Developed by the American Academy of Pediatrics (AAP) in collaboration with CDC:
Ted Talk featuring Michael Boticelli, former Director of National Drug Control Policy
The goal/purpose of this activity was to provide strategies for safe opioid use in the hospital and after patient discharge.
Training Curricula and Slides
Recorded Webinars, Toolkits and Other Resources
For more, visit ATTC ›
International studies indicate that addiction to alcohol and other drugs are among the most stigmatized conditions in society and stigma is a major barrier to seeking treatment in the United States. Studies highlight several factors that influence the degree of stigma related to different health conditions and how these may lead to discrimination and poorer health outcomes. Recent research also underscores the importance of language and terminology in inducing implicit cognitive biases which may unconsciously affect clinicians’ and policymakers’ attitudes, judgments, and behaviors toward those suffering from addiction.
Assessing risk for opioid misuse, treatment of chronic pain and the role of shame in patients with opioid use disorders are just three of the topics covered in a collection of resources from a national training and mentoring project developed by physicians to promote the fundamental role of self-education and in curbing the opioid epidemic.
A free subscription to Medscape is required to complete this CME/ABIM MOC/CE
activity. Join Medscape ›
The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.
Upon completion of this activity, participants will be able to:
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.
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
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.
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.
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:
Gilead Sciences, Inc
Merck & Co, Inc
Additional support for select activity types in this national program is provided by:
For our viral hepatitis effort:
Gilead Sciences, Inc
Merck & Co, Inc
Created by Michael Boticelli, former Director of National Drug Control Policy. Offering advice to clinicians on language and addiction.
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 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.
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.
There are identifiable behaviors and risk factors that make people vulnerable to prescription opioid abuse or addiction; understanding these factors is vital to recognizing patients at risk. In this free live webinar, experts Dr. Larry Driver and Dr. Lynn Webster will present healthcare providers with treatment strategies that meet the unique needs of patients who suffer from chronic pain and addiction. A question-&-answer period at the end of the webinar will allow participants to get expert feedback on the specific problems and questions that they face in their practice.
The Journal of the American Medical Association. Published online February 26, 2014.
Authors: Yngvild Olsen, MD, MPH1; Joshua M. Sharfstein, MD2
Article by David Rosenbloom, PhD, gives a good background on stigma and addiction and offers 5 things people can do to fight stigma and addiction.
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.
The science behind addiction is explored. Strategies for nurses to use in caring for persons with addiction are provided. Harm reduction for persons with addiction is described, and ways nurses can provide care from this perspective are explored.
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.
Under the conditions specified in this REMS, prescribers of ER/LA opioid analgesics are strongly encouraged to do all of the following:
View Webinar Library ›
This free webinar will examine techniques used to teach nurses Motivational Interviewing (MI) for brief intervention. Presenters will explore a variety of techniques used to teach MI for nurses and nursing students.
Video created by The Pew Charitable Trusts.
This webinar provides nurses who spend time trying to encourage patients to consider healthy behavior change an overview of motivational interviewing. Tools to initiate a patient-practitioner conversation around behavior change are introduced. Motivational interviewing (MI) is a clinical method for helping people to resolve ambivalence about change by helping them find their own reasons for motivation and commitment to change. A sequence of skills to begin to develop the techniques of MI are offered. Nurses participating in this session are encouraged to practice these skills to develop greater proficiency in this technique. Specific examples relevant to pain management are described.
The webinar provides a clear presentation of Motivational Interviewing that is readily transferable to everyday clinical practice. Motivational Interviewing is a clinical style for engaging patients in treatment, enhancing motivation to reduce substance use, and supporting adherence to recommended behavioral or pharmacological treatments.
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.
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.
MI founder William Miller talks about how Motivational Interviewing helps people resolve their ambivalence about changing addictive behaviors. Watch the full video here.
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.
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.
The basic principles of Motivational Interviewing are represented by the acronym OARS. Using each of these components help make the discussion more successful in encouraging change.
Examples of reflections: “That must be difficult.” “I hear that you’re upset.” “It sounds like…” “What I hear you saying is…” “So on the one hand it sounds like… And, yet on the other hand…”
Below are some examples of questions often used in MI. Successful discussions all look different, but these examples can be a useful starting point to help your loved one begin to think about change.
[Link to MI Tri-Fold]
People with opioid use disorder and their families often believe many myths and inaccuracies about MAT, overshadowing the evidence in support of MAT’s benefits. Many of the negative attitudes towards MAT among patients, their doctors, and their peers may come from misunderstandings of how these treatments work. Common myths and inaccuracies about methadone treatment may prevent patients and their families from recognizing the evidence in support of methadone’s benefits.
Myth #1: MAT replaces one addiction with another.
Sometimes patients and their families or friends wonder why doctors use drugs like buprenorphine or methadone to treat opioid addiction, since these medicines are in the same family as heroin and prescription opioid pain medication. However, physician-prescribed buprenorphine and methadone are not just “substituting” one addiction for another.
Addiction treatment uses longer-acting and safer medications to help overcome more dangerous opioid addictions. Many studies have shown that maintenance treatment with long-acting opioids like methadone or buprenorphine helps keep patients healthier, reduces criminal activity, and helps prevent drug-related diseases like HIV/AIDs and Hepatitis.
Patients who strongly object to using maintenance opioids for any reason may choose a different type of MAT. For example, naltrexone is not an opioid drug, and actually works by blocking the effects of opioids in the brain for up to one month. For more information, see the Community Resources section of PCSSMAT.org.
Myth #2: MAT is a bad moral choice. It is inferior to complete, unassisted abstinence.
Some of the negative stigma of MAT comes from different ways of understanding addiction.
Addiction as a moral and spiritual problem: Some people with opioid use disorder and their communities view addiction as a moral and spiritual failing, not as a medical disease. In this view, medical treatment with methadone may seem like a “crutch,” or a weak moral choice, because patient is continuing to use an opioid on a daily basis. Complete, unassisted abstinence is the most common treatment plan in this view of addiction. MAT’s ability to make addiction recovery easier and less painful may not be seen as a benefit, but may suggest that a patient “isn’t as serious” about quitting., MAT patients do not meet many 12-step programs’ definitions of abstinence because of their use of opioidmedications, and they may be excluded from these groups.However, individuals attending 12-step groups may be criticized as having “traded one drug for another” if they reveal that they are seeking treatment with buprenorphine or methadone. This is not always the case, and many AA and NA members understand the role of MAT in recovery.
Addiction as a medical disease: Instead of understanding addiction as only a moral or spiritual failing, many medical professionals have begun to view opioid addiction as a medical disease. The disease of addiction can be caused by repeated exposure to a drug, coupled with genetic or environmental risk factors, leading to physical changes in the brain’s opioid receptors. In this view, addiction can be treated and managed with medication, much like other medical diseases.
Myth #3: MAT is not effective because it does not immediately end drug dependence.
opioid use disorder or Addiction is not “cured” by the use of MAT. Addiction is a “chronic” (long-lasting) disease. Medical treatment for addiction can be comoared to medical treatment for other common chronic diseases like diabetes or high blood pressure. Just as diabetes is not “cured” by the use of insulin, and people with high blood pressure often continue taking medications for many years, so people with opioid addiction are not “cured” but instead well-managed by MAT.
Misconception #4: “I’ve known a few people who could stop using opioids without help from any kind of medication. MAT is only for the weak. “
Though opioid abuse may begin with a series of poor judgments, addiction involves real, physical changes in the brain. While some people are eventually able to quit using opioids on their own, the majority of patients go though many dangerous cycles of relapse and recovery. MAT can make the recovery process much safer, and has saved many lives by preventing death from overdose or dangerous behaviors associated with “street” drug use.
[Link to Myths and Misconceptions Trifold]
—Frank, D. (2011.) The trouble with morality: the effects of 12-step discourse on addicts’ decision-making. J Psychoactive Drugs 43(3), 245-256.
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 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.”
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.
Webcast recordings from the National OWH Meeting on Opioid Use, Abuse, and Overdose in Women are now available on the HHS YouTube Channel.
September 29, 2016:
September 30, 2016:
Negative attitudes towards the use of methadone are common among patients, their doctors, their families, and their peers, as well as in most 12-step programs.Methadone treatment’s negative stigma may prevent those that would benefit from methadone from seeking treatment. “Stigma” means rejection or disgrace, which many patients feel they will suffer if they choose to seek methadone treatment. This stigma may cause friends, family, and other addicts to look down on those who choose methadone treatment, preventing them from receiving the treatment’s full benefits.  Patients often feel that they have to hide their use of methadone from others, and have trouble gaining social acceptance in their communities and among other addiction patients. 
Why is there a negative stigma associated with Methadone?
Methadone is perceived by many as “substituting” one addiction for another. Methadone treatment is only provided in special addiction clinics, separated from the rest of healthcare, which may contribute to its stigma. This separation may also serve to distance methadone from the medical model of understanding addiction as an illness rather than as a moral failing.
Patients, their families, and their communities could benefit from greater acceptance of methadone treatment’s proven benefits in reducing illicit opioid use and its negative consequences. 
— Frank, D. (2011). “The trouble with morality: the effects of 12-step discourse on addicts’ decision-making.” J Psychoactive Drugs 43(3). 245-256.  Frank, D. (2011).  Etesam, F., Assarian, F., Hosseini, H., & Ghoreishi, F. S. (2014.) Stigma and its determinants among male drug dependents receiving methadone maintenance treatment. Arch Iran Med. Feb 17(2). 108-14.  PCSS-MAT.  Frank, D. (2011).
Hospitals are on the front lines of our efforts to address the national opioid crisis. ONDCP has recently engaged with a number of innovators and pioneers who are developing effective hospital-based approaches to the epidemic. These include:
ONDCP Acting Director Richard Baum was recently briefed by the creators of two innovative fire department-led initiatives to address the opioid epidemic. Safe Station, a program developed in May 2016 by the City of Manchester, New Hampshire, welcomes people seeking help for addiction at any of the city’s 10 fire stations, where they will be given a brief medical assessment to determine if hospitalization is required and handed off to a recovery coach or case manager for direct linkage to treatment. Within its first year of operation, the program has helped over 1,600 people seeking help for opioid use disorder or another substance use disorder.
Launched in 2016, the Revere, Massachusetts, Substance Use Disorder Initiative (SUDI) fields a team consisting of a fire fighter, a recovery coach, and a harm reduction specialist who conduct door-to-door follow up visits at the homes of overdose survivors and provide them and their with families information and resources including overdose prevention and naloxone training and kits, and offer to assist individuals in accessing treatment. The initiative is housed in a central office and coordinates the city’s public health and public safety efforts in response to the opioid crisis.
ONDCP is reaching out to these and other innovative initiatives to learn from their successes so their models and best practices can be quickly replicated in communities across the country as we work to address the ongoing addiction and opioid epidemic.
Have a promising practice to share? Email your model to [email protected]
ONDCP continues to engage with Federal partners to advance the use of medication-assisted treatment (MAT) – medications approved for the treatment of opioid use disorder (buprenorphine, methadone, or naltrexone ) – for people involved in the criminal justice system who have this disease, and it’s encouraging to see an increasing number of criminal justice systems that are beginning to implement MAT. ONDCP is championing MAT adoption in the criminal justice system in a number of ways, including by:
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:
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:
From the New England Journal of Medicine: A primer on treating opioid use disorder. Read article.
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 .
This training was originally presented by Adam Bisaga, MD, during the American Academy of Addiction Psychiatry 26th Annual Meeting in 2015. View training.
Basic, evidence-based guide on addiction.
Blog post by Dr. Nora Volkow, NIDA Director
People with substance use disorders and other mental health issues face greater stigma than those with other illnesses…..
This module describes the history of methadone maintenance and the effectiveness and key myths of opioid agonist treatment. The module explores empathizing with patients taking methadone or buprenorphine and empowering clinicians to support patients and their significant others.
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.
AMHSA Discussion Guide for Primary Health Care Providers
This guide provides clinicians with questions to begin discussions with adult patients about mental illness, substance use disorders, or both. It includes resources for patients who need an evaluation after a positive screening.
Online module addresses motivational interviewing and stigma.
This study provides a systematic review of existing research that has empirically evaluated interventions designed to reduce stigma related to substance use disorders.
“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.
Shame plays an important role in Opioid Use Disorders (OUD) and can impede treatment if not addressed appropriately. In this module, participants will learn to recognize and treat shame in patients with OUD. Participants will learn about particular subsets of people with OUD who have specific concerns regarding shame, including people who inject heroin, and opioid-addicted pregnant women and mothers. Finally, treatment options that address shame in people with OUD will be outlined.
Follow-up Q and A Webinar: The Role of Shame in Opioid Use Disorders
This Q and A webinar further discussed Dr. Braun-Gabelman’s online module, “The Role of Shame in Opioid Use Disorders,” and allowed participants of the module to pose questions to Dr. Braun-Gabelman; she also presented a few cases related to this topic.
U.S. Surgeon General created this website as a resource for healthcare providers who prescribe opioids.
Surgeon General launches national initiative to improve opioid prescribing, including new website. United States Office of the Surgeon General ›
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 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.
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.
Neuroscientist Nora Volkow, director of the National Institute on Drug Abuse at the NIH, applies a lens of addiction to the obesity epidemic.
This guide on addiction and stigma, created by Boston Medical Center, can be used as a template for your organization.
Plenary Session: Sunday, October 23, 2016
Pamela Gonzalez, MD, MS, FAAP
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.