Skip to main content
Help

Prescription Drug Misuse and Addiction: Compassionate Care for a Complex Problem

Prescription Drug Misuse and Addiction: Compassionate Care for a Complex Problem

Internet Enduring Material Sponsored by:

Stanford University School of Medicine

Stanford School of Medicine logo

Presented by:

Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine

Course Description

This CME activity provides a practical approach to the management of prescription drug misuse and addiction, including how to use the clinical interview and CURES (California’s Prescription Drug Monitoring Program) to identify if a problem exists, and how to intervene once the problem has been identified. Animated didactic videos, interactive slides, and video case scenarios will be used to put these principles into practice with a treatment algorithm. The most compassionate approach to tapering patients down and off the medication they are misusing will also be discussed.

Intended Audience

This course is designed for physicians and all health care providers who interact with patients around the issue of prescription medication, e.g. nurses, pharmacists, physician assistants.

Dates, Duration & Fee

  • Release Date: October 23, 2015
  • Expiration Date: August 31, 2018
  • Estimated Time to Complete: 2 hours
  • CME Credits Offered: 2.00
  • Registration Fee: FREE

Please review all of the information on this page before clicking the Courseware tab at the top of the page to begin the course.

To Obtain CME Credits

  • Review the information below and complete the entire activity.
  • Complete the CME Post-test, CME Evaluation Survey, and CME Activity Completion Statement at the end of the activity.
  • You must receive a score of 75% or higher on the post-test in order to receive a certificate. You will have two attempts to answer each multiple-choice question (or one attempt for questions with only two options) to pass the post-test.
  • Once you attest to completing the entire online activity and have scored 75% or higher on the post-test, your certificate will be generated automatically and will be available on your Dashboard page.
  • Physicians will be awarded AMA PRA Category 1 Credits™. All other participants will receive a Certificate of Participation.

Learning Objectives

At the conclusion of this activity, participants should be able to:

  • Describe the current state of the prescription drug misuse problem.
  • Describe the role of the provider in the prescription drug misuse problem.
  • Recognize drug-seeking patterns and strategies used by patients who are misusing prescription medications.
  • Diagnose a prescription drug use problem when it is present.
  • Reduce or avoid using enabling and defensive behaviors which exacerbate the problem in the patient.
  • Describe the implications for treatment and outcomes when prescription drug misuse is recognized as a chronic medical illness.
  • Interpret findings on CURES, California’s prescription drug monitoring program, to identify a prescription drug problem.

Table of Contents

  1. Introduction
  2. Describing the Prescription Drug Epidemic
  3. The Doctor-Patient Relationship
  4. How Doctors Can Help Instead of Harm?
  5. Course Wrap-up
  6. Resources and References
  7. Help!

Disclosures

The following planners, speakers and authors have indicated that they have no relationships with industry to disclose relative to the content of this activity:

Anna Lembke, MD
Assistant Professor of Psychiatry and Behavioral Sciences
Director, Stanford Addiction Medicine Program
Stanford University School of Medicine
Course Director
Speaker

Technical Design and Development

Mike McAuliffe
Stanford EdTech

Kimberley Walker, PhD
Stanford EdTech

Greg Bruhns
Stanford Online

Pamela Nemecek
Role Play Actor

Hardware/Software Requirements

  • Computer with Internet connection
  • Current version of Chrome or Safari browser. You must have javascript enabled.

Accreditation and Designation of Credits

The Stanford University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Stanford University School of Medicine designates this enduring material for a maximum of 2.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The California Board of Registered Nursing recognizes that Continuing Medical Education (CME) is acceptable for meeting RN continuing education requirements as long as the course is certified for AMA PRA Category 1 Credits™ (rn.ca.gov). Nurses will receive a Certificate of Participation following this activity that may be used for license renewal.

Commercial Support Acknowledgement

This activity received no commercial support.

Cultural and Linguistic Competency

California Assembly Bill 1195 requires continuing medical education activities with patient care components to include curriculum in the subjects of cultural and linguistic competency. It is the intent of the bill, which went into effect July 1, 2006, to encourage physicians and surgeons, CME providers in the State of California and the Accreditation Council for Continuing Medical Education to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development. The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area. The Stanford University School of Medicine Multicultural Health Portal also contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws. You are encouraged to visit the portal: http:/ /lane.stanford.edu/portals/cultural.html.

CME Privacy Policy

Click here to review the Stanford Center for CME Privacy Policy.

Contact Information

If you are having technical problems (video freezes or is unplayable, can't print your certificate, etc.) you can submit a Help Request to the OpenEdX Team. If you have questions related to CME credit, requirements (Pre-test, Post-test, Evaluation, Attestation) or course content, you can contact the CME Online support team at cmeonline@stanford.edu

Bibliography

Administration SA and MHS. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013.

Centers for Disease Control and Prevention (institution). No Title. http://www.cdc.gov/vaccines/about/terms/glossary.htm#e. Accessed July 30, 2015.

Chen LH, Hedegaard H, Warner M. QuickStats: Rates of deaths from drug poisoning and drug poisoning involving opioid analgesics—United States, 1999–2013. MMWR Morb Mortal Wkly Rep. 2015;64(01):32.

Crews F, He J, Hodge C. Adolescent cortical development: a critical period of vulnerability for addiction. Pharmacol Biochem Behav. 2007;86(2):189-199.

Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; 2013.

Drugfree.org. 2012 Partnership Attitude Tracking Study. 2013. http://www.drugfree.org/wp-content/uploads/2013/04/PATS-2012-FULL-REPORT2.pdf. Accessed December 16, 2013.

George O, Le Moal M, Koob GF. Allostasis and addiction: role of the dopamine and corticotropin-releasing factor systems. Physiol Behav. 2012;106(1):58-64.

Humphreys K. Circles of Recovery: Self-Help Organizations for Addictions. Vol (Edwards G, ed.). Cambridge: Cambridge University Press; 2004.

Kauer JA, Malenka RC. Synaptic plasticity and addiction. Nat Rev Neurosci. 2007;8(11):844-858.

Lembke A. From self-medication to intoxication: time for a paradigm shift. Addiction. 2013;108(4):670-671.

Lembke A. Why doctors prescribe opioids to known opioid abusers. N Engl J Med. 2013;368(5):485.

Manchikanti L. National drug control policy and prescription drug abuse: facts and fallacies. Pain Physician. 2007;10(3):399-424.

Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician. 2008;11:S63-S88.

McDonald DC, Carlson K, Izrael D. Geographic variation in opioid prescribing in the U.S. J Pain. 2012;13(10):988-996.

Nestler EJ. Is there a common molecular pathway for addiction? Nat Neurosci. 2005;8(11):1445-1449.

Paulozzi LJ. Prescription drug overdoses: a review. J Safety Res. 2012;43(4):283-289.

Paulozzi LJ, Jones CM, Mack KA, Rudd RA. Vital Signs: Overdoses of Prescription Opioid Pain Relievers --- {United States}, 1999–2008. MMWR Morb Mortal Wkly Rep. 2011;60(43):1487-1492.

Ries RK, Fiellin DA, Miller SC, Saitz R. Principles of Addiction Medicine, 4th Ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Williams; 2009.

Robison LM, Sclar DA, Skaer TL, Galin RS. National trends in the prevalence of attention-deficit/hyperactivity disorder and the prescribing of methylphenidate among school-age children: 1990-1995. Clin Pediatr (Phila). 1999;38(4):209-217.

Schultz W. Potential vulnerabilities of neuronal reward, risk, and decision mechanisms to addictive drugs. Neuron. 2011;69(4):603-617.

Selemon LD. A role for synaptic plasticity in the adolescent development of executive function. Transl Psychiatry. 2013;3:e238.

Steketee JD, Kalivas PW. Drug wanting: behavioral sensitization and relapse to drug-seeking behavior. Pharmacol Rev. 2011;63(2):348-365.

Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. Rockville, MD; 2013.

Sullivan MD, Howe CQ. Opioid therapy for chronic pain in the United States: promises and perils. Pain. 2013;154 Suppl:S94-S100.

Warner M, Chen LH, Makuc DM, Anderson RN MA. Drug poisoning deaths in the United States, 1980–2008. NCHS data brief, no 81 Hyattsville, MD US Dep Heal Hum Serv CDC. 2011.

Weisner CM, Campbell CI, Ray GT, et al. Trends in prescribed opioid therapy for non-cancer pain for individuals with prior substance use disorders. Pain. 2009;145(3):287-293.

Wise RA, Koob GF. The development and maintenance of drug addiction. Neuropsychopharmacology. 2014;39(2):254-262.

©2015 Stanford University School of Medicine

  1. Course Number

    008
  2. Classes Start

    Oct 23, 2015
Enroll