Buprenorphine Training: Waiver Training for NPs & PAs [Part 1: 8 of 24 hours]

Authors

As an ACCME accredited provider of continuing medical education, Clinical Tools, Inc.complies with the Standards for Commercial Support issued by the ACCME and requires disclosure of and resolution of any conflicts of interest for those in control of content.
T Bradley Tanner, MD (President, Clinical Tools, Inc.)T. Bradley Tanner, MD is president of Clinical Tools and responsible for the vision of the company. He has received funding via grants and contracts from NIDA, NIAAA, NIMH, NCI, AHRQ, CDC, the Dept of Defense, and NASA to develop medical and health education projects. Dr. Tanner served as principal investigator on 2 NIDA grants to develop the DATA-2000 qualifying buprenorphine training program and clinical practice tools on BupPractice.com. He also has a strong background in technology and oversees development and delivery of all Clinical Tools websites. Dr. Tanner is also a board-certified psychiatrist with experience in inpatient, outpatient, and emergency health settings. He currently treats patients and educates medical students and residents via his role a Clinical Associate Professor of Psychiatry at the University of North Carolina Chapel Hill.
Disclosure: Has disclosed no relevant financial relationships.
Karen Rossie, DDS, PhD (Research Scientist, Clinical Tools, Inc. )Karen Rossie, DDS, PhD, directs projects at Clinical Tools. She majored in biology at Cleveland State University and studied dentistry at Case Western Reserve University followed by completing a Masters in pathology at Ohio State University, and later, a PhD in Psychology from the Institute of Transpersonal Psychology. She taught and practiced oral pathology and oral medicine for 15 years at the Ohio State University and University of Pittsburgh, doing research in autoimmune disease, bone marrow transplantation, oral cancer, salivary gland disease, candidiasis, and diabetes. She has used this diverse background to lead or contribute to CTI projects related to tobacco cessation, opioid abuse treatment, anxiety, dementia care, alcohol use disorder, screening and brief interventions for substance abuse, obesity, and pain and addiction.
Disclosure: Has disclosed no relevant financial relationships.

Reviewers

Judith Martin, MD (President of California Society of Addiction Medicine (CSAM) and Medical Director, BAART Turk Street Clinic)Dr. Martin's residency specialty is family practice and she has worked in addiction medicine since 1986, and is certified in addiction medicine by the American Society of Addiction Medicine (ASAM). She works with heroin-addicted patients and their families in East Oakland, as the Medical Director of The 14th Street Clinic. She also serves as the Medical Director for the East Bay Community Recovery Project, a multi-service agency that includes a residential program for addicted women and their children, Project Pride. Dr. Martin has published several papers related to methadone maintenance and she has taught in the Division of Family Medicine at Stanford University School of Medicine. Currently, Dr. Martin is the President of the California Society of Addiction Medicine (CSAM), has served on CSAM's executive council, and she chairs their Committee for the Treatment of Opiate Dependence. Since 2001, she has been involved in efforts to train physicians in opiate dependence and the use of buprenorphine for the treatment of opiate addiction. She is currently co-chair of the American Society of Addiction Medicine's Buprenorphine Training Subcommittee.
Disclosure: Has disclosed no relevant financial relationships.
Steve Applegate, MEd, MEdMr. Applegate has experience in substance use counseling, state initiatives impacting substance use, and professional training. His prior positions include director of higher education and instructional design at the North Carolina Governor's Institute on Alcohol and Substance Abuse, project director of the North Carolina Initiative of the Mid-Atlantic Addiction Technology Transfer Center, and program director of the Addiction Sciences Center (an outpatient substance abuse treatment center at the University of Virginia Health Sciences Center). Mr. Applegate works as an on-site consultant and travels to the Clinical Tools (CTI) office on a monthly basis from his office in Richmond, VA. Mr. Applegate helped design the CTI Instructional Manual and works to continue to revise it as we expand our Instructional Design methodology. Mr. Applegate has extensive experience with online education and training, especially in the area of substance abuse. He often pushes the envelope of technology and brainstorms with Clinical Tools how we can utilize new technology within our products. He helped guide development of the curriculum plan and assessments in Phase I of the current project.
Disclosure: Has disclosed no relevant financial relationships.

Audience and Accreditation

Audience:

Providers

TypeEst. TimeReleasedExpires
AMA PRA Category 1 Credit(s)™9hr(s)11/21/1611/21/17
DCBN9 hr(s)11/21/1611/21/17
FAPA9 hr(s)11/21/1611/21/17

Designation Statement: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education by Clinical Tools, Inc.. Clinical Tools, Inc. is accredited by the ACCME to provide continuing medical education for physicians.
AMA PRA Category 1 Credit(s)™ Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 9 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
DCBN Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 9 hour(s) of DCBN credit. Clinical Tools, Inc. is an approved provider by the District of Columbia Board of Nursing and is registered with CE Broker, Provider #50-1942. Providers and other health professionals should claim only the credit commensurate with the extent of their participation in the activity.
FAPA Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 9 hour(s) of FAPA credit. Providers and other health professionals should claim only the credit commensurate with the extent of their participation in the activity.
A letter of completion for up to 9 hour(s) is available for non-physicians.
A score of 70% on the post-test is required to complete the activity.

Overview

Goal: To provide a core training to Nurse Practitioners and Physician Assistants who meet the requirement of the federal CARA 2016 law (which includes an 24 hour training experience), in order to increase the number of providers who are knowledgeable about and qualified to prescribe buprenorphine to their patients with opioid use disorder.

Professional Practice GapsPart 1:

Data from the 2013 National Survey on Drug Use and Health shows that a serious epidemic of opioid misuse continues at a rate similar to the previous 5 years (SAMHSA, 2014). Of Americans over age twelve: 289,000 currently use heroin and 4.5 million currently engage in misuse of pain relievers. Although the number of people receiving treatment for opioid use disorder has increased, the number of people being treated is still only a small fraction of those needing treatment: Past year treatment for prescription pain reliever misuse was still only received by 746,000 individuals in 2013 (SAMHSA, 2014).

Buprenorphine is a safe and effective treatment for opioid use disorder that offers patients a more widely available, accessible, convenient treatment option as compared to traditional opioid treatment programs (OTP) (SAMHSA, 2001; Johnson et al., 2003; SAMHSA, 2004). The Drug Addiction Treatment Act (DATA) of 2000—an amendment to the Controlled Substances Act — allowed physicians who are not part of an OTP to prescribe buprenorphine with additional training and a waiver to the Controlled Substances Act. The Comprehensive Addiction and Recovery Act of 2016 (CARA) added nurse practitioners and physician assistants to the list of providers who can train to prescribe buprenorphine and become waivered.

The law requires physicians to complete an 8-hour buprenorphine training conducted by an approved organization in order to prescribe it; the required training for nurse practitioners and physician assistants is 24 hours. While buprenorphine is relatively safe, there are risks of overdose and death due to buprenorphine and there is a risk of diversion (FSMB, 2013), which, in addition to skills needed to prescribe the medication effectively for each individual, are among the reasons for the mandatory training.

This buprenorphine training activity prepares providers to prescribe buprenorphine safely and effectively to address needs of the millions of Americans with opioid use problems. The activity has been developed to meet the DATA 2000 training guidelines as defined in Public Law 106-310-106th Congress as well as the Comprehensive Addiction and Recovery Act of 2016 (S 524, Title III, Section 303-114th Congress) and is endorsed by the American Society of Addiction Medicine, one of the approved training organizations named in DATA 2000. The activity content was initially based upon SAMHSA’s 2004 publication Treatment Improvement Protocol (TIP) #40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction and follow the Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office (FSMB, 2013). It has been edited to SAMHSA's Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder - Review and Update (2016), ASAM's National Practice Guideline For the Use of Medication in the Treatment of Addiction Involving Opioid Use (2015), and the CDC's guidelines on opioid treatment (Dowell et al., 2015) as well as CARA 2016. The courses are regularly reviewed and updated by ASAM members who are experts in the field of addiction medicine and buprenorphine treatment.

References:
American Society of Addiction Medicine (ASAM). The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. American Society of Addiction Medicine. June 1, 2015. Available at: http://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement1b630f9472bc604ca5b7ff000030b21a.pdf?sfvrsn=0 Accessed on: 2015-10-06.
Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep. 2016; ePub: March 2016: DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1er. Available at: http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm Accessed on: 2016-03-16.
FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website http://www.fsmb.org. 2013. Available at: https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/2013_model_policy_treatment_opioid_addiction.pdf Accessed on: 2013-10-11.
Johnson RE, Strain EC, Amass L. Buprenorphine: how to use it right. Drug Alcohol Depend. 2003; 70(suppl 2): S59-S77. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12738351 Accessed on: 2013-10-08.
Substance Abuse and Mental Health Services Administration (SAMHSA). Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 40, USDHHS Publication (SMA) 04-3939. 2004b. Available at: https://www.ncbi.nlm.nih.gov/books/NBK64245/ Accessed on: 2013-10-08.
Substance Abuse and Mental Health Services Administration (SAMHSA). Use of Buprenorphine in the Pharmacologic Management of Opioid Dependence: A Curriculum for Physicians. Substance Abuse and Mental Health Services Administration. 2001. Available at: http://www.uiphp.org.ua/media/1488 Accessed on: 2013-10-08.
Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings . NSDUH Series H-48. 2014; HHS Publication No. (SMA) 14-4863: . Available at: http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf Accessed on: 2015-03-12.
Substance Abuse and Mental Health Services Administration. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Advisory. Winter 2016; 15 (1): . Available at: http://store.samhsa.gov/shin/content//SMA16-4938/SMA16-4938.pdf Accessed on: 2016-03-05.
U.S. House of Representatives. Comprehensive Addiction and Recovery Act of 2016. docs.house.gov. 2016. Available at: http://docs.house.gov/billsthisweek/20160704/CRPT-114HRPT-S524.pdf Accessed on: 2016-11-17.
This activity is designed to change: Competence, Performance, Patient Outcome.

Educational Objectives:

After completing this activity participants will be able to:
  • Expand your practice to comply with the regulations and requirements of office-based buprenorphine treatment so that you can prescribe buprenorphine to your patients when appropriate

  • Relate buprenorphine's pharmacological properties to its drug effects and understand the physiological effects of opioids and opioid treatments on patients

  • Identify, assess, and diagnose opioid use disorder in your patients

  • Use medical and substance use disorder history information to assess your patients in terms of suitability for treatment with buprenorphine

  • Provide effective and successful treatment to your patients throughout the phases of buprenorphine treatment: induction, maintenance, and discontinuation, and deal with complications that arise

  • Assess and adapt treatment guidelines to best treat your patients from specific patient populations, including those with psychiatric comorbidities, adolescents, the elderly, pregnant women, methadone transfers, and patients with pain

  • Prescribe, refer, or implement appropriate psychosocial therapies for treating opioid use disorder for your patients

Modules in this Training Activity

  • About Prescribing Buprenorphine v4.0

  • Impact of Opioid Use Disorder v4.0

  • Pharmacology of Buprenorphine and Other Opioids v4.0

  • Detection and Diagnosis of Opioid Use Disorder v4.0

  • Assessing Patients for Buprenorphine Treatment v4.0

  • Buprenorphine Protocol: Induction v4.0

  • Buprenorphine Protocols: Maintenance and Discontinuation v4.0

  • Buprenorphine Protocols: Methadone Patients and Other Subpopulations v4.0

  • Managing Patients in a Buprenorphine Practice v4.0

  • Regulations for Office-Based Opioid Treatment v4.0

Practice Gap References:

21 USC § 812 . Schedules of controlled substances. www.law.cornell.edu/uscode. 2012. Available at: http://www.law.cornell.edu/uscode/text/21/812#b_3 Accessed on: 2013-12-04.
Actavis Elizabeth LLC. Buprenorphine HCl and naloxone HCl prescribing information. Actavis. 2013. Available at: http://pi.actavis.com/data_stream.asp?product_group=1853&p=pi&language=E Accessed on: 2014-10-07.
Addiction Treatment Forum. History of Buprenorphine. Addiction Treatment Forum Website. 2013. Available at: http://atforum.com/2013/02/history-of-buprenorphine/ Accessed on: 2015-04-09.
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Review Dates

Content Review:Editorial Review:
Fri, 11/18/2016Fri, 11/18/2016

Participation Requirements

Activity Credit: Obtaining credit for participation in this activity requires that you complete the pre-assessments, work through the modules (including all in-module interactive activities), complete the post-assessments with a 70% score on the post-test, and then request credit. At the end of the activity, you will be instructed on how to print out a certificate for your records.

Time Requirement: Keep track of the amount of time it takes you to complete this activity. You will be required to spend a set amount of time in order to claim credit. You should claim credit only for the time actually spent in the activity.

Technical Requirement: To participate in this activity, you will need a computer, an Internet connection, and a Web browser. This activity requires Chrome, Firefox, and IE7 or higher.

FundingInitial development of this activity was supported by a grant from the National Institute on Drug Abuse (#R44-DA12066).
Training Activity References:
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