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      Thursday, June 8, 2023
      News & Perspective Drugs & Diseases CME & Education Academy Video Decision Point
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      CME / CE

      Case Challenges in Opioid Use Disorder: Use of Medications in Treatment

      • Authors: Joshua D. Lee, MD, MSc
      • CME / CE Released: 12/17/2018; Reviewed and Renewed: 12/29/2020
      • THIS ACTIVITY HAS EXPIRED FOR CREDIT
      • Valid for credit through: 12/29/2021
      Start Activity

      Target Audience and Goal Statement

      This activity is intended for psychiatrists, primary care physicians, nurse practitioners, physician assistants, nurses, and other clinicians who manage patients with opioid use disorder.

      The goal of this activity is to help clinicians recognize and effectively treat opioid use disorder (OUD) using available medication therapies.

      Upon completion of this activity, participants will:

      • Have increased knowledge regarding the
        • Use of medications for the management of OUD
      • Have greater competence related to
        • Diagnosis of OUD
        • Development of a recovery plan for OUD that utilizes medications as a part of therapy

       

      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

      • Joshua D Lee, MD, MSc

        Associate Professor
        NYU Langone Health
        New York, New York

        Disclosures

        Disclosure: Joshua D. Lee, MD, MSc, has disclosed no relevant financial relationships.

      Editors

      • Marcello Morgan, MD, MPH

        Scientific Director, Medscape, LLC

        Disclosures

        Disclosure: Marcello Morgan, MD, MPH, has disclosed no relevant financial relationships.

      • Beverly Caley, JD

        Freelance Writer

        Disclosures

        Disclosure: Beverly Caley, JD, has disclosed no relevant financial relationships.

      CME Reviewer/Nurse Planner

      • Amy Bernard, MS, BSN, RN-BC, CHCP

        Lead Nurse Planner, Medscape, LLC

        Disclosures

        Disclosure: Amy Bernard, MS, BSN, RN-BC, CHCP, has disclosed no relevant financial relationships.

      Accreditation Statements



      In support of improving patient care, Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

        For Physicians

      • Medscape, LLC designates this enduring material for a maximum of 1.0 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

      • Awarded 1.0 contact hour(s) of continuing nursing education for RNs and APNs; 1.0 contact hours are 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 75% on the post-test.

      Follow these steps to earn CME/CE credit*:

      1. Read the target audience, learning objectives, and author disclosures.
      2. Study the educational content online or printed out.
      3. 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.

      From Medscape Education Family Medicine
      CME / CE

      Case Challenges in Opioid Use Disorder: Use of Medications in Treatment

      Authors: Joshua D. Lee, MD, MScFaculty and Disclosures
      THIS ACTIVITY HAS EXPIRED FOR CREDIT

      CME / CE Released: 12/17/2018; Reviewed and Renewed: 12/29/2020

      Valid for credit through: 12/29/2021

      processing....

      References

      1. American Society of Addiction Medicine. National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. https://www.asam.org/resources/guidelines-and-consensus-documents/npg. June 2015. Accessed August 22, 2018.
      2. Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction: A Treatment Improvement Protocol. TIP 40. https://www.naabt.org/documents/TIP40.pdf. 2004. Accessed September 5, 2018.
      3. Wu LT, Zhu H, Swartz MS. Treatment utilization among persons with opioid use disorder in the United States. Drug Alcohol Depend. 2016;169:117-127.
      4. Haight SC, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid Use Disorder Documented at Delivery Hospitalization - United States, 1999-2014. MMWR Morb Mortal Wkly Rep. 2018;67:845-849.
      5. National Institute on Drug Abuse. Medications to Treat Opioid Use Disorder. https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/overview. Updated June 2018. Accessed August 22, 2018.
      6. Campbell ANC, Barbosa-Leiker C, Hatch-Maillette M, et al. Brief Report: Gender differences in demographic and clinical characteristics of patients with opioid use disorder entering a comparative effectiveness medication trial. Am J Addict. 2018.
      7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
      8. Goldstein RZ, Volkow ND. Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nat Rev Neurosci. 2011;12:652-669.
      9. National Institute on Drug Abuse. Drugs, brains, and behavior: the science of addiction. NIH Publication No. 18-DA-5605. Printed in April 2007. Updated July 2018.
      10. Edelman EJ, Oldfield BJ, Tetrault JM. Office-Based Addiction Treatment in Primary Care: Approaches That Work. Med Clin North Am. 2018;102:635-652.
      11. Huhn AS, Dunn KE. Why aren't physicians prescribing more buprenorphine? J Subst Abuse Treat. 2017;78:1-7.
      12. Kermack A, Flannery M, Tofighi B, McNeely J, Lee JD. Buprenorphine prescribing practice trends and attitudes among New York providers. J Subst Abuse Treat. 2017;74:1-6.
      13. US Department of Health and Human Services, Office of the Surgeon General. Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health. https://www.ncbi.nlm.nih.gov/books/NBK424857/pdf/Bookshelf_NBK424857.pdf. November 2016. Accessed September 5, 2018.
      14. Andrilla CHA, Moore TE, Patterson DG, Larson EH. Geographic Distribution of Providers With a DEA Waiver to Prescribe Buprenorphine for the Treatment of Opioid Use Disorder: A 5-Year Update. J Rural Health. 2018.
      15. Mannelli P, Swartz M, Wu LT. Withdrawal severity and early response to treatment in the outpatient transition from opioid use to extended release naltrexone. Am J Addict. 2018.
      16. Saloner B, Stoller KB, Alexander GC. Moving Addiction Care to the Mainstream - Improving the Quality of Buprenorphine Treatment. N Engl J Med. 2018;379:4-6.
      17. Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. Training Materials and Resources. https://www.samhsa.gov/programs-campaigns/medication-assisted-treatment/training-materials-resources. Accessed September 13, 2018.
      18. MacDonald K, Lamb K, Thomas ML, Khentigan W. Buprenorphine Maintenance Treatment of Opiate Dependence: Correlations Between Prescriber Beliefs and Practices. Subst Use Misuse. 2016;51:85-90.
      19. Jonan AB, Kaye AD, Urman RD. Buprenorphine Formulations: Clinical Best Practice Strategies Recommendations for Perioperative Management of Patients Undergoing Surgical or Interventional Pain Procedures. Pain Physician. 2018;21:E1-E12.
      20. Lee JD, Nunes EV, Jr., Novo P, et al. Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial. Lancet. 2018;391:309-318.
      21. Kenney SR, Anderson BJ, Bailey GL, Stein MD. The relationship between diversion-related attitudes and sharing and selling buprenorphine. J Subst Abuse Treat. 2017;78:43-47.
      22. US Food and Drug Administration webpage. Approved risk evaluation and mitigation strategies. https://www.accessdata.fda.gov/scripts/cder/rems/index.cfm. Accessed December 28, 2020.
      23. Weinstein ZM, Kim HW, Cheng DM, et al. Long-term retention in Office Based Opioid Treatment with buprenorphine. J Subst Abuse Treat. 2017;74:65-70.
      24. Vivitrol [package insert]. Waltham, MA: Alkermes, Inc.; 2015.
      25. Bisaga A, Mannelli P, Sullivan MA, et al. Antagonists in the medical management of opioid use disorders: historical and existing treatment strategies. Am J Addict. 2018;27:177-187.
      26. National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide. 3rd ed. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition. Updated January 2018. Accessed August 22, 2018.
      27. Cornish R, Macleod J, Strang J, Vickerman P, Hickman M. Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database. BMJ. 2010;341:c5475.
      28. Sordo L, Barrio G, Bravo MJ, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j1550.
      29. Nunes EV, Gordon M, Friedmann PD, et al. Relapse to opioid use disorder after inpatient treatment: Protective effect of injection naltrexone. J Subst Abuse Treat. 2018;85:49-55.
      30. Larochelle MR, Bernson D, Land T, et al. Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study. Ann Intern Med. 2018;169:137-145.
      31. National Institute on Drug Abuse. Effective treatments for opioid addiction. https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction. Updated November 2016. Accessed August 22, 2018.
      32. Knudsen HK, Studts JL. Physicians as Mediators of Health Policy: Acceptance of Medicaid in the Context of Buprenorphine Treatment. J Behav Health Serv Res. 2018.
      33. Krawczyk N, Feder KA, Fingerhood MI, Saloner B. Racial and ethnic differences in opioid agonist treatment for opioid use disorder in a U.S. national sample. Drug Alcohol Depend. 2017;178:512-518.
      34. Krupitsky E, Nunes EV, Ling W, Illeperuma A, Gastfriend DR, Silverman BL. Injectable extended-release naltrexone for opioid dependence: a double-blind, placebo-controlled, multicentre randomised trial. Lancet. 2011;377:1506-1513.
      35. Bisaga A, Mannelli P, Yu M, et al. Outpatient transition to extended-release injectable naltrexone for patients with opioid use disorder: A phase 3 randomized trial. Drug Alcohol Depend. 2018;187:171-178.
      36. Soares WE, 3rd, Wilson D, Rathlev N, et al. Healthcare utilization in adults with opioid dependence receiving extended release naltrexone compared to treatment as usual. J Subst Abuse Treat. 2018;85:66-69.
      37. Bentzley BS, Barth KS, Back SE, Book SW. Discontinuation of buprenorphine maintenance therapy: perspectives and outcomes. J Subst Abuse Treat. 2015;52:48-57.
      38. Friedmann PD, Dunn KE, Nunes EV, O'Brien CP. Effectiveness, Implementation and Real-World Experience with Extended-Release Naltrexone (XR-NTX): A Special Issue of JSAT. J Subst Abuse Treat. 2018;85:31-33.
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