A Primer on Risk Management for Prescribers of Controlled Prescription Drugs
- Credit Type
- CME
- Credit Amount
- 0.5
- Release Date
- 07/05/2011
- Expiration Date
- 07/05/2012
- Activity Type
- Webcast
Activity Goal
This educational activity is intended to review strategies for stratifying patients according to their risk of opioid misuse, abuse, and diversion.
Intended Audience
Pain specialists, anesthesiologists, physiatrists, neurologists, palliative care specialists, primary care physicians, nurse practitioners, pharmacists, allied health professionals, fellows, and residents.
Needs Assessment and Learner’s Gap
Physicians have grown increasingly reluctant to prescribe opioid medications, citing concerns over the escalating epidemic of opioid misuse, abuse, and diversion.1 For patients with chronic pain, limited access to opioids can lead to inadequate treatment. Responsible opioid prescribing is therefore a critical component of pain medicine, requiring improved recognition of a broad continuum of behaviors from adherence to addiction. Validated screening instruments are available to help clinicians stratify patients for risk of nonmedical opioid use.2 The Opioid Risk Tool (ORT) and the Screener and Opioid Assessment for Patients with Pain – Revised (SOAPP – R) are commonly used in primary care and specialty clinics.3,4 A patient interview can assess known opioid abuse risk factors such as smoking, psychiatric disorders, and personal or family history of substance abuse. Prescription monitoring programs (available in many states) can provide insights about prescription compliance. Urine drug tests are also useful; a negative test for the prescribed opioid in urine should prompt further evaluation, as should positive tests for illicit drugs or opioids other than the one prescribed. Finally, patient monitoring for aberrant medication behaviors should be individualized, with the level of scrutiny and frequency of visits matched to the level of risk.
References
- Birnbaum HG, White AG, Reynolds JL, et al. Estimated costs of prescription opioid analgesic abuse in the United States in 2001: a societal perspective. Clin J Pain. 2006;22:667-676.
- Passik SD. Issues in long-term opioid therapy: unmet needs, risks, and solutions. Mayo Clin Proc. 2009;84:593-601.
- Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Med. 2005;6:432-442
- 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.
Learning Objectives
At the conclusion of this presentation, you will be able to:
- Describe the spectrum of opioid use behaviors, including adherence, misuse, abuse, diversion, and addiction.
- Conduct a thorough and ongoing assessment of risk for aberrant drug behaviors.
- Individualize monitoring according to level of risk for aberrant drug behavior.
Faculty Disclosure
Steven D. Passik, PhD has reported that he does not have any financial relationships to disclose
Credit Designation
Credit Designation designates this internet point-of-care activity for a maximum of 0.5 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Method of Participation
There are no fees for participating in and receiving credit for this activity. Prior to viewing the webcasts, each participant must read the learning objectives and acknowledge receipt of the CME information. Additionally, each participant must also complete a prequestionnaire before beginning the activity. Upon completion of this prequestionnaire, the activity will commence. Once the final webcast is viewed, credit may be obtained by completing the posttest, program evaluation, and the attestation statement. Credit is available through July 5, 2012.
Copyright Information
As herein stated, the term "Continuum Affiliates" means Beth Israel Medical Center, St. Luke's-Roosevelt Hospital Center, Long Island College Hospital, and the New York Eye & Ear Infirmary. Continuum Health Partners, Inc. is the parent company of each of the Continuum Affiliates.
Unless otherwise stated, the contents of this activity are copyrighted as a collective work under the laws of the United States and other copyright laws by Continuum Health Partners, Inc., all rights reserved. The collective work may include works that are the property of other authors and that are also protected by copyright and other intellectual property laws. Any redistribution, retransmission, or publication of any copyrighted material is strictly prohibited without the express written consent of Continuum Health Partners, Inc. and all other copyright owners.
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