Clinical Challenges in Prescribing Controlled Drugs:
PRESCRIBING OPIOIDS FOR CHRONIC PAIN

Purpose of the Courses

Each year, millions of patients are treated for a variety of serious medical conditions with prescription drugs whose therapeutic benefits are accompanied by psychoactive effects. This is particularly true of the management of chronic pain, which often involves potent opioid analgesics.

Recent indicators present troubling evidence that the misuse and abuse of prescription opioids is on the rise. Physicians and other health care professionals thus face the challenge of minimizing the potential for misuse of these important medications without impeding patients' access to needed medical care.

The CME courses described here provide specific knowledge and skills associated with safe prescribing of opioids for chronic pain. Course faculty and accompanying resource materials address practice management, legal and regulatory issues, opioid pharmacology, and clinical strategies for managing challenging patient situations.

Primary care physicians constitute the principal audience for the courses, although physician extenders such as independent nurse practitioners and physician assistants also are welcomed.

Educational Objectives

Identify clinical situations in which opioids are indicated and contraindicated for the treatment of chronic pain.

Select patients who are appropriate candidates for long-term therapy with opioids, including methadone.

Educate patients about methadone's unique pharmacologic properties, such as its long duration of action and absence of euphoric effect (lack of knowledge of these characteristics on the part of physicians and patients has contributed to inadvertent overdoses and fatalities).

Understand the difference between drug-induced dependence and addiction.

Follow a careful, evidence-based protocol for starting patients on long-term opioid therapy, whether from a drug-naive state or in transition from another analgesic.

Perform careful patient monitoring and take other appropriate steps to minimize the potential for opioid diversion, abuse, or addiction.

Continuing Medical Education Credits

This educational activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through joint sponsorship with the local host organizations and the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration.

Course sponsors must be accredited by the ACCME to provide continuing medical education for physicians. The local sponsor designates this educational activity for an appropriate number of Category 1 credit(s) in the Physician Recognition Program™ of the American Medical Association.

Typical Program

The course can be delivered in as little as 90 minutes or as much as six hours. At least three hours is recommended to allow adequate time for audience-faculty interaction. The following example is based on a three-hour presentation.

Schedule of Courses

All courses are sponsored by local medical organizations and state agencies, with support from the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration.

July 25, 2008: Seattle, Washington

Sponsor:

• American Osteopathic Association

Co-sponsors:

• University of Washington Medical School
• Seattle VAMC
• American Osteopathic Academy of Addiction Medicine

For information or to register, contact:

• Nina Albano Vidmer at 708-338-0760 or ninabeana@ameritech.net.

Sept. 12, 2008: Portland, Maine (with teleconferencing to 5 sites in Vermont)

Sponsors:

• Maine Board of Medicine
• Maine Board of Osteopathic Medicine

Co-sponsors:

• Maine State Medical Association
• Maine State Department of Health
• Maine Medical Center

For information or to register, contact:

• George Dreher, M.D., Maine Medical Center, at DREHEG@mmc.org.

Sept. 20, 2008: Fort Lauderdale, Florida

Sponsors:

• Florida Board of Osteopathic Medicine
• Nova Southeastern University College of Osteopathic Medicine

Co-sponsors:

• American Osteopathic Academy of Addiction Medicine
• Florida Department of Alcohol and Drug Abuse

For information or to register, contact:

• David Gensure, Director of Continuing Education, Nova Southeastern University, at 954-262-1072.

Additional courses are being scheduled; dates will be added to the calendar as they are confirmed.

Acknowledgements

Support for the development of the prescribing courses has been provided by JBS International, Inc., under contract 270-2003-0001-0006 with the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration. Kenneth Hoffman, M.D., M.P.H., and Jennifer Fan, Pharm.D., J.D., both of the Division of Pharmacologic Therapies of the Center for Substance Abuse Treatment, served as Government Project Officers. Robert Lubran, M.S., M.P.A., Director of the Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, provided valuable guidance, as did other experts within government agencies and private sector organizations.

Bonnie B. Wilford, M.S., Director of the Center for Health Services & Outcomes Research, serves as Project Director. Gail Jara is the Project’s Education Coordinator. The following individuals made significant contributions to the development of this continuing medical education program, and their contributions are acknowledged with gratitude.

• Edward C. Covington, M.D., Director, Chronic Pain Rehabilitation Program, Cleveland Clinic Foundation, Cleveland, Ohio
• Scott Fishman, M.D., Professor and Chief, Division of Pain Medicine, Department of Anesthesia and Pain Medicine, University of California/Davis School of Medicine
• G. Douglas Gourlay, M.D., FASAM, Wasser Pain Management Centre, Toronto, Ontario, Canada
• William L. Harp, M.D., Executive Director, Virginia Board of Medicine, Richmond, VA
• Margaret K. Kotz, D.O., Director, Addiction Recovery Services, Department of Psychiatry, and Associate Professor, Case Western Reserve University School of Medicine, Cleveland, OH
• Joyce Lowinson, M.D., Professor Emerita, New York University School of Medicine, New York City, and Executive Director, International Society for Pain and Chemical Dependency
• William Marcus, J.D., Assistant Attorney General for the State of California (retired), Los Angeles, CA
• Judith Martin, M.D., East Bay Recovery Project and the 14th Street Clinic, Oakland, CA
• Robert Morrow, M.D., Montefiore Medical Center, New York, NY
• Michael H. Moskowitz, M.D., Assistant Professor, Department of Anesthesia and Pain Medicine, University of California/Davis School of Medicine, Davis, CA
• Theodore V. Parran, Jr., M.D., Associate Clinical Professor, Case Western Reserve University School of Medicine, Cleveland, OH
• Norman Wetterau, M.D., FAAFP, FASAM, Tricounty Family Medicine, Danville, NY, and the New York State Academy of Family Physicians

Appreciation also is expressed to Lisa Robin of the Federation of State Medical Boards for assistance in providing educational resources.

Disclaimer

The views expressed in this course and related materials do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.