pain. Includes many useful resources.
Turn the Tide Website

U.S. Surgeon General created this website as a resource for healthcare providers who prescribe opioids.

United States Office of the Surgeon General

Surgeon General launches national initiative to improve opioid prescribing, including new website. United States Office of the Surgeon General ›

VA Releases Video Tutorials on Naloxone

The VA has released a series of tutorials on Naloxone, a highly effective treatment for reversing an opioid overdose if it is administered at the time of overdose.

  • The first video demonstrates how to train people on how to use VA Auto-Injector Naloxone Kits.
  • The second video demonstrates how to train people on how to use VA Intranasal Naloxone Kits.
  • The third video demonstrates how to train people on how to use VA Intramuscular Naloxone Kits.
VA/DoD Practice Guidelines for Management of Substance Use Disorder

The guideline describes the critical decision points in the Management of Substance Use Disorder and provides clear and comprehensive evidence based recommendations incorporating current information and practices for practitioners throughout the DoD and VA Health Care systems. The guideline is intended to improve patient outcomes and local management of patients with substance use disorder.

Disclaimer:This Clinical Practice Guideline is intended for use only as a tool to assist a clinician/healthcare professional and should not be used to replace clinical judgment.

View guidelines.

Veterans With PTSD at Increased Risk for Receiving, Abusing Opioids, Study Finds
Webinar: Innovative Practices in Medication Assisted Treatment and Primary Care Coordination

The ONDCP hosted a webinar on MAT and Primary Care Coordination. The webinar showcased two approaches to care in which Medication Assisted Treatment is provided and care for individuals with substance use disorders is integrated with regular medical care. Watch video.

Youth Opioid Addiction: a Part of Your Practice, so What Should You Know?

Plenary Session: Sunday, October 23, 2016
Pamela Gonzalez, MD, MS, FAAP

Watch video ›

Resources for Health Professionals and Pharmacists

This resource list was developed for health professionals and pharmacists.

Note: Note: Inclusion on the list does not indicate PCSS-O, AAAP, or partner organizations endorse any of the resources listed and exclusion in no way implies other resources are not available or valuable.