Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. A single-question screening test for drug use in primary care. Arch Intern Med. 2010;170:1155-1160.
Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Medicine. 2005;69:432-442.
Akbik H, Butler SF, Budman SH, Fernandez K, Katz NP, Jamison RN. Validation and clinical application of the Screener and Opioid Assessment for Patients with Pain (SOAPP). J Pain Symptom Manage. 2006;32:287-293.
Substance Abuse and Mental Health Services Administration. Results from the 2011 National Survey on Drug Use and Health: Volume 1. Summary of National Findings. NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012
Centers for Disease Control and Prevention. CDC grand rounds: prescription drug overdoses -- a US epidemic. MMWR Morb Mort Wkly Rep. 2012:61:10-13.
National Institute on Drug Abuse. Research Report Series: Prescription Drugs: Abuse and Addiction. 2011. http://www.drugabuse.gov/sites/default/files/rrprescription.pdf
Fishbain DA, Rosomoff HL, Rosomoff RS. Drug abuse, dependence, and addiction in chronic pain patients. Clin J Pain. 1992;8:77-85.
Boscarino JA, Rukstalis M, Hoffman SN, et al. Risk factors for drug dependence among out-patinets on opioid therapy in a large US health-care system. Addiction. 2010;105:1776-1782.
Brown J, Setnik B, Lee K, et al. Assessment, stratification, and monitoring of the risk for prescription opioid misuse and abuse in the primary care setting. J Opioid Manag. 2011;7:467-483.
Michna E, Ross EL, Hynes WL, et al. Predicting aberrant drug behavior in patients treated for chronic pain: importance of abuse history. J Pain Symptom Manage. 2004;28:250-258.
Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med. 2005;6:107-112.
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Ballantyne JC, Mao J. Opioid therapy for chronic pain. N Engl J Med. 2003;349:1943-1953.
Eisenberg E, McNicol ED, Carr DB. Efficacy and safety of opioid agonists in the treatment of neuropathic pain of nonmalignant origin: systematic review and meta-analysis of randomized controlled trials. JAMA. 2005;293:3043-3052.
Martell BA, O’Connor PG, Kerns RD, et al. Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann Intern Med. 2007;146:116-127.
Passik SD, Kirsh KL. Assessing aberrant drug-taking behaviors in the patient with chronic pain. Curr Pain Headache Res. 2004;8:289-294.
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Paterick TJ, Carson GV, Allen MC, Paterick TE. Medical informed consent: general considerations for physicians. Mayo Clin Proc. 2008;83:313-319.
Christo PJ, Manchikanti L, Ruan X, et al. Urine drug testing in chronic pain. Pain Physician. 2011;14:123-143.
McCarberg BH. A critical assessment of opioid treatment adherence using urine drug testing in chronic pain management. Postgrad Med. 2011;123:124-131.
Carroll CP, Haythornthwaite J. Maladaptive opioid use behaviors and psychiatric illness: what should we do with what we know? Curr Pain Headache Rep. 2011;15:91-93.
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CME/CE

Managing Pain Patients Who Abuse Prescription Drugs

Authors: Gayathri J. Dowling, PhD; Richard A. Denisco, MD
CME/CE Released: 9/26/2012; Reviewed and Renewed: 10/2/2014
THIS ACTIVITY HAS EXPIRED
Valid for credit through: 10/2/2015

Target Audience and Goal Statement

This activity is intended for primary care providers, neurologists, anesthesiologists, pain specialists, obstetrician/gynecologists, orthopedists, nurse practitioners, nurses and other healthcare practitioners who manage patients with chronic pain.

The goal of this activity is to describe the symptoms and prevalence of opioid addiction and dependence in patients with chronic pain, and the steps clinicians can take to screen for, prevent, and treat such these conditions.

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

Develop strategies to assess and monitor patients taking opioids for abuse and potential diversion of medication
Propose communication strategies to engage patients in dialog focused on treatment of prescription drug abuse or addiction
Formulate treatment management and possible referral plans to prevent and address opioid addiction in patients with a diagnosis of chronic pain

Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Author(s)

Gayathri J. Dowling, PhD

Acting Chief, Science Policy Branch, National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, Bethesda, MD

Disclosures

Disclosure: Gayathri J. Dowling, PhD has disclosed no relevant financial relationships.

Dr Dowling does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Dowling does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Richard A. Denisco, MD

Medical Officer, National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, Bethesda, MD

Disclosures

Disclosure: Richard A. Densico, MD, has disclosed no relevant financial relationships.

Dr. Denisco does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr. Denisco does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor(s)

Jane Lowers

Group Scientific Director, Medscape LLC

Disclosures

Disclosure: Jane Lowers has disclosed no relevant financial relationships.

Colleen Quinn

Clinical Editor, Medscape, LLC

Disclosures

Disclosure: Colleen Quinn has disclosed no relevant financial relationships.

Writer(s)

Lynne Kolton Schneider, PhD

Freelance writer, Boca Raton, Florida

Disclosures

Disclosure: Lynne Kolton Schneider has disclosed no relevant financial relationships.

Additional Planners/Reviewers

Robert Carroll, PhD, RN

Project director, IQ Solutions, Rockville, MD

Disclosures

Disclosure: Robert Carroll, PhD, RN, has disclosed no relevant financial relationships.

Denise Crute, MA

Director of training, IQ Solutions, Rockville, MD

Disclosures

Disclosure: Denise Crute, MA has disclosed no relevant financial relationships.

Bill H. McCarberg, MD

Primary Care Physician, Adjunct Assistant Clinical Professor, University of California, San Diego; Founder, Chronic Pain Management Program, Kaiser Permanente, San Diego, California

Disclosures

Disclosure: Bill McCarberg, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: PriCara; Forest Laboratories, Inc.; Endo Pharmaceuticals; Sucampo Pharmaceuticals, Inc.; NeurogesX, Inc.; Teva Pharmaceuticals; Insys Therapeutics, Inc; QRX Pharma Ltd; Salix Pharmaceuticals, Inc.

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Nurse Planner

Laurie E. Scudder, DNP, NP

Nurse Planner, Continuing Professional Education Department, Medscape, LLC; Clinical Assistant Professor, School of Nursing and Allied Health, George Washington University, Washington, DC

Disclosures

Disclosure: Laurie E. Scudder, DNP, NP, has disclosed no relevant financial relationships.

Accreditation Statements

For Physicians

Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Medscape, LLC designates this enduring material for a maximum of 1.75 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

Contact This Provider

For Nurses

Medscape, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Awarded 1.75 contact hour(s) of continuing nursing education for RNs and APNs; 1.75 of these credits is in the area of pharmacology.

Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

Read the target audience, learning objectives, and author disclosures.
Study the educational content online or printed out.
Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

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Screening Tools

NIDA Drug Use Screening Tool (NIDA QuickScreen and NM-ASSIST)
- Electronic version
- Pdf version
- Resource Guide -- This guide is designed to assist clinicians serving adult patients in screening for drug use
Opioid Risk Tool (ORT)
This survey enables the clinician to determine a patient’s potential risk for developing aberrant behaviors when prescribed opioids for chronic pain.
Screener and Opioid Assessment for Patients with Pain (SOAPP) Version 1.0 - 14Q
This assessment is a tool for clinicians to help determine how much monitoring a patient on long-term opioid therapy might require.
*Copyrights apply
Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R)
This questionnaire is for patients who are on or being considered for medication for pain.
*Copyrights apply
Current Opioid Misuse Measure (COMM)
Assessment helps clinicians identify whether a patient currently on long-term opioid therapy may be exhibiting aberrant behaviors associated with misuse of opioid medications.
*Copyrights apply
Pain Assessment and Documentation Tool (PADT)
Clinician-directed interview that assesses pain relief, side effects, and aspects of functioning as well as potential aberrant drug- related behavior
SAFE score: Social function, Analgesia, physical Functioning and Emotional functioning
The SAFE tool offers a mechanism for the clinician to measure the patient’s functioning across multiple domains and to document the rationale for continuation, modification, or cessation of opioid therapy.
A summary of SAFE and other tools can be found here.

Sample Treatment Agreements

Opioid and pain treatment agreement samples

Other Modules from the NIDA Centers of Excellence

The Clinical Assessment of Substance Use Disorders
Drexel University College of Medicine
This educational module on the clinical assessment of substance abuse disorders presents written text and instructional videos that provide the knowledge, skills, and attitudes needed in the screening, evaluation, and referral of patients with substance use disorders.
Opioid Risk Management Objective Structured Clinical Exams (OSCE)
Boston University School of Medicine
This module provides training on opioid risk management communication through simulation with standardized patients.
Prescription Drug Abuse: An Introduction
Boston University School of Medicine
Provides an overview of prescription drug abuse, framed within the clinical scenario of chronic pain management in the outpatient setting.
A Problem-Based Learning Case on Prescription Drug Abuse: Patient S.K.
Tufts University School of Medicine
Examines prescription drug abuse and offers a case study to help students understand the screening and diagnostic tools available for alcohol and drug abuse.
Minimizing the Misuse of Prescription Opioids in Patients With Chronic Nonmalignant Pain
University of Massachusetts Medical School
Uses a case study to address the management of patients with chronic nonmalignant pain that integrates techniques to prevent and detect misuse of prescription opioids.
Patient-Centered Learning: Substance Abuse in a Physician – The Connor Johnson Case
University of North Dakota School of Medicine & Health Sciences
The case presented herein is designed for three 2-hour meetings and emphasizes the importance of considering substance abuse in the differential diagnosis, even when not obvious, and highlights the issue of substance abuse among physicians.
Talking to Patients About Sensitive Topics: Communication and Screening Techniques for Increasing the Reliability of Patient Self-Report
University of North Dakota School of Medicine & Health Sciences
This module on interviewing patients about sensitive subjects isgeared toward first- or second-year medical students who have had prerequisite training in taking a basic medical history and in general communication skills such as active listening, paraphrasing, etc.
- Communication and Screening Techniques for Increasing the Reliability of Patient Self-Report: Lecture
- Communication and Screening Techniques for Increasing the Reliability of Patient Self-Report: Handout

Tools to Assess Drug Use

Drug Testing as a Tool
This page discusses the benefits and limitation of drug tests; different types of drug tests; and the reliability, validity, and accuracy of drug test results.
Urine Specimen Collection Handbook for Federal Agency Workplace Drug Testing Programs
This manual outlines the proper procedures used to collect and test urine samples for drug abuse.
Drugs of Abuse Tests
The information on this webpage may be helpful to anyone who performs drugs of abuse testing, including consumers, employers, or trained medical professionals.

Training for Physicians Who Wish to Prescribe Methadone and Buprenorphine

SAMHSA Helps Bring Buprenorphine to the Field/Training Physicians
This article describes how to comply with the Drug Addiction Treatment Act of 2000 for physicians who want to prescribe the medication for detoxification or maintenance treatment for patients with drug addictions.
Physician Waiver Qualifications
This page describes the qualifications a physician must have to obtain a waiver to prescribe the medication for detoxification or maintenance treatment for patients with drug addictions.
How to Obtain a Waiver
The page describes the actions a physician must take to obtain a waiver.

Substance Abuse Treatment Resources

Substance Abuse and Mental Health Treatment
This page provides links that can help people find treatment for substance abuse and mental health.
Substance Abuse Treatment Facility Locator by SAMHSA
This page can help people find treatment programs for substance abuse.
Seeking Drug Abuse Treatment: Know What to Ask
This NIDA booklet offers guidance in seeking drug abuse treatment and lists 5 questions to ask when searching for a treatment program.
Principles of Drug Addiction Treatment: A Research-Based Guide.
This NIDA publication presents research-based principles of addiction treatment for a variety of drugs, including nicotine, alcohol, and illicit and prescription drugs, that can inform drug treatment programs and services.

Information About Safe Medication Disposal

Safe Disposal of Medicines
This page describes how to safely dispose of unneeded medications.

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CME/CE Information

Resources

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References

Faculty and Disclosures

Author(s)

Gayathri J. Dowling, PhD

Richard A. Denisco, MD

Editor(s)

Jane Lowers

Colleen Quinn

Writer(s)

Lynne Kolton Schneider, PhD

Additional Planners/Reviewers

Robert Carroll, PhD, RN

Denise Crute, MA

Bill H. McCarberg, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Nurse Planner

Laurie E. Scudder, DNP, NP

CME/CE

Managing Pain Patients Who Abuse Prescription Drugs

Target Audience and Goal Statement

Disclosures

Author(s)

Gayathri J. Dowling, PhD

Richard A. Denisco, MD

Editor(s)

Jane Lowers

Colleen Quinn

Writer(s)

Lynne Kolton Schneider, PhD

Additional Planners/Reviewers

Robert Carroll, PhD, RN

Denise Crute, MA

Bill H. McCarberg, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Nurse Planner

Laurie E. Scudder, DNP, NP

Accreditation Statements

For Physicians

For Nurses

Instructions for Participation and Credit

Managing Pain Patients Who Abuse Prescription Drugs

Screening Tools

Sample Treatment Agreements

Other Modules from the NIDA Centers of Excellence

Tools to Assess Drug Use

Training for Physicians Who Wish to Prescribe Methadone and Buprenorphine

Substance Abuse Treatment Resources

Information About Safe Medication Disposal