Methods for Evaluating the Opioid Analgesic Risk Evaluation and Mitigation

Strategy

December 11, 2020

Docket No. FDA-2020-N-1561

Center for Drug Evaluation and Research

Food and Drug Administration

Department of Health and Human Services

Issues Paper
 CONTENTS

OVERVIEW.................................................................................................................................... 1

BACKGROUND............................................................................................................................. 2

History of the Opioid Analgesic REMS...................................................................................... 2

OVERVIEW OF ISSUES ............................................................................................................... 5

Development and Evaluation of Continuing Education .............................................................. 5

Applying Lessons Learned From the ER/LA REMS Assessment to the Development of the OA

REMS Assessment ...................................................................................................................... 6

Proposed Study To Evaluate the Effect of OA REMS-Compliant CE on Prescriber Behavior

and Patient Outcomes .................................................................................................................. 9

SCIENTIFIC WORKSHOP DISCUSSION TOPICS ................................................................... 11

APPENDICES .............................................................................................................................. 13

 Methods for Evaluating the Opioid Analgesic Risk Evaluation and

Mitigation Strategy

OVERVIEW
The Opioid Analgesic Risk Evaluation and Mitigation Strategy (OA REMS), required by
the Food and Drug Administration (FDA) and implemented by the manufacturers of
opioid analgesics intended for use in an outpatient setting, is one strategy among multiple
national and state efforts to reduce the risk of abuse, misuse, addiction, overdose, and
deaths caused by prescription opioid analgesics. The primary component of this risk
evaluation and mitigation strategy (REMS) is a voluntary education program for
prescribers, nurses, pharmacists, and other health care providers involved in the treatment
or monitoring of patients with pain. A consortium of manufacturers, known as the REMS
Program Companies (RPC), conducts annual assessments of the OA REMS and provides
summaries of data that are used to determine whether the REMS is meeting its risk
mitigation goals.
In January 2019, FDA issued a draft guidance for industry REMS Assessment: Planning
and Reporting, which describes how to develop a REMS assessment plan and the
selection of metrics and data sources that will be used to assess whether the program is
meeting its risk mitigation goals.1 The REMS assessment plan for the OA REMS
includes a mixed methods approach as recommended in the draft guidance.
FDA is holding a scientific workshop to publicly discuss methods to evaluate the OA
REMS. The workshop has three main topics for discussion:
1. Specific, measurable outcomes that might demonstrate that voluntary training,
based on the Opioid Analgesics REMS Education Blueprint for Health Care
Providers Involved in the Treatment and Monitoring of Patients With Pain (FDA
Blueprint), is effective in educating prescribers and other health care providers
(including pharmacists and nurses) involved in the treatment and monitoring of
patients in pain about recommended pain management practices and the
appropriate use of opioid analgesics
2. The feasibility of conducting a study to specifically evaluate the effect of OA
REMS-compliant continuing education (CE) on prescriber behavior and patient
outcomes amidst the numerous concomitant strategies to combat the opioid crisis
at the Federal, State, and local levels
3. Whether there might be suitable alternative study approaches to better understand
the influence of CE, more broadly, on pain management practice and patient
outcomes if a study to directly measure the impact of REMS-compliant CE is
thought to be infeasible

1
When final this guidance will represent FDA’s current thinking on this topic. For the most recent version
of a guidance, check the FDA guidance web page at https://www.fda.gov/regulatory-information/search­
fda-guidance-documents.

BACKGROUND

HISTORY OF THE OPIOID ANALGESIC REMS

The Extended-Release and Long-Acting Opioid Analgesic REMS

In 2010, FDA determined that a REMS would be required for the extended-release and
long-acting (ER/LA) opioid analgesic products, and on July 9, 2012, the ER/LA Opioid
Analgesics REMS,2 hereafter referred to as the ER/LA REMS, was approved. The goal of
the ER/LA REMS was to reduce serious adverse outcomes resulting from inappropriate
prescribing, misuse, and abuse of ER/LA opioid analgesics while maintaining patient
access to pain medications. Adverse outcomes of interest included addiction,
unintentional overdose, and death.
The ER/LA REMS required manufacturers of these products to provide training on the
safe use of these products to prescribers of ER/LA opioid analgesics,3 which was
accomplished through unrestricted grants to CE Providers of Accredited CE. Completion
of the CE by individual prescribers was voluntary. The ER/LA REMS also included a
product-specific Medication Guide for patients; distribution of letters to prescribers,
professional organizations, and licensing boards to notify them of the ER/LA REMS; and
a Patient Counseling Document. The ER/LA REMS outlined specific performance goals
for the number of prescribers trained at 2, 3, and 4 years from the time of the availability
of the first REMS-compliant training.
Assessments of the ER/LA REMS were required at 6 months, 1 year, and annually
thereafter from the date of approval of the REMS. The assessments included:

• The number of ER/LA prescribers completing the REMS training

• An audit of the quality of the content of the educational materials
• Prescriber and patient knowledge surveys of the risks of ER/LA opioid analgesics
• Surveillance and monitoring for events of interest
• An evaluation of drug utilization patterns
• An evaluation of changes in prescribing behavior (prescriptions to opioid tolerant
patients, excessive prescriptions for early refills)
• Monitoring of patterns of prescribing to identify changes in access to ER/LA
opioid analgesics
On May 3 and 4, 2016, FDA held a joint meeting of the Drug Safety and Risk
Management (DSaRM) Advisory Committee and the Anesthetic and Analgesic Drug

2
A more detailed history of the ER/LA REMS may be found in the FDA background document for the
May 3 and 4, 2016, joint meeting of the Drug Safety and Risk Management Advisory Committee and the
Anesthetic and Analgesic Drug Products Advisory Committee, available at
https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAnd
AnalgesicDrugProductsAdvisoryCommittee/UCM497290.pdf, accessed July 30, 2020.
3
For the purposes of the ER/LA REMS, an ER/LA prescriber was defined as clinicians who are registered
with the Drug Enforcement Agency to prescribe Schedule II and/or III controlled substances and have
written at least one ER/LA opioid analgesic prescription in the past year.

Products (AADP) Advisory Committee (meeting of the DSaRM and AADP Advisory
Committees or joint advisory committee meeting) to discuss whether the ER/LA REMS
was meeting its goals and assuring safe use of ER/LA opioid analgesics; whether it was
not unduly burdensome to patient access to the drugs; and to the extent practicable,
whether it minimized the burden to the health care delivery system. Findings and
conclusions from REMS assessments were presented, and committee members agreed
that it could not be determined that the REMS was meeting its goal of reducing serious
adverse outcomes resulting from inappropriate prescribing, misuse, and abuse of ER/LA
opioid analgesics. Some of the challenges of determining whether the goals were met
included issues with representativeness of patient and prescriber surveys, which limited
the evaluation of patient and prescriber understanding of risks and safe prescribing and
use practices for these products. Observed trends in the utilization of ER/LA opioid
analgesics and adverse events of interest also complicated the evaluation of the ER/LA
REMS, because these trends predated the implementation of the REMS. In addition,
multiple concurrent activities directed at reducing harm from opioid analgesics also made
the evaluation of the ER/LA REMS difficult. The DSaRM and AADP Advisory
Committees acknowledged challenges with evaluating the REMS-compliant training;
however, they maintained that it was important to rigorously assess the REMS to
determine whether it was meeting its goals.
Despite the challenges with assessing the ER/LA REMS and determining whether it was
meeting its goals, the DSaRM and AADP Advisory Committees ultimately advised that
the ER/LA REMS be modified to:

• Expand REMS requirements to include immediate-release (IR) opioid analgesics

• Expand the FDA Blueprint to incorporate information on pain management more
broadly and to include other health care professionals involved in the
management of patients with pain
• Require that education be mandatory, though options other than a REMS should
be explored

The Opioid Analgesic REMS

On September 18, 2018, the ER/LA REMS was modified to include the IR opioid
analgesics intended for use in the outpatient setting (and not covered by other REMS
programs). The OA REMS now covers all branded and generic:

• Oral dosage forms of extended-release and immediate-release opioids containing

codeine and codeine analogs, hydrocodone, hydromorphone, levorphanol,
meperidine, morphine, oxycodone, oxymorphone, pentazocine, tapentadol, and
tramadol
• Intranasal, buccal, and transdermal delivery systems containing fentanyl,

butorphanol, and buprenorphine

• Methadone tablets and solutions indicated for use as analgesics

Additionally, the FDA Blueprint was expanded to incorporate the fundamentals of pain
management. The education was also expanded to nurses, pharmacists, and other health
care providers involved in the treatment or monitoring of patients with pain. As was done

under the ER/LA REMS, the RPC is fulfilling its requirement to provide education under
the OA REMS through unrestricted grants to CE Providers of Accredited CE.
The OA REMS covers approximately 360 individual products that are listed on the FDA
REMS website, available at
https://www.accessdata.fda.gov/scripts/cder/rems/index.cfm?event=RemsDetails.page&R
EMS=17.
The goal of the OA REMS is to educate prescribers and other health care providers
(including pharmacists and nurses) on the treatment and monitoring of patients with pain.
The education provided through the REMS is based on the FDA Blueprint (Appendix 1).
Through better education, the health care team will have an improved understanding of
how to manage pain and the role of opioid analgesics as well as nonpharmacologic and
non-opioid analgesics in pain management. The education will also provide information
about the risks of opioids and use of other therapies, which is intended to assist health
care providers in reducing adverse outcomes of addiction; unintentional overdose; and
death resulting from inappropriate prescribing, abuse, and misuse. The REMS aims to
accomplish this goal by:
1. Ensuring that training based on the FDA Blueprint is effective in educating
prescribers and other health care providers involved in the treatment and
monitoring of patients in pain (including pharmacists and nurses) about
recommended pain management practices and appropriate use of opioid
analgesics.
2. Informing patients about their roles and responsibilities regarding their pain
treatment plan, including the risks of opioid analgesics and how to use and store
them safely, as outlined in the Medication Guides and Patient Counseling Guide
for opioid analgesics.
The OA REMS requires that the REMS be assessed at 6 months, 1 year, and annually
thereafter from the date of approval of the REMS. The full assessment plan for the OA
REMS can be found in Appendix 2. The assessment includes:

• Evaluations of the distribution of letters to health care providers, professional

societies, and licensing boards
• The status of grants and descriptions of CE programs awarded
• The number of CE activity completers
• Audits of activities
• The overall pain/opioid CE landscape
• An evaluation of the effect of REMS CE on prescriber behavior and patient
outcomes
• Surveillance and monitoring related to opioid analgesic use, misuse, abuse,
overdose, addiction, and death
• An evaluation of drug utilization patterns
• An evaluation of CE completers’ knowledge

 • An evaluation of patient experiences around pain management and an evaluation

of patient knowledge

OVERVIEW OF ISSUES

DEVELOPMENT AND EVALUATION OF CONTINUING EDUCATION

Moore et al. proposed an outcomes framework for planning and assessing Continuing
Medical Education (CME) activities identifying seven levels of outcomes to determine
learning and assessment strategies in CME.4 These levels have been presented as a
pyramid, with the simplest outcomes of learner participation and satisfaction forming the
base of the pyramid, followed by knowledge, competence, performance, and patient
health, with community health at the pinnacle. Typically, participants in a CE activity for
health care providers (e.g., physicians, nurses, pharmacists) complete a knowledge
assessment and answer questions on their intent to change behavior following completion
of a CE activity. These evaluations most often provide information on the lower levels of
the pyramid. Studies of CME effectiveness have attempted to answer the challenging
question of the effect of this education on the higher levels of this pyramid, including
prescriber performance and patient health, and a limited number of studies have
demonstrated favorable effects of education on physician performance and patient
outcomes. The literature describes challenges, however, with the evaluation of a single
educational activity and the expectation that completion of a single activity will result in
immediate effects in practice change. Accreditors and providers of CE cite previous
research, summarized by Wakefield et al.,5 that describes the complexity of changing
clinical practice, and describes “stages” in the change process, concluding that, “[i]t is
extremely unlikely that any single educational intervention can address all of these stages
and effect a specific change in the clinical practice of the majority of participants.”
Nevertheless, in their 2015 systematic review of CME effectiveness, Cervero and
colleagues6 concluded:

• CME does improve physician performance and patient health outcomes.

• CME has a more reliably positive impact on physician performance than on
patient outcomes.
• CME leads to greater improvement in physician performance and patient
outcomes if it is more interactive, uses more methods, involves multiple
exposures, is longer, and is focused on outcomes that are considered important by
physicians.

4
Moore Jr. DE, Green JS, Gallis HA, 2009, Achieving Desired Results and Improved Outcomes:
Integrating Planning and Assessment Throughout Learning Activities. J Contin Educ Health Prof, 29(1):1­
5.
5
Wakefield JG, 2004, Commitment to Change: Exploring Its Role in Changing Physician Behavior
through Continuing Education, J Contin Educ Health Prof, 24:197-204.
6
Cervero R, Gaines J, 2015, The Impact of CME on Physician Performance and Patient Health Outcomes:
An Updated Synthesis of Systematic Reviews, J Contin Educ Health Prof, 35(2):131-138.

The CE community (i.e., CE Accreditors and CE Providers) has encouraged the RPC to
fund a variety of educational activity types. The most recently awarded grants for the OA
REMS (December 2018) awarded funding to 14 grant applications with a variety of
formats, including didactic, case-based, multimedia, interactive, and adaptive learning,
and the RPC stated their aim to fund grants for programs with unique and innovative
formats that are more conducive to the adult learner.7

APPLYING LESSONS LEARNED FROM THE ER/LA REMS ASSESSMENT TO THE

DEVELOPMENT OF THE OA REMS ASSESSMENT
The assessment of the ER/LA REMS focused on the number of ER/LA opioid analgesic
prescribers completing REMS training, prescriber and patient knowledge of the risks and
safe use of ER/LA opioid analgesics, changes in the utilization of ER/LA and IR opioid
analgesics following REMS approval, and changes in safety outcomes of interest (i.e.,
serious adverse outcomes resulting from inappropriate prescribing, misuse, and abuse).
Over the years that the ER/LA REMS and now the OA REMS have been in place,
evaluation of the effect of the voluntary CE programs on prescribing practices and patient
outcomes has proven to be challenging. A more complete discussion of these challenges
can be found in the meeting materials for the May 3 and 4, 2016, joint meeting of the
DSaRM and AADP Advisory Committees.2 Some examples of the challenges discussed
were:

• Though a large number of ER/LA opioid prescribers (as well as other health care
providers) completed REMS training, these numbers did not reach the
prespecified targets outlined in the REMS and represented a minority of ER/LA
opioid prescribers.
• Surveys of knowledge of both patients and prescribers showed overall a good
understanding of the risks and safe use of ER/LA opioid analgesics; however,
methodological flaws limited the representativeness of the surveyed populations
to the overall population of ER/LA prescribers and patients treated with ER/LA
opioid analgesics, which did not allow a robust assessment of the impact of
training on prescriber and patient knowledge.
• Some measures of adverse outcomes of interest (e.g., poison center calls
involving misuse or abuse of ER/LA opioid analgesics) did decrease following
the approval of the ER/LA REMS; however, these decreases began before
approval of the REMS, and decreases were also seen for drug classes not covered
by the REMS. Therefore, it was not clear whether the implementation of the
REMS contributed to the decline, particularly given the evolving landscape of the
opioid crisis and the many other concurrent efforts to reduce inappropriate
prescribing and opioid overdoses.
• Given that a minority of prescribers had completed REMS-compliant training and
changes in prescribing or patient outcomes could not be linked to completion of
CE, it was unclear whether any changes in prescribing patterns or patient

7
Information on available accredited REMS CE can be found at
https://opioidanalgesicrems.com/RpcUI/home.u, accessed August 7, 2020.

 outcomes were even occurring in the subset of prescribers who had completed
training.
In the background document8 for the May 3 and 4, 2016, joint meeting of the DSaRM
and AADP Advisory Committees, FDA noted:
Without being able to link prescriber participation in REMS training to changes
in practice or patient outcomes, it is exceedingly difficult to assess the impact of
the REMS on any of the surveillance outcomes. Discussion is needed to explore
whether it would be worthwhile and feasible to conduct a study that directly
examines the association between provider participation in trainings and specific
desired changes in prescribing or practice behaviors or patient outcomes.
Although it would be challenging, this type of study could augment and
complement an evaluation on the impact of REMS training on prescriber
knowledge and self-reported behavior change. A discussion of such a study
would need to address issues such as study design, sample size, data sources,
cohort selection and defining exposure, defining and operationalizing outcome
metrics, and controlling for confounding.

At the joint advisory committee meeting, FDA presented for consideration and discussion
a study design evaluating changes in selected outcome measures for prescribers who
complete REMS training compared with prescribers who have not. A number of
challenges were anticipated with such a design. Prescriber-level data on training
completion, prescribing patterns, and patient outcomes would need to be linked.
Outcomes, time frames, and appropriate study population and settings would need to be
carefully selected, defined, and operationalized. Also, selection bias and other
confounding factors would have to be adequately addressed. It was unclear whether such
a study would indeed be feasible and likely to yield valuable findings.
The May 3 and 4, 2016, joint advisory committee panel provided thoughts on challenges
to such an evaluation, including the likelihood of detecting a change in prescriber
behavior from one educational intervention, the difficulty in defining inappropriate
prescribing, and the feasibility of an observational study that would capture the outcome
of appropriate prescribing. One panelist stated that educating prescribers on how to safely
use these products empirically makes sense; however, attempting to prove that prescriber
behavior and patient outcomes actually improve as a result may not be possible and
would likely be unsuccessful.
Following the May 3 and 4, 2016, joint advisory committee meeting, a team was formed
in FDA’s Center for Drug Evaluation and Research (CDER) to propose a REMS
modification that considered the DSaRM and AADP Advisory Committees’ advice. The
team focused on three proposed modifications to the REMS: (1) including IR opioid
analgesics; (2) broadening the educational content to include general pain management
principles; and (3) expanding training targets to all health care providers involved in the
care of patients with pain. As part of the proposed modifications, the FDA team also

8
Available at
https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAnd
AnalgesicDrugProductsAdvisoryCommittee/UCM497290.pdf, p. 161.

revised the REMS goals and the assessment plan to include methods and metrics that
would more rigorously evaluate the REMS intervention. Similar to the ER/LA REMS
assessment plan, the OA REMS assessment plan includes training completion numbers,
audits of CE activities for content and quality, stakeholder knowledge surveys, drug use
trends and patterns, and surveillance of adverse events of interest as well as the CE
Providers’ requirement for post-training knowledge assessments for participants to obtain
credit. However, the OA REMS assessment plan also includes methods and metrics to
more rigorously evaluate the REMS intervention, including:

• The development and validation of a new instrument for use across several
different CE formats to evaluate participant knowledge before and after
completing an activity to better understand how CE completion affects knowledge
about best pain management practices and appropriate opioid prescribing. A
patient focus group component would be added to collect information about
patient experiences around pain management.
• An evaluation of the overall pain and opioid CE program landscape in the United
States, and governmental and nongovernmental policies targeting opioid
prescribing would be provided to inform concurrent educational interventions.
• An evaluation of the effect of completing REMS-compliant CE on participants’
behavior and patient outcomes, and on any barriers that providers may face in
treating patients with pain according to the best practices outlined in the FDA
Blueprint, would be provided.
In addition, following the May 3 and 4, 2016, joint advisory committee meeting, FDA
directed the RPC to submit concept papers on the evaluation of the impact of the ER/LA
REMS on:
• Prescribing practices and patient outcomes
• Prescriber and patient knowledge using alternate study designs
• Patient access
In June 2018, the RPC provided a report of a preliminary assessment of the impact of a
single large ER/LA REMS-compliant CE program, the Pri-Med CE program, on opioid
prescribing patterns. This report included results of a study that linked the National
Prescriber Index (NPI) numbers of prescriber CE completers and non-completers with
those providers’ opioid analgesic prescriptions dispensed, using the IQVIA Real-World
Data Prescription claims file. Comparisons of opioid prescribing characteristics in the
year after Pri-Med CE completion were compared to the same measures in those
prescribers during the year before the education, as well as to these measures in
prescribers who did not complete Pri-Med CE training. Neither of these comparisons
demonstrated measurable differences either in overall opioid prescribing volume or in
discouraged practices, such as prescribing high-dose opioid analgesics to opioid-naïve
patients and concomitant dispensing of ER/LA opioid analgesics with central nervous
system depressant medications. It was also noted, however, that the providers included in
the study came overwhelmingly from primary care and had very low volume of opioid
prescribing, in general. In addition, despite baseline matching of CE completers and non­
completers on categories of opioid prescription volume, prescribers who did not complete
the Pri-Med CE had subsequent 20 to 25 percent lower opioid prescription volume than

those who did, suggesting that providers with a greater expectation of prescribing opioids
may have self-selected to pursue training. Report authors noted that the study design did
not account for confounding by secular trends and other interventions to influence opioid
prescribing behavior.
To date, the Pri-Med CE program is the only RPC-funded REMS CE provider that has
captured participant NPI numbers. Both CE Providers and Accreditors have cautioned
FDA against requiring collection of NPI numbers of CE participants based on privacy
concerns as well as the likelihood of missing some members of the health care team who
do not have NPI numbers. It should also be noted that in the 2018 Request for
Applications for grant support for REMS-compliant CE, Pri-Med was not awarded grant
funding to provide OA REMS-compliant CE.
Despite these efforts to improve the assessment of the OA REMS, many challenges
remain. Foremost among these is the wide variety of CE venues, formats, and targeted
health care provider types for the currently funded REMS CE activities, as well as the
expectations of effect from a one-time completion of the CE. In addition, multiple
concurrent education activities from non-REMS sources may make the effect of REMS-
compliant CE more difficult to detect.

PROPOSED STUDY TO EVALUATE THE EFFECT OF OA REMS-COMPLIANT CE ON

PRESCRIBER BEHAVIOR AND PATIENT OUTCOMES
In response to FDA’s request for a study proposal to evaluate the effect of the new OA
REMS-compliant CE on prescriber behavior and patient outcomes (a required element of
the assessment plan), the RPC provided a White Paper entitled Evaluation of the Impact
of REMS-Compliant Accredited CE as part of the 12-month OA REMS assessment
report, which was received September 18, 2019 (Appendix 3). The White Paper proposed
a retrospective observational study using prescription dispensing claims data (and
potentially other administrative claims data). The study employed a conceptual
framework incorporating past prescribing behavior, patient and prescriber characteristics,
and environmental factors and local secular trends in opioid prescribing and patient
management to inform the determinants of opioid prescribing. This framework was
proposed to be the basis for statistical modeling of opioid prescription and pain
management practices over time. NPI-linked individual-level data on completion of
REMS-compliant CE would then be superimposed on this model to assess the marginal
effect of REMS-compliant CE on opioid prescribing and pain management practices. The
study would use a multivariable repeated measures analysis with prescriber-semesters as
the unit of observation, controlling for time-varying predictors of both prescribing
behavior and REMS-compliant CE completion. The main endpoints would be based on
the Centers for Disease Control and Prevention (CDC) guidelines for population-level
assessment of safe opioid prescribing and patient management.9 This study would require

9
Centers for Disease Control and Prevention. Quality Improvement and Care Coordination: Implementing
the CDC Guideline for Prescribing Opioids for Chronic Pain. 2018. National Center for Injury Prevention
and Control, Division of Unintentional Injury Prevention, Atlanta, GA. Available at
https://www.cdc.gov/drugoverdose/pdf/prescribing/CDC-DUIP­
QualityImprovementAndCareCoordination-508.pdf.

access to NPI numbers for prescribers who have completed REMS-compliant CE and a
data resource that can be linked to the NPI, possibly using an irreversible encryption
technique to preserve prescriber anonymity while allowing linkage of diverse data
streams.
Subsequently, the RPC’s Concurrent Education Interventions Report, which describes
other CE programs related to opioid prescribing and pain management in the United
States (Appendix 4), and the RPC’s Legislative and Policy Changes Report, which
describes governmental and nongovernmental policies targeting opioid prescribing
(Appendix 4), were completed (both also required as part of the 12-month assessment
report, as described above). Following receipt of these reports, the authors of the White
Paper submitted an addendum (Appendix 5) stating reasons why the observational
population-level assessment study proposed in the White Paper (and described above)
would not be feasible. The authors describe how the impact of 273 existing non-REMS
CE programs, many of which had content that overlapped that of REMS-compliant CE,
and the 526 identified policies directed at opioid prescribing provide insurmountable
barriers to evaluate the impact of OA REMS-compliant CE. Given the widespread
requirements for opioid-related CE from State medical boards, the authors note that the
options for a concurrent comparator group become extremely limited, because the few
providers who have not received any training may no longer be good representatives of
the counterfactual scenario, i.e., usual care without any effects of recent CE training. In
addition, considering the hundreds of recent laws and policies related to opioid
prescribing being implemented variably across States and local areas at different times,
the authors opined that adjusting for all of these impacts on prescribing trends using
statistical modeling is “aspirational at best, and may be foolhardy.” The addendum
suggested, instead, the ongoing monitoring of prescription patterns at the State level and
comparing them to CDC guidelines to assess the net impact of the forces changing opioid
prescribing practice in the United States.
Members of the FDA REMS Assessment review team met to discuss the White Paper and
the addendum described above and agreed that the proposed claims-based study would
likely face some potentially insurmountable hurdles and may yield little useful
information on the specific impact of the REMS-compliant CE activities on prescriber
behavior and patient outcomes. Some team members noted, however, that the RPC had
only proposed one study design—a large retrospective, observational population-based
study using prescription claims data—then subsequently determined that it would be
infeasible. The RPC did not share any assessments of the feasibility of any additional
designs or approaches, for example, smaller, targeted investigations within individual
health care systems; prospective studies; or interventional designs (i.e., pragmatic trials).
Such approaches, however, would still face similar challenges as the claims-based study
proposed by the RPC, including (1) identifying an appropriate study population, (2)
identifying and operationalizing meaningful outcome metrics capable of detecting
potentially small and highly variable effects of CE, (3) isolating any effects of the
REMS-compliant CE from the many other policies and educational activities in this area,
and (4) interpreting findings in light of the widely varying formats and participant
compositions of funded REMS-compliant CE programs.

10

Specifically, regarding meaningful outcome metrics, it is important to note that the FDA
Blueprint largely consists of statements such as “[health care providers] should be
knowledgeable about….” rather than specific practices that should occur, such as “pain
contracts must be completed for all patients receiving opioid analgesics.” Considering
that the FDA Blueprint addresses pain management practices more broadly rather than
just opioid analgesic prescribing, determining which are key practice measures to
evaluate in a given prescriber population and determining how to collect information on
whether those practices have changed or differ across groups is scientifically challenging.
Also, given the plethora of CE activities available, it is unclear how well the results of a
study of one or a subset of CE activities might be generalizable to the wide variety of
REMS-compliant CE activities. In addition, the inclusion of other, non-prescriber
members of the health care delivery team as targets for REMS-complaint CE
acknowledges their contribution to facilitating best practices in pain management. It is
unclear, however, how studies focused on evaluating prescriber behavior and the
outcomes of patients linked to those prescribers would incorporate the contributions of
other health care professionals in achieving safer prescribing practices and optimizing
outcomes for patients with pain.
Given these many challenges, FDA REMS Assessment review team considered whether
a pilot study or studies may be of value to further assess the feasibility of different
approaches to studying the effect of REMS-compliant CE on prescriber behavior and
patient outcomes. The team also considered whether alternative approaches should be
explored if it is ultimately determined that a rigorous evaluation of the effect of REMS-
compliant CE on practice and patient outcomes is infeasible. For example, our
understanding of the role of CE might be enhanced by a mixed-methods investigation of
the major drivers of pain management practice and opioid prescribing in the U.S. health
care system, including the barriers to change and reactions to the many recent efforts to
reduce opioid analgesic prescribing.

SCIENTIFIC WORKSHOP DISCUSSION TOPICS

The main objective of the workshop is to discuss three major topics. This objective will
be achieved through FDA and guest speaker presentations and facilitated discussion with
the panel of experts. The three major topics are as follows:
1. Specific, measurable outcomes that might demonstrate that the REMS training based
on the FDA Blueprint is effective in educating prescribers and other health care
providers (including pharmacists and nurses) involved in the treatment and
monitoring of patients in pain about recommended pain management practices and
the appropriate use of opioid analgesics.

2. The feasibility of conducting a study to specifically evaluate the effect of OA REMS-

compliant CE on prescriber behavior and patient outcomes amidst the numerous
concomitant strategies to combat the opioid crisis at the Federal, State, and local
levels. This discussion will include, for example, what effect size might be
reasonable to expect to result from a one-time completion of a CE program and
whether there are methods (e.g., study design, data sources, metrics) that could isolate

11

 and identify the effect that REMS-compliant CE has on prescriber behavior and
patient outcomes. Participants may also be asked to discuss:

• Whether a pilot study would be informative and, if so, what features of the pilot
study would be key
• Which types of stakeholders might be well-positioned to conduct such a study
• How a study might evaluate the varying formats of CE activity
• Reasonable timing for outcome evaluation relative to completion of a CE activity

3. Whether there might be suitable alternative study approaches to better understand the
influence of CE, more broadly, on pain management practice and patient outcomes, if
a study to directly measure the impact of REMS-compliant CE is thought to be
infeasible.

12

APPENDICES

APPENDIX 1: FDA Opioid Analgesic REMS Education Blueprint for Health Care
Providers Involved in the Treatment and Monitoring of Patients with Pain

APPENDIX 2: Opioid Analgesic REMS Assessment Plan July 2020

APPENDIX 3: White Paper

APPENDIX 4: Concurrent Educational Interventions Report and Legislative and Policy

Changes Report

APPENDIX 5: Addendum to White Paper

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FDA Education Blueprint for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain
September 2018

Introduction

FDA’s Opioid Analgesic REMS Education Blueprint for Health Care

Providers Involved in the Treatment and Monitoring of Patients with Pain

Background

In July 2012, FDA approved the Extended-Release and Long-Acting (ER/LA) Opioid Analgesic
Risk Evaluation and Mitigation Strategy (ER/LA REMS) to ensure that the benefits of ER and
LA opioid analgesics used in the outpatient setting outweigh the risks. That REMS was modified
and the new Opioid Analgesic REMS includes, in addition to ER/LA opioid analgesics, all
immediate-release (IR) opioids used in the outpatient setting that are not already covered by
another REMS program. The Opioid Analgesic REMS is intended to support other national
efforts underway to address the misuse and abuse of prescription opioid analgesics.

As part of the Opioid Analgesic REMS, all opioid analgesic companies must provide the
following:

• Education for health care providers (HCPs) who participate in the treatment and
monitoring of pain. For the purpose of the Opioid Analgesic REMS, HCPs will include
not only prescribers, but also HCPs who participate in the treatment and monitoring of
patients who receive opioid analgesics, including pharmacists and nurses.

o Education will be offered through accredited continuing education (CE) activities.

These activities will be supported by unrestricted educational grants from opioid
analgesic companies.

• Information for HCPs to use when counseling patients about the risks of ER, LA, and IR
opioid analgesic use.

To facilitate the development of CE educational materials and activities as part of the Opioid
Analgesic REMS, FDA has also revised the education blueprint ― originally designed to
facilitate development of CE educational materials under the ER/LA REMS. FDA has
completed the revisions to the FDA Education Blueprint for Health Care Providers Involved in
the Treatment and Monitoring of Patients with Pain (FDA Blueprint), following publication of a
draft version and consideration of received public comments.

The FDA Blueprint contains a high-level outline of the core educational messages that will be
included in the educational programs developed under the Opioid Analgesic REMS. The FDA
Blueprint focuses on the fundamentals of acute and chronic pain management and provides a
contextual framework for the safe prescribing of opioid analgesics. The core messages are
directed to prescribers, pharmacists, and nurses, but are also relevant for other HCPs who
participate in the management of pain. The course work is not intended to be exhaustive nor a
substitute for a more comprehensive pain management course.

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Accrediting bodies and CE providers will ensure that the CE activities developed comply with
the standards for CE of the Accreditation Council for Continuing Medical Education, 1, 2 or
another CE accrediting body, depending on the target audience’s medical specialty or health care
profession.

FDA is making the FDA Blueprint, approved as part of the Opioid Analgesic REMS, available
on the REMS@FDA Website (www.fda.gov/REMS), where it will remain posted for use by CE
providers as they develop the CE materials and activities. A list of the REMS-compliant CE
activities supported by unrestricted educational grants from the opioid analgesic companies to
accredited CE providers will be posted at www.opioidanalgesicREMS.com as that information
becomes available.

Reasons Why HCP Education Is So Important

Adverse outcomes of addiction, unintentional overdose, and death resulting from inappropriate
prescribing, abuse, and misuse of opioids have emerged as major public health problems. It is
critical that HCPs are knowledgeable about the risks associated with opioid analgesics as they
pertain to their patients as well as from a public health perspective. The data continue to show
problems associated with prescription opioid analgesics.

• In 2015, over 52,404 Americans died from drug poisonings, and of these, 24% or

approximately 12,570 deaths involved opioid analgesics. 3

• Based on the 2016 National Survey on Drug Use and Health (NSDUH), an estimated
11.5 million Americans aged 12 or older misused a prescription pain reliever in the past
year ― with hydrocodone, oxycodone, and codeine products being the most commonly
reported. 4

• The most common source of pain relievers in the 2016 NSDUH was “a friend or relative”
(53%). “A physician’s prescription” was the second most common source, reported by
approximately 35% of respondents. 5

The nation is facing competing public health problems: the need to adequately treat a large
number of Americans with acute and chronic pain and an epidemic of prescription opioid abuse.

1
Accreditation Council for Continuing Medical Education. 2016. Accreditation Requirements. Criteria for CME
Providers-Accreditation Criteria. Accessed July 2018.
2
Accreditation Council for Continuing Medical Education. 2016. Accreditation Requirements. Criteria for CME
Providers-Standards for Commercial Support. Accessed July 2018.
3
See https://www.cdc.gov/nchs/data/factsheets/factsheet_drug_poisoning.pdf. Accessed July 2018.
4
Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health
indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication
No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality,
Substance Abuse and Mental Health Services Administration.
5
Ibid.

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FDA Education Blueprint for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain
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Described in the 2011 report by the National Academies of Science, Engineering, and Medicine
(NASEM), Relieving PAIN in America, A Blueprint for Transforming Prevention, Care,
Education, and Research, 6 100 million Americans suffer from common chronic pain conditions;
fewer than half of Americans undergoing surgery report adequate pain relief; and 60% of
Americans visiting the emergency department with acute painful conditions receive analgesics.

The increasing availability of prescription opioids since the 1990’s has been accompanied by an
epidemic of opioid addiction. The Substance Abuse and Mental Health Services
Administration’s National Survey of Drug Use and Health has shown that most people who use
prescription analgesics “nonmedically” obtain them from friends or family, who it is believed
obtained the drugs from a doctor’s prescription. 7

Some of the immediate consequences of untreated or undertreated pain include reduced quality
of life, impaired physical function, and high economic costs. Chronic pain is associated with
physical disability, fear, anger, depression, anxiety, and reduced ability to carry out the roles of
family member, friend, and employee. It is critically important that HCPs have all the
information they need to properly treat their patients and safely manage their pain. It is also
critical for HCPs to understand when opioid analgesics are the appropriate treatment and how to
implement best practices to ensure their patients’ safety. A 2017 report by NASEM, Pain
Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of
Prescription Opioid Use, describes the challenges of providing adequate pain management and
calls for the establishment of “comprehensive pain education materials and curricula” for HCPs. 8

Having broad knowledge about how to manage patients with pain can create the opportunity for
HCPs to consider all options for pain management, including nonpharmacologic and non-opioid
pharmacologic options, and to reserve opioids for when non-opioid options are inadequate and
when the benefits of the opioids are expected to outweigh the risks. This information can also
aid HCPs in identifying and intervening when encountering obstacles that may reduce access to
nonpharmacological and non-opioid medication options. Fully informed HCPs can help
contribute to national efforts to address opioid addiction and reduce opioid misuse and abuse.

6
http://www.nationalacademies.org/hmd/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming­
Prevention-Care-Education-Research.aspx. Accessed July 2018.
7
https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf, Table 6.53A.
Accessed July 2018.
8
http://nationalacademies.org/hmd/Reports/2017/pain-management-and-the-opioid-epidemic.aspx. Accessed July
2018.

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FDA Education Blueprint for Health Care Providers

Involved in the Treatment and Monitoring of Patients with Pain

Purpose of the Opioid Analgesic REMS HCP Educational Effort

Following completion of educational activities under the Opioid Analgesic REMS, HCPs should
be knowledgeable about the following.

• The fundamental concepts of pain management, including definitions and mechanisms of

pain
• How to assess patients in pain, identifying risk factors for abuse and addiction
• The range of therapeutic options for managing pain, including nonpharmacologic

approaches and pharmacologic (non-opioid and opioid analgesics) therapies

• How to integrate opioid analgesics into a pain treatment plan individualized to the needs
of the patient
• How to safely and effectively manage patients on opioid analgesics in the acute and
chronic pain settings, including initiating therapy, titrating, and discontinuing use of
opioid analgesics
• How to counsel patients and caregivers about the safe use of opioid analgesics, including
proper storage and disposal
• How to counsel patients and caregivers about the use of naloxone for opioid overdose
• When referral to a pain specialist is appropriate
• The fundamental elements of addiction medicine
• How to identify and manage patients with opioid use disorder

In addition, HCPs will gain an understanding of current information about safe opioid practices
and about current Federal 9 and State regulations, national guidelines, 10 and professional
organization 11 and medical specialty guidelines on treating pain and prescribing opioids. HCPs
will also become familiar with the use of naloxone and with the importance of its availability for
use by patients and caregivers both in the community and in the home.

9
For example, see https://www.deadiversion.usdoj.gov/21cfr/cfr/2106cfrt.htm and
https://www.deadiversion.usdoj.gov/21cfr/21usc/829.htm. Accessed July 2018.
10
For example, see Dowell D, Haegerich TM, Chou R. 2016. CDC Guideline for Prescribing Opioids for Chronic
Pain –United States, 2016. MMWR Recomm Rep 2016; 65 (No.RR-1): 1-49. Accessed July 2018.
11
For example, see Federation of State Medical Boards’ Guidelines for the Chronic Use of Opioid Analgesics.
Accessed July 2018.

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FDA Education Blueprint for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain
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Section 1: The Basics of Pain Management

I. THE NEED FOR COMPREHENSIVE PAIN EDUCATION

The FDA Blueprint was developed with two, competing, U.S. public health concerns in mind,
(1) the large number of Americans with acute and chronic pain and (2) the epidemic of
prescription opioid abuse.

1. Providing health care providers (HCPs) with a thorough understanding of the risks
associated with opioids can give HCPs the opportunity to consider all pain management
options, including nonpharmacologic and pharmacologic options, prescribing opioids
only when non-opioid options are inadequate and when the benefits of using an opioid
are expected to outweigh the risks.

2. When HCPs have information about the risks of opioid misuse and abuse, they will be
better able to create opportunities for patient counseling and other strategies to reduce
these risks.

II. DEFINITIONS AND MECHANISMS OF PAIN

Pain can be categorized according to its duration, underlying pathophysiology of the original
insult, and whether a central sensitization component has developed. An understanding of these
different categorizations can help direct therapeutic decisions.

When defining, and classifying pain, the following should be taken into consideration:

1. Biological significance of pain (survival value)

2. Relationship between acute and chronic pain
3. Distinction between nociceptive and neuropathic pain

III. ASSESSING PATIENTS IN PAIN

HCPs should be knowledgeable about how to assess each patient when initiating a pain
management program. When appropriate, evidence-based, standardized scales and tools can be
used to document pain characteristics and guide management decisions throughout treatment,
noting the strengths and weaknesses regarding specificity and sensitivity of these scales.

Important elements of an initial assessment should include the following:

1. Patient history

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FDA Education Blueprint for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain
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2. Screening tools to evaluate the known risk factors for development of chronic pain after
an acute injury or disease

3. Screening tools to evaluate the known risk factors for opioid use disorder (OUD) or abuse

4. Queries of state prescription drug monitoring programs (PDMPs)

5. Pain assessment scales/tools

6. Functional assessment scales

7. Physical examination

8. Family planning, including information about use of contraceptives, pregnancy

intent/status and plans to breastfeed

9. Psychological and social evaluation

10. Diagnostic studies when indicated

Section 2: Creating the Pain Treatment Plan

A comprehensive pain treatment plan should be developed and customized to the needs of the
individual patient. The treatment plan should include the types of therapies planned, the goals of
treatment, and an explanation of the patient and prescriber roles and responsibilities. The goals
of treatment should be based on (1) expected outcomes of pain reduction; (2) improvement in
functional outcomes impaired by pain (e.g., activities of daily living); and (3) quality of life.

If HCPs encounter potential barriers to managing patients with pharmacologic and/or

nonpharmacologic treatment options, such as lack of insurance coverage or inadequate
availability of certain HCPs who treat patients with pain, attempts should be made to address
these barriers. The overall treatment approach and plan should be well documented in the patient
record, including written agreements and informed consent/patient provider agreements (PPAs)
that reinforce patient-provider responsibilities and avoid punitive tones.

I. COMPONENTS OF AN EFFECTIVE TREATMENT PLAN

1. The goals of treatment, including the degree of improvement in pain and function when
function has been impaired by pain

2. Possible constituents of the treatment plan, including nonpharmacologic approaches and

pharmacologic therapies

3. Patient/prescriber/health care team interactions, including

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• Patient responsibilities/compliance with the plan

• Responsibilities of the prescriber and health care team, including patient monitoring
• Plans for reviewing functional goals
• Use of supplemental medication for intermittent increases in pain
• Use of PPAs

II. GENERAL PRINCIPLES OF NONPHARMACOLOGIC APPROACHES

Pain can arise from a wide variety of causes. There are a number of nonpharmacologic and self-
management treatment options that have been found to be effective alone or as part of a
comprehensive pain management plan, particularly for musculoskeletal pain and chronic pain.
Examples include, but are not limited to, psychological, physical rehabilitative, and surgical
approaches, complementary therapies, 12 and use of approved/cleared medical devices for pain
management. HCPs should be knowledgeable about the range of treatment options available, the
types of pain that may be responsive to those options, and when they should be used as part of a
multidisciplinary approach to pain management. HCPs should also be aware that not all
nonpharmacologic options have the same strength of evidence to support their utility in the
management of pain, and some may be more applicable for some conditions than others.

III. GENERAL PRINCIPLES OF PHARMACOLOGIC ANALGESIC THERAPY

A variety of analgesics, including non-opioid and opioid medications, are available for use to
manage pain symptoms. HCPs should be well informed about the range of analgesics available
and the types of pain that may be responsive to those analgesics.

A. Non-opioid medications

When using non-opioid medications in pain management, HCPs should be knowledgeable about
the following:
1. Mechanism of action of analgesic effect
2. Indications and uses for pain management
3. Routes of administration and formulations used in pain management
4. Initial dosing, dose titration, dose tapering (when appropriate) for analgesia
5. Contraindications
6. Adverse events, with emphasis on labeled warnings
7. Drug interactions ― both pharmacodynamic and pharmacokinetic

B. Opioid analgesic medications

Opioid analgesic medications can be used successfully as a component of pain management.

However, opioids carry risks not present with most non-opioid analgesics, specifically the risks

12
For example, see https://nccih.nih.gov. Accessed July 2018.

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of addiction, abuse and misuse, which can lead to respiratory depression, overdose and death.
Therefore, it is the responsibility of HCPs to be knowledgeable, not just about the presence of
such risks, but about how to weigh these risks before prescribing an opioid and about how to
properly manage patients who are prescribed opioids, both for short-term and long-term use.
When using opioid analgesics as part of pain management, HCPs should be knowledgeable about
the following:

1. General precautions
a. Even at prescribed doses, opioid analgesics carry the risk of misuse, abuse, opioid use
disorder, overdose, and death
b. Importance of the appropriate use of PDMPs 13 and their use as a clinical decision
support tool
c. DSM-5 (R) criteria (or the most recent version) for OUD and the concepts of abuse
(taking an opioid to get high) vs. misuse (taking more than prescribed for pain or
giving to someone else in pain) 14
d. The concepts of tolerance and physiological dependence and how they differ from
OUD (addiction)
e. Recognition that some opioid analgesics (e.g., Transmucosal Immediate Release
Fentanyl products, some ER/LA products) are safe only for opioid-tolerant patients

2. Mechanism of action and analgesic effect

3. Types of opioids (full agonists, partial agonists)

4. Indications and uses for pain management

5. Range of opioid analgesic products available for pain management and their related
safety concerns
a. Routes of administration including oral, transmucosal, transdermal
b. Release characteristics of immediate release (IR), extended-release (ER), long-acting
(LA)
c. Abuse-deterrent formulations (ADFs)
• Definition of ADF based on the FDA guidance for industry, Abuse-Deterrent
Opioids – Evaluation and Labeling 15
• Recognition that all ADFs have the same potential for addiction and overdose
death as non-abuse-deterrent opioids
• How to understand FDA-approved ADF product labeling

6. Initial dosing, dose titration, dose tapering (when appropriate) for analgesia
a. Concepts and limitations of the conversion charts in labeling and the limitations of
relative potency or equianalgesic dosing tables in literature

13
SAMHSA Prescription Drug Monitoring Programs: A Guide for Healthcare Providers. Accessed July 2018.
14
American Psychiatric Association DSM-5-Opioid Use Disorder Diagnostic Criteria. Accessed July 2018.
15
See FDA guidance for industry Abuse-Deterrent Opioids —Evaluation and Labeling. Accessed July 2018.

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FDA Education Blueprint for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain
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b. Interindividual variability of response

c. Special populations
• Pregnant, postpartum, breastfeeding, and neonatal opioid withdrawal syndrome
• Renal and hepatic impairment
• Children and adolescents
• Genetic and phenotypic variations
• Older adults
• Sleep disorders
• Common and uncommon psychiatric disorders

7. Contraindications

8. Adverse Events
a. Medication errors
b. Periods of greater risk for significant respiratory depression, including at treatment
initiation and with dose increases
c. Serious adverse drug reactions (including overdose and death)
d. Labeled warnings
e. Common adverse drug reactions

9. Drug interactions
a. Pharmacokinetic interactions based on metabolic pathway
b. Pharmacokinetic and pharmacodynamic interactions with alcohol
c. Concerns with particular drug–drug interactions, including, but not limited to:
• Benzodiazepines and other central nervous system depressants, including alcohol
• Monoamine oxidase inhibitors
• Antidiuretic hormone drugs

10. Key safety strategies for use with opioid medications

a. Dosing instructions including daily maximum
b. Safe storage to reduce risk of accidental exposure/ingestion by household contacts,
especially children/teens and to reduce risk of theft
c. Naloxone products for use in the home to reduce risk of overdose deaths in patients
and household contacts
d. Proper disposal of used (e.g., transdermal systems) and unused opioids
e. Pain management after an opioid overdose
f. Driving and work safety

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FDA Education Blueprint for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain
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IV. MANAGING PATIENTS ON OPIOID ANALGESICS

HCPs should be knowledgeable about the appropriate use of opioids in patients with acute and
chronic pain, including the importance of balancing potential benefits with the risks of serious
adverse outcomes such as overdose and death.

A. Initiating treatment with opioids ― acute pain

1. Patient selection ― consider when an opioid is an appropriate option and consult the
PDMP

2. Dosing — as needed vs. around-the clock dosing, prescribing an appropriate quantity

based on the expected duration of pain, i.e., the least amount of medication necessary to
treat pain and for the shortest amount of time

3. Naloxone for home use ― prescribe and discuss the use of naloxone products and the
various means of administration

4. Screening tools for risk of abuse

B. Initiating treatment with opioids ― chronic pain

1. Patient selection
a. Differences in benefit and risk and expected outcomes for patients with chronic pain,
palliative care, or end-of-life care
b. Differences in initiating treatment in opioid nontolerant vs. opioid-tolerant patients

2. Dosing
a. As needed vs. around-the-clock
b. How to determine a safe initial dose
c. Safe conversion from other opioids

3. Considerations in opioid selection

a. IR or ER/LA
b. Special precautions with methadone
c. Products restricted to opioid-tolerant patients

4. When and how to use an opioid or non-opioid analgesic to supplement pain management

C. Ongoing management of patients on opioid analgesics

1. Periodic review of pain and functional goals

2. Review adverse events at each visit

• Eliciting signs or symptoms of opioid abuse
• Screening for endocrine function may be recommended

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FDA Education Blueprint for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain
September 2018

• Importance of adverse event reporting and mechanisms to report

3. Review refill history/review PDMP

4. How to determine when an opioid analgesic is no longer necessary/beneficial

D. Long-term management

1. Evaluation of the patient with worsening pain for changes in underlying condition and for
signs of OUD before increasing opioid dosage

2. Changing opioid medications

• Concept of incomplete cross-tolerance when converting patients from one opioid to
another
• Concepts and limitations of the conversion charts in labeling and the limitations of
relative potency or equianalgesic dosing tables in literature

3. Monitoring of patient adherence to the treatment plan, especially regarding misuse and
abuse:
• Perform medication reconciliation ― recognize, document, and address aberrant
drug-related behavior
• Determine if nonadherence is due to inadequate pain management
• Understand the utility and interpretation of urine drug testing (e.g., screening and
confirmatory tests) and use as indicated
• Screen and refer for substance use disorder treatment when concerns arise

E. How to recognize and intervene upon suspicion or identification of an OUD

HCPs should understand how to monitor patients taking opioid analgesics and identify the signs
and symptoms of opioid misuse, abuse, and OUD and be knowledgeable about how to begin the
process of intervention upon suspicion of an OUD.

F. When to consult with a pain specialist

HCPs should be knowledgeable about when referral to a pain management specialist is indicated,
including identifying patients at high risk for OUD and patients unable to achieve adequate pain
management.

G. Medically directed opioid tapering

HCPs should be knowledgeable about how to safely taper opioid analgesics, including how to
recognize and manage signs and symptoms of opioid withdrawal. HCPs should be
knowledgeable about the particular risks associated with tapering during pregnancy.

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H. Importance of patient education

HCPs should recognize their role in reducing the risks associated with opioid analgesics through
patient education at initiation of an opioid and throughout long-term management.

1. Inform patients about pain management expectations and managing pain through

different pharmacologic and nonpharmacologic modalities.

2. Use the Patient Counseling Guide: What You Need to Know About Opioid Pain
Medicines as part of discussion with patients and caregivers when prescribing opioid
analgesics.

3. Counsel the patient about the following:

a. Importance of adherence to prescribed dosing regimen
b. Patients should use the least amount of medication necessary to treat pain and for the
shortest amount of time
c. The risk of serious adverse events that can lead to death
d. The risk of addiction that can occur even when product is used as recommended
e. Known risk factors for serious adverse events, including signs and symptoms of
overdose and opioid-induced respiratory depression, GI obstruction, and allergic
reactions, among others
f. The most common side effects, along with the risk of falls, working with heavy
machinery, and driving
g. When to call the prescriber (e.g., managing adverse events, ongoing pain)
h. How to handle missed doses
i. The importance of full disclosure of all medications and supplements to all HCPs and
the risks associated with the use of alcohol and other opioids/benzodiazepines
j. Product-specific concerns, such as not to crush or chew ER products; transdermal
systems and buccal films should not be cut, torn, or damaged before use, etc.
k. How to safely taper dose to avoid withdrawal symptoms
l. Safe storage and disposal, risks of theft by family members and household visitors
m. Never share any opioid analgesic with another person
n. How and when to use naloxone products and their various means of administration
o. Seeking emergency medical treatment if an opioid overdose occurs
p. How to report adverse events and medication errors to FDA (1-800-fda-1088 or via
http://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Forms/UCM1639
19.pdf)

V. ADDICTION MEDICINE PRIMER

HCPs should be knowledgeable about the basic elements of addiction medicine and be familiar
with the definition, neurobiology, and pharmacotherapy of OUDs. In particular, stigmatizing or
blaming language should be replaced with language that acknowledges that addiction,

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reclassified as substance use disorder 16 in the revised Diagnostic Statistical Manual–V, is a

disease. The term opioid use disorder 17 should be used when referring to the use of opioids,
rather than other substances.

It should also be noted that there may be a different approach with a patient who misuses an
opioid analgesic by taking the product differently than prescribed for the purpose of managing
pain, in contrast to the patient who abuses an opioid analgesic with the intent of getting high.
HCPs should be familiar with the following:

1. The neurobiology of OUD (addictive cycle)

2. Use of screening tools to identify patients at risk, based on known risk factors, and to
identify patients developing signs of opioid dependence or addiction as early as possible.

3. Management of OUD, including the types of pharmacologic and nonpharmacologic

treatments available and when to refer to an addiction medicine specialist.

16
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (Copyright 2013). American Psychiatric
Association.
17
Id.

13
1. REMS Outreach and Communication

a. For each healthcare provider (e.g., prescriber, pharmacist) to be sent information

regarding REMS-compliant accredited continuing education (CE), provide the date
when the letters were sent; the number of letters electronically sent, received,
undeliverable, and opened; and the number of letters mailed and undeliverable

b. For each professional society, association, and licensing board to be sent

information regarding REMS-compliant accredited CE, provide the number of
letters electronically sent, received, undeliverable, and opened; and the number of
letters mailed and undeliverable

2. REMS Implementation and Operations

a. Status of grants

i. The status of the request for proposals for grants for REMS-compliant
accredited CE including:

1. Request for Application (RFA) issued: date and number of

applications submitted in response to each RFA

2. RFAs awarded: date, number, and name of grantee

3. Date/timeframe next RFA to be issued

ii. The status of the requests for proposals for any grants to CE Providers or
other CE organizations with expertise in assessing CE outcomes who agree
to conduct evaluations of health care providers who have taken REMS-
compliant accredited CE funded under this REMS.

b. Grant review committee

i. Individuals from the REMS Program Companies (RPC) reviewing grants

will include the following clinical licensures: pharmacists, nurses,
physicians. Additionally, there will be involvement by individuals with
regulatory and pharmacovigilance experience. The job title, licensure, and
professional degree of individuals will be provided for each grant review
cycle.

ii. Include any external members (non-RPC) involved in the grant review,
including those from the broad-based CE community. Provide the job title,
 licensure and professional degree of the individual for each grant review
cycle

c. For CE programs awarded during the assessment period:

i. Description of each grantee and projected number of completers

ii. For the first assessment, the date the first program based upon the FDA
Opioid Analgesic REMS Education Blueprint for Health Care Providers
Involved in the Treatment and Monitoring of Patients with Pain (“FDA
Blueprint”), became available

iii. Description of CE program:

1. Level of outcome the activity1 is designed to impact

2. CE format (live, webinar, etc.)
3. Duration of activity for live or webinar activities
4. Average duration to complete for internet/enduring activities
5. Education methods and tools (case-based, multimedia, didactic,
interactive, adaptive, etc.) 1,2

iv. All reports submitted to the RPC by CE grantees during the assessment
period.

d. Number of completers of OA REMS Continuing Education activities during the

assessment period; provide description of learners by standard learner category
data. 3

i. Summary of reports from any CE Provider that tracks participants that begin
an activity but do not complete it; only provide when insight on lack of
completion is available (e.g., participant didn’t complete because activity
too long, too difficult, etc.)

1 2
Stevenson R, Moore DE. Ascent to the Summit of the CME Pyramid. JAMA 2018;319(6):543-544
Cervero R, Gaines J. The Impact of CME on Physician Performance and Patient Health Outcomes: An Updated
Synthesis of Systematic Reviews J Contin Educ Health Prof 2015;35(2):131–138
2
Agency for Research Health and Quality. (2007). Effectiveness of Continuing Medical Education. Retrieved May
9, 2018, from https://archive.ahrq.gov/downloads/pub/evidence/pdf/cme/cme.pdf
3 Standard Continuing Education (CE) learner data to be captured by all CE Providers for Opioid Analgesic REMS
includes geographic location (state of primary practice), DEA prescriber status (individual registration or
institutional authorization), profession, practice area, and length of time in practice.
 e. Independent Audit: The results of independent audits of the CE. Audits must be
conducted on a random sample of at least 10% of the REMS-compliant accredited
CE funded under the Opioid Analgesic REMS and must include/evaluate:

i. a description of the organization(s) conducting the audit(s)

ii. whether the content of the REMS-compliant accredited CE covers all

elements of the FDA Blueprint approved as part of the REMS;

iii. whether the integrated or post-course knowledge assessment measures

knowledge of all sections of the FDA Blueprint; and

iv. whether the REMS-compliant accredited CE was conducted in

accordance with the Accreditation Council for Continuing Medication
Education (ACCME) standards for CE or appropriate standards for
accreditation bodies

f. Concurrent Educational interventions

i. For the year prior to the assessment period through the assessment period,
provide an evaluation of the overall pain/opioid CE landscape including
but not limited to:

1. States requiring prescribers, pharmacists or nurses to complete

opioid or pain management continuing education for
licensing/renewal of licensing:

a. Enumeration of these states and their requirements for

continuing education on either pain or safe opioid use,
b. estimates of annual licensed prescribers in those states
c. which, if any, opioid analgesic or ER/LA Opioid Analgesics
REMS CE were permissible in which states, for prescribers
to meet requirements

2. Health systems, including government (DOD, VA, IHS, etc.), that

require opioid or pain management continuing education; include
number of completers if available

3. Any additional available data on continuing education programs

available during this time with a focus on pharmacological pain
management or safe opioid use

3. Health Outcomes and/or Surrogates of Health Outcomes

a. Surveillance and monitoring of data relating to opioid analgesic use, misuse, abuse,
overdose, addiction, and death. Surveillance data should include the following:

i. Nationally representative data or data from large stable populations on

opioid analgesic misuse, abuse, addiction, overdose, and death, to allow
reliable assessment of national trends and demographic patterns (e.g., age
group specific rates and trends)

ii. Both overall and drug-specific outcome rates, as available, in each data
source

iii. Data on trends and patterns of illicit opioid (e.g., heroin) use and related
morbidity and mortality

b. Evaluation of drug utilization patterns: Nationally-projected data on drug

utilization trends and patterns, including an evaluation of trends in:

i. Dispensing of opioid analgesics subject to the Opioid Analgesic REMS, by

drug, age group, prescriber specialty

ii. An evaluation of opioid tolerance for products that require patients to be

opioid tolerant prior to use

iii. An evaluation of concomitant prescribing of gabapentinoids,

benzodiazepines, and other CNS depressants with opioid analgesics

c. Evaluation of patient experiences around pain management

d. An evaluation of patients’ experiences with acute and chronic pain management in

various settings: this may include a survey, focus group, or other assessment of
patient experience, including but not limited to access to coordinated pain
management care, non-pharmacological options, and judicious and informed
prescribing of opioids. The evaluation may also include an assessment of negative
patient experiences, such as perceived overprescribing of opioids, providers’
refusal to provide care, or forced rapid tapering or discontinuation.

e. Evaluation of prescriber behavior and patient outcomes: The results of an

evaluation of the effect of REMS-compliant CE on prescriber behavior and patient
outcomes. This evaluation should include the following:

i. Development and use of metrics that assess prescriber behaviors and patient
outcomes relating to key messages in FDA Blueprint. The assessment
should also include an evaluation of potential unintended adverse patient
 outcomes resulting from changes in prescribing practices (e.g., withdrawal
symptoms or increased pain due to inappropriate rapid opioid tapering,
patient abandonment, seeking of illicit opioids, suicide
attempts/completion)

ii. Use of an appropriate control group (i.e., providers who have not completed
REMS-compliant accredited CE), and rigorous control for confounding, to
allow an assessment of whether any observed changes in prescriber
behaviors or patient outcomes can be attributed to the CE

f. Evaluation of healthcare providers’ perceptions of the key influences (e.g.,

education, state legislation, system-level policies, fear of reprimand or litigation,
insurance reimbursement, time constraints) on pain management practices for
prescribers and other members of the healthcare team and what the impacts have
been on patient outcomes. For the 24-month assessment,

i. Conduct a literature review and summarize previous work in this area

ii. Propose a study or studies to address the evaluation of the key influences
on a sample of opioid prescribers. These studies may employ mixed-
methods approaches and other emerging research methodologies most
appropriate for answering the question.

4. Knowledge

a. Evaluation of CE participants: The results of evaluations to determine the impact

of REMS-compliant accredited CE on participants’ knowledge, attitudes, and self-
reported behavior around pain management and appropriate opioid prescribing. All
evaluations should be representative and generalizable to the targeted health care
professionals taking the REMS-compliant accredited CE and assess understanding
of key elements from all sections of the FDA Blueprint. Multiple methodologies
should be used, including but not limited to the following:

i. These assessments could be integrated into live, online, or multimedia

formats using interactive approaches to enhance the educational value of
the activity. Different versions or subsets of questions from a standardized
assessment tool could be employed to cover all key messages and sections
of the FDA Blueprint, in aggregate, while reducing the time burden for
individual participants and allowing the assessment to be tailored for
different types of healthcare professionals.
 ii. A long-term follow-up evaluation of participants to assess retention of
knowledge and skills, application of learning to clinical practice, self-
reported change in behavior, and barriers to change. Consider incentivizing
participation in follow-up assessment, for example through additional CE
credits.

b. Evaluation of Patient Understanding: The results of an evaluation of patients’ and

caregivers’ understanding of the serious risks of opioid analgesics and their
understanding of how to use these products safely. This evaluation may include, for
example, surveys of patients from a representative sample of patients taking opioid
analgesics with respect to education level, insurance status, and geographic
location.

5. During transition from the ER/LA Opioid Analgesics REMS to Opioid Analgesic REMS,
data to be included until the last enduring activity has been reported:

a. For each CE activity released under the ER/LA Opioid Analgesics REMS that
remains active, provide the name of the CE Provider, the title of the activity, and
the date the activity will expire

b. Aggregate data on participants and completers should be collected using original

MEMS 2.0 definitions

6. Methodologies: A timeline for submission of the assessment protocols, including data

sources and the methodologies used to conduct all the above described analyses. Each
assessment report should update the dates of submission for each component of the
assessment.

The requirements for assessments of an approved REMS under section 505-1(g)(3) include with
respect to each goal included in the strategy, an assessment of the extent to which the approved
strategy, including each element of the strategy, is meeting the goal or whether 1 or more such
goals or such elements should be modified.
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REMS Program Companies
Opioid Analgesic REMS
Twelve-Month FDA Assessment Report FINAL
V 1.0

Appendix 10 Concurrent Education Interventions Report

Proprietary and Confidential Page 85 of 105

Continuing Education: Pain Management and Safe Opioid Prescribing

July 2019

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TABLE OF -CONTENTS
LIST OF TABLES ............................................................................................................................................................................... 3

1. INTRODUCTION....................................................................................................................................................................... 4

1.1 OVERVIEW ............................................................................................................................................................................ 4

1.2 METHODOLOGY .................................................................................................................................................................... 4

1.2.1 DETERMINING STATE CE REQUIREMENTS ............................................................................................................................ 4

1.2.2 ASCERTAINING ESTIMATES OF ANNUAL LICENSED PRESCRIBERS......................................................................................... 5

1.2.3 HEALTH SYSTEMS REQUIRING OPIOID OR PAIN MANAGEMENT CE...................................................................................... 5

1.2.4 DETERMINING ADEQUACY OF REMS CE TO MEET CE REQUIREMENTS ............................................................................... 5

1.2.5 ADDITIONAL DATA ON AVAILABLE CE PROGRAMS .............................................................................................................. 5

2. STATE CONTINUING EDUCATION REQUIREMENTS ................................................................................................... 6

2.1 MEDICAL DOCTORS AND DOCTORS OF OSTEOPATHY ........................................................................................................... 6

2.2 PHYSICIAN ASSISTANTS ........................................................................................................................................................ 7

2.3 PODIATRISTS ......................................................................................................................................................................... 8

2.4 NATUROPATHIC PHYSICIANS ................................................................................................................................................ 9

2.5 NURSES ................................................................................................................................................................................. 9

2.6 DENTISTS .............................................................................................................................................................................. 9

2.7 OPTOMETRISTS ................................................................................................................................................................... 10

2.8 PHARMACISTS ..................................................................................................................................................................... 10

3. LARGE SYSTEM CONTINUING EDUCATION REQUIREMENTS ............................................................................... 12

4. SUFFICIENCY OF REMS EDUCATION PROGRAMS..................................................................................................... 14

5. ADDITIONAL CONTINUING EDUCATION PROGRAMS AVAILABLE ..................................................................... 17

APPENDIX A: “NUMBER OF AFFECTED PRESCRIBERS” LEGEND FOR APPENDICES B-I ....................................... 18

APPENDIX B: STATE PAIN AND OPIOID CE REQUIREMENTS-MEDICAL DOCTORS AND DOCTORS OF

OSTEOPATHY.................................................................................................................................................................................. 19

APPENDIX C: STATE PAIN AND OPIOID CE REQUIREMENTS-PHYSICIAN ASSISTANTS......................................... 29

APPENDIX D: STATE PAIN AND OPIOID CE REQUIREMENTS-PODIATRISTS ............................................................. 35

APPENDIX E: STATE PAIN AND OPIOID CE REQUIREMENTS-NATUROPATHS .......................................................... 40

APPENDIX F: STATE PAIN AND OPIOID CE REQUIREMENTS-NURSES ......................................................................... 42

APPENDIX G: STATE PAIN AND OPIOID CE REQUIREMENTS-DENTISTS .................................................................... 49

APPENDIX H: STATE PAIN AND OPIOID CE REQUIREMENTS-OPTOMETRISTS ........................................................ 53

APPENDIX I: STATE PAIN AND OPIOID CE REQUIREMENTS-PHARMACISTS ............................................................ 56

APPENDIX J: SUFFICIENCY OF REMS EDUCATION, BY STATE ...................................................................................... 59

APPENDIX K: CONTINUING EDUCATION PROGRAMS....................................................................................................... 64

 

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LIST OF TABLES
Table 1: Number of States in Which Standard REMS CE is Sufficient to Meet State Requirements......................... 16

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1. INTRODUCTION
1.1 Overview

In July 2012, the United States Food and Drug Administration (FDA) approved the initial Extended-Release
(ER) and Long-Acting (LA) Opioid Analgesics Risk Evaluation and Mitigation Strategy (REMS) to ensure
that the benefits of ER and LA opioid analgesics used in the outpatient setting outweigh the risks. In
September 2018, FDA released its updated Opioid Analgesic REMS Education Blueprint for Health Care
Providers Involved in the Treatment and Monitoring of Patients with Pain.

As part of an effort to evaluate the effectiveness of the Extended-Release/Long-Acting (ER/LA) REMS

program, the Opioid Analgesic REMS Program was mandated by FDA to provide an evaluation of the overall
pain/opioid CE landscape. This mandate included the following directions:

“For the year prior to the assessment period through the assessment period, provide an evaluation of
the overall pain/opioid CE landscape including but not limited to:
1. States requiring prescribers, pharmacists or nurses to complete opioid or pain management
continuing education for licensing/renewal of licensing:
a. Enumeration of these states and their requirements for continuing education on either
pain or safe opioid use;
b. estimates of annual licensed prescribers in those states;
c. which, if any, opioid analgesic or ER/LA Opioid Analgesics REMS CE were
permissible in which states, for prescribers to meet requirements;
2. Health systems, including government (DOD, VA, IHS, etc.), that require opioid or pain
management continuing education; include number of completers if available; and
3. Any additional available data on continuing education programs available during this time
with a focus on pharmacological pain management or safe opioid use”

The assessment period referenced above extends from September 18, 2018 through July 17, 2019.

The Opioid Analgesic REMS Program’s Metrics Subteam contracted with RKT Consulting, LLC, to carry out
the research needed to meet this FDA request. Presented in this report are the results of that research.
1.2 Methodology
1.2.1 Determining State CE Requirements

To determine each state’s CE requirements, both in general and focused on pain management and safe opioid
use, websites for the relevant licensing boards were accessed. Links to information for licensees about CE
requirements were followed, as well as links to relevant sections of the state’s statutes and regulations.
Additionally, websites for national organizations representing the professions covered by the FDA request
were reviewed, along with websites of independent CE providers whose posted information included lists of
state CE requirements. In some cases, it was necessary to conduct additional internet searches focused on
“controlled substance”, “opioid”, or “pain management” CE requirements. This redundant process revealed a
number of cases in which the states’ websites were not current and the follow-up process enabled the research
team to have a high degree of confidence in the findings presented below. If a requirement needed
clarification, the research team contacted the relevant licensing board.

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Requirements for general CE were recorded, and exact language regarding the pain management/opioid CE
requirements was copied and pasted into the report appendices.
1.2.2 Ascertaining Estimates of Annual Licensed Prescribers

Several sources were used to estimate the current number of licensed prescribers, nurses, and pharmacists:
• Each state’s licensing board websites for each profession were reviewed for links to this information
• If the website did not contain information about the number of licensees, a telephone call and email
contact was placed to the licensing board
• In many instances, licensing boards did not have this information readily available and required
considerable time to produce the result.
• When unable to obtain the necessary information from the licensing board, the consultants accessed
the United States Department of Labor's Bureau of Labor Statistics’ Occupational Employment
Statistics query system. This resource provided the number of employed professionals in each state, as
opposed to the number of licensed professionals, but was considered the most accurate available
estimate of the number of affected licensees

In some states, not all licensees are required to complete pain management/opioid CE. However, it was rare
that licensing boards could provide information on what proportion of their licensees met the criteria
obligating them to complete the CE requirements of interest. Superscripts defined in Appendix A are used in
Appendices B through I to indicate any factors affecting the accuracy of the estimates provided.
1.2.3 Health Systems Requiring Opioid or Pain Management CE

Section 3 of this report describes efforts undertaken to determine if large health systems have relevant CE
requirements for their prescriber, nurse, or pharmacist employees.
1.2.4 Determining Adequacy of REMS CE to Meet CE Requirements

The methodology used to determine if completing a REMS-compliant CE program would enable a licensee to
meet the state’s CE requirements is described at the beginning of Section 4 of this report.
1.2.5 Additional Data on Available CE Programs

Efforts undertaken to identify additional available CE programs are described in detail in Section 5 of this
report.

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2. STATE CONTINUING EDUCATION REQUIREMENTS

In order to evaluate the effectiveness and uptake of opioid analgesic REMS CE programming, FDA requested
information about state requirements for prescriber, pharmacist, and nursing CE related to either pain
management or safe opioid use. Specifically, FDA’s request was:
“For the year prior to the assessment period through the assessment period, provide an evaluation of
the overall pain/opioid CE landscape including but not limited to:
1. States requiring prescribers, pharmacists or nurses to complete opioid or pain management
continuing education for licensing/renewal of licensing:
a. Enumeration of these states and their requirements for continuing education on either
pain or safe opioid use,
b. estimates of annual licensed prescribers in those states…”
While pharmacists and nurses represent singular professions, the term “prescribers” encompasses several
distinct groups, including medical doctors, doctors of osteopathy, physician assistants, advanced practice
nurses, podiatrists, naturopathic physicians, dentists, and optometrists, each of which may have a scope of
practice including opioid prescribing.
The following sections present the findings of research conducted to fulfill FDA’s request. For each
profession, each jurisdiction’s general CE requirements for licensees, specific requirements regarding pain
management and opioid CE, and the best available estimate of the number of affected providers is presented.
Highlights of the findings are also presented, both to summarize the CE requirement picture for that
profession as well as to indicate provisions that are substantially different from the norm.
2.1 Medical Doctors and Doctors of Osteopathy
Medical Doctors (MDs) and Doctors of Osteopathy (DOs) are required by forty states to complete CE related
to pain management, substance use disorder, or safe opioid prescribing. Details of state requirements may be
found in Appendix B.
Highlights related to the forty states with such CE requirements include the following:
• Twenty-eight states require 3.5 hours or less of pain- and opioid-related CE for each licensure renewal
period.
• Eight states have pain- and opioid-related CE requirements based on a practitioner’s status as a pain
specialist and/or employment at a pain management clinic. Of these, six states (Alabama, Arkansas,
Ohio, South Carolina, Texas, Washington, and West Virginia) require additional CE due to a
practitioner’s status as a pain specialist and/or employment in a pain management clinic, while the
other two states (Georgia and Tennessee) exempt pain specialists from obtaining CE that is otherwise
required for non-specialists.
• Six states (California, Georgia, Louisiana, Oregon, Rhode Island, and Washington) have one-time
pain- and opioid-related CE requirements that either are prerequisites to initial licensure or are
required of all licensees one time within a certain timeframe.
• Three states (Kentucky, Nebraska, and Vermont) require that the pain- and opioid-related CE
specifically cover topics related to use of the state’s prescription drug monitoring program (PDMP).
• Seven states (Georgia, Massachusetts, New Mexico, Tennessee, Vermont, Washington, and
Wisconsin) require that the pain- and opioid-related CE specifically cover information related to state
and/or federal laws, rules, and guidelines.
• New York has no general CE requirement for MDs and DOs. However, all prescribers in the state with
a DEA registration, as well as medical residents who prescribe controlled substances under a facility
DEA registration, are required to complete at least three hours of CE in pain management, palliative

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care, and addiction prior to each biennial license renewal. Eight separate topic areas must be included
in the pain management CE.
• New Mexico has instituted a series of requirements that are very similar across all prescribing
professions. The requirements for MDs and DOs are a good example of what is found for most other
professions. MDs and DOs are required to complete five hours of CE every two years, covering a
range of topics including a review of the medical board’s rules regarding pain management.
• Oregon is another state with similar requirements spanning a number of professions. Each MD and
DO must complete a 1-hour pain management CE course provided by the Oregon Pain Management
Commission, plus an additional six hours of CE in the subjects of pain management or the treatment of
terminally ill and dying patients. Note that this is a one-time requirement only.
• Similarly, Rhode Island has implemented identical mandatory CE across several professions. MDs,
DOs, and other prescribers in the state have a one-time requirement to complete eight hours of CE on
topics such as appropriate prescribing for pain, pharmacology, dependence potential, and alternatives
to opioids for pain management. Those who have taken DATA 2000 training to prescribe
buprenorphine are exempt from the eight-hour requirement.
2.2 Physician Assistants
Physician assistants (PAs) are required by thirty-four states to complete CE related to pain management,
substance use disorder, or safe opioid prescribing. One additional state imposes a requirement for completion
of pharmacology-specific CEs, although there is no specification that such education must involve opioid
analgesics or any other controlled substance.
Details of state requirements may be found in Appendix C.
Highlights of these CE requirements include the following:
• Twenty-five states require 3.5 hours or less of pain- and opioid-related CE for each renewal period.
• Alabama requires holders of its state Controlled Substances Certificate to complete a 12-hour program
approved by the Board of Medicine. After completing this program, physician assistants are required
to complete four hours of CE every two years as part of their license renewal requirements.
• Arkansas has a complex requirement that includes five hours related to pain management for PAs
prescribing hydrocodone-containing medications and three hours of prescribing education related to
pain treatment for all PAs, every two years.
• Kentucky requires 4.5 hours every three years, related to use of the state’s PDMP, pain management,
addiction disorders, or some combination of these topics.
• Massachusetts imposes a requirement only for PAs prescribing controlled substances. Those
individuals need four CE credits every two years, with topics coming from a lengthy list related to
pain management and safe opioid use.
• Mississippi’s standard for PAs is one of the most stringent for any profession, anywhere in the
country. PAs are required to complete ten hours of CE related to prescribing medications every year,
with “an emphasis on controlled substances”. It should be noted that this requirement only applies to
PAs authorized to prescribe controlled substances.
• New Mexico has instituted a series of requirements that are very similar across all prescribing
professions. The requirements for PAs are a good example of what is found for most other professions.
PAs are required to complete five hours of CE every two years, covering a range of topics including a
review of the medical board’s rules regarding pain management.
• New York has no general CE requirement for PAs. However, all prescribers in the state with a DEA
registration, as well as medical residents who prescribe controlled substances under a facility DEA
registration, must complete at least three hours of CE in pain management, palliative care, and

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addiction prior to each biennial license renewal. Eight separate topic areas must be included in the pain
management CE.
• Ohio’s requirement is unique among PAs, in that the licensing board requires 12 pharmacology-
specific CE credits, over and above the basic requirement of 100 hours every two years, in order to
renew a Certificate to Prescribe. Although this requirement does not specifically tie to pain
management or opioid therapy, it is nonetheless included here because completion of an opioid
analgesic REMS CE program would help meet the requirement.
• Oregon is another state with similar requirements spanning a number of professions. Each PA must
complete a 1-hour pain management CE course provided by the Oregon Pain Management
Commission, plus an additional six hours of CE in the subjects of pain management or the treatment of
terminally ill and dying patients. Note that this is a one-time requirement only.
• Pennsylvania has legislated an initial requirement for four board-approved CE hours, consisting of two
hours in pain management or the identification of addiction, and two hours in the practices of
prescribing or dispensing of opioids. Following completion of this initial requirement, for each
subsequent renewal of the license, a PA must complete two hours of CE on pain management,
identification of addiction, or prescribing practices.
• Similarly, Rhode Island has implemented identical mandatory CE across several professions. PAs and
other prescribers there have a one-time requirement to complete eight hours of CE on topics such as
appropriate prescribing for pain, pharmacology, dependence potential, and alternatives to opioids for
pain management. Those who have taken DATA 2000 training to prescribe buprenorphine are exempt
from the eight-hour requirement.
• South Carolina imposes no general CE requirement for PAs to renew their licenses, but those who
prescribe controlled substances are mandated to complete four hours of CE every two years related to
approved procedures of prescribing and monitoring controlled substances in Schedules II, III, and IV.
• Texas requires completion of ten hours of CE related to pain management, but only for PAs employed
in registered pain management clinics.
2.3 Podiatrists
Doctors of podiatric medicine are required to obtain pain management/opioid use disorder/safe opioid use CE
in twenty-nine states.
Details of these requirements may be found in Appendix D.
An overview of these requirements identifies:
• Twenty-four states require three or fewer hours of pain- and opioid-related CE for each renewal
period.
• Michigan requires five hours of CE in pain and symptom management for each license renewal period.
• Mississippi requires five hours of CE for each two-year renewal cycle, related to controlled substance
prescribing, but only for podiatrists holding a current DEA registration.
• Oregon requires completion of seven hours of CE, including one hour of CE consisting of a program
provided by the Oregon Pain Management Commission.
• Texas requires ten hours of CE related to pain management, but only for providers employed by a
registered pain management clinic. There is no requirement for providers employed elsewhere.
• Utah requires 3.5 hours of CE every two years. The content of this education must include all elements
of the FDA blueprint for the ER/LA Opioid REMS program.
• Including the states mentioned above, five states permit some podiatrists to be exempt from these CE
requirements. The criteria for exemption vary from state to state.

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2.4 Naturopathic Physicians

Only five states and the District of Columbia allow naturopathic physicians to prescribe controlled substances,

including opioid analgesics. Of these, four states have CE requirements related to pain management,

substance use disorder, and/or safe opioid prescribing.

Details of these requirements may be found in Appendix E.

Summarized results include:

• Arizona requires three hours of CE related to opioid use disorder.
• California has a one-time requirement for 12 hours of CE in pain management and care of the

terminally ill. This requirement now also specifically includes content on the risks of addiction

associated with Schedule II drugs.

• Oregon requires all health care providers, including naturopaths, to complete seven hours of CE in
pain management within two years of first licensure. One hour of this content consists of a course
designed by the Oregon Pain Commission.
• Vermont requires two hours of CE each licensure period, covering a wide range of topics related to
pain management, substance use disorder, and safe opioid prescribing.
2.5 Nurses
Several types of nurses may have prescriptive privileges that include opioid analgesics. These include
Advanced Practice Registered Nurses (APRNs), Nurse Practitioners (NPs), Certified Registered Nurse
Anesthetists (CRNAs), and Certified Nurse Midwives (CNM). Forty-five states and the District of Columbia
require some or all of these types of nurses to accrue continuing education in pain management, substance use
disorder, and/or safe opioid prescribing as a condition of license renewal. In several cases, these requirements
have been instituted despite nurses generally having no CE requirements for license renewal.
Details regarding pain management/opioid CE requirements for nurses may be found Appendix F.
Following is a summary of key findings for nurses:
• Twenty-seven states and the District of Columbia impose requirements for CE in pharmacology for
nurses with prescriptive authority. Often, these requirements are substantial, with many in the 10-to-15
hour range. Several of these states also specify that these CE hours must include content related to
pain management, substance use disorders, or safe opioid use. Even though many of these
requirements are solely focused on pharmacology, they have been retained in this analysis because an
opioid REMS CE program would serve to partially fulfill that requirement.
• Seven states have no standard CE requirement for nurses, but have pain management/opioid CE
requirements for APRNs. Note that five of those seven states require APRNs to maintain national
certification, which may entail completing CE requirements.
• Nurses in Texas are required to obtain pain management/opioid CE only if they are employed by a
registered pain management clinic.
• Massachusetts sets out requirements for APRN pain management/opioid CE, but it does not specify
the minimum number of CE hours required.
• Delaware, Michigan, New Jersey, Oregon, Rhode Island, Texas (only if employed in a registered pain
management clinic), Utah, and Vermont have pain management/opioid CE requirements for all nurses,
not just for the subset eligible to prescribe controlled substances.
2.6 Dentists
Thirty-two states impose a CE requirement related to pain management and/or safe opioid use as a condition
of license renewal for dentists.

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Details of requirements for dentists can be found in Appendix G.

Following is a summary of key findings regarding required CE for dentists:
• Nearly all state dental licensing boards require either two or three hours of CE focused on pain
management, substance use disorders, and/or safe opioid use, during each license renewal period.
• Only two boards require more than three hours:
- Utah requires 3.5 hours of CE every two years, focused on controlled substance prescribing. The
required content of this CE includes all elements of the ER/LA Opioid REMS.
- Rhode Island requires completion of eight hours of Category 1 CE for any dentist with a Schedule
II DEA registration. However, this is a one-time requirement, and there is no provision requiring
further pain management or safe opioid use CE for subsequent license renewals.
• Four states limit this CE requirement to subsets of dentists either who prescribe controlled substances
in general, or who specifically prescribe opioid analgesics.
2.7 Optometrists
Optometrists are permitted to prescribe controlled substances, including opioid analgesics, in every state and
the District of Columbia. Eighteen states require CE focused on pain management and/or safe opioid use.
Details of the requirements can be found in Appendix H.
A summary of the key findings for those 18 states includes:
• Only Rhode Island and Utah have requirements that exceed three hours per license renewal period.
- Utah requires 3.5 hours of CE every two years, focused on controlled substance prescribing. The
required content of this CE includes all elements of the ER/LA Opioid REMS Continuing
Education Blueprint.
- Rhode Island requires completion of eight hours of Category 1 CE for any optometrist who
prescribes a Schedule II opioid. However, this is a one-time requirement, and there is no provision
requiring further pain management or safe opioid use CE for subsequent license renewals.
• Arizona limits its CE requirement to optometrists who are authorized to prescribe Schedule II

hydrocodone products.

• West Virginia limits its CE requirement to optometrists who have prescribed, administered, or
dispensed controlled substances during the previous two years. Licensees who certify that they have
not prescribed, administered, or dispensed controlled substances during the entire preceding two-year
period are exempt from the requirement.
2.8 Pharmacists
Although pharmacists in some states may play a role in prescribing through collaborative practice agreements,
most of their work related to pain management and safe opioid use involves accurately dispensing
medications pursuant to a legal and appropriate prescription, in accordance with the “corresponding
responsibility” language found in the federal Controlled Substances Act. Additionally, pharmacists may
counsel patients for whom opioids are prescribed about safe use, secure storage, and appropriate disposal.
Given their important role, states are beginning to establish pain management/opioid CE requirements for
pharmacists
State CE requirements for pharmacists, related to safe opioid use or pain management, can be found in
Appendix I.
A summary of the findings follows:
• Fourteen states and the District of Columbia have pharmacist CE requirements related to pain

management and/or opioid use.

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• Only three of these requirements are for more than three hours of CE every renewal period:
- Mississippi requires five hours of CE each year, related to opioid abuse and prevention of some
other drug of abuse or addiction-related issue.
- Oregon has a one-time requirement to complete seven CE hours within 24 months of the licensee’s
first license renewal; one hour must be the module from the Oregon Pain Management
Commission.
- Pennsylvania requires four hours of Board-approved education consisting of two hours in pain
management or the identification of addiction and two hours in the practices of prescribing or
dispensing of opioids, every two years.
• Although the required topics are relatively evenly divided, there is a slight preference for CE focused
on preventing, detecting, and treating opioid misuse, abuse, and addiction, over a focus on pain
management.

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3. LARGE SYSTEM CONTINUING EDUCATION REQUIREMENTS

FDA requested that RPC produce information regarding CE requirements by health systems. The specific
language of the request was as follows:
“For the year prior to the assessment period through the assessment period, provide an evaluation of
the overall pain/opioid CE landscape including but not limited to…
2. Health systems, including government (DOD, VA, IHS, etc.), that require opioid or pain
management continuing education; include number of completers if available.”
Consultants contacted sources within the Department of Defense (DOD), Veterans Administration (VA), and
Indian Health Service (IHS), inquiring about such requirements. It was determined that opioid or pain
management continuing education requirements at these three agencies are as follows:
• DOD: The Department of Defense requires prescribers and pharmacists to complete a two-hour CE
program every three years. The current iteration of this program is titled, “DoD Opioid Prescriber
Safety Training Program”. It can be accessed at https://events-
na7.adobeconnect.com/content/connect/c1/1124277231/en/events/event/shared/1959741235/event_reg
istration.html?connect-session=na7breez3zhbxwab8y3stzxv&sco-id=1959741152&_charset_=utf-8
• VA: The Veterans Administration currently has no requirement for opioid or pain management

continuing education for any of its staff.

• IHS: The Indian Health Service requires that all IHS prescribers, contractors, clinical residents, and
trainees complete its Essential Training on Pain and Addiction course within the first six months of
employment. Refresher training must be completed every three years. This course may be accessed at
https://www.ihs.gov/painmanagement/trainingopportunities/essentialtraining/.
No information is available regarding the number of providers who have completed these training programs.
Additionally, the contractor attempted to contact the largest private health systems in the United States, to
determine if they imposed any requirements on their employees. Searches for the largest systems, based on
annual revenue and on number of facilities, turned up slightly different list memberships. The following 13
systems made up a combined list:
• HCA
• Ascension Health
• Catholic Health Initiatives
• Dignity Health
• Trinity Health
• Providence St. Joseph Health
• Tenet Healthcare
• Community Health Systems
• University of California Health
• Universal Health Services
• Kaiser Permanente
• UPMC Health System
• Carolinas Healthcare System Atrium Health
Each of these health systems was contacted through two routes. First, the website of each system was
searched for a point of contact. These searches yielded two types of contacts: public relations staff, and
webforms allowing users to post a message to a source within the system. Second, searches were conducted
on LinkedIn for the Chief Medical Officers (or individuals with substantially similar roles) within each
system. Individuals at ten health systems were identified through these searches. Messages were sent to all

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identified points of contact, using email addresses and webforms from the websites and LinkedIn’s messaging
function, requesting information related to pain management or opioid CE requirements for employees of the
systems.
Of the 13 systems, only Trinity Health responded. The contact at Trinity Health reported that the system has
established a requirement for two hours of accredited CE related to pain management and/or safe opioid use
for all opioid prescribers, as well as a one-hour requirement for nurses and pharmacists. Additionally, all staff
must adhere to CE requirements established by their respective licensing boards. The Trinity Health contact
indicated that tracking completion of this educational requirement is challenging; each institution typically
carries it out, and there is no central reporting mechanism in place.

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4. SUFFICIENCY OF REMS EDUCATION PROGRAMS

Nearly every state regulatory board overseeing prescribers, pharmacists, and nurses requires its licensees to
complete CE as a means of maintaining and enhancing their competency to provide health care. Over the past
five to ten years, most licensing boards, either acting independently or in response to legislative mandate,
have added specific requirements focused on pain management and/or safe opioid use. This report details
those requirements above.
FDA has made the following request:
“For the year prior to the assessment period through the assessment period, provide an evaluation of
the overall pain/opioid CE landscape including but not limited to:
1. States requiring prescribers, pharmacists or nurses to complete opioid or pain management
continuing education for licensing/renewal of licensing:…
c. which, if any, opioid analgesic or ER/LA Opioid Analgesics REMS CE were
permissible in which states, for prescribers to meet requirements”
To conduct this evaluation, two individual reviewers experienced with CE and opioid analgesic policy
analyzed each pain/opioid CE requirement in each state and the District of Columbia, for each discipline,
comparing those requirements to the FDA’s 2018 REMS Education Blueprint. Each reviewer independently
determined whether each licensing board CE requirement would be fulfilled if a practitioner took a CE course
of sufficient length, designed to comply with the 2018 REMS Education Blueprint (“standard REMS CE”).
• If all of the state’s content requirements were contained in the 2018 REMS Blueprint, the requirement
was rated “meets”, indicating that CE programs derived solely from the REMS Blueprint can meet the
state requirements.
• If some, but not all, of the state’s content requirements were contained in the 2018 REMS Blueprint,
the requirement was rated “partially meets”, indicating that CE programs derived solely from the
REMS Blueprint can only partially meet the state requirements.
• Finally, if none of the state’s content requirements were contained in the 2018 REMS Blueprint, the
requirement was rated “does not meet”, indicating that CE programs derived solely from the REMS
Blueprint cannot meet the state requirements.

Note that this assessment does not evaluate time-based aspects of the states’ requirements, as CE programs
based on the 2018 REMS Blueprint could vary in length.
The two reviewers reconciled their findings, and then discussed and resolved any inconsistent determinations.
A summary of findings shows that some form of pain/opioid CE is required in nearly every state for at least
one discipline, and very often across most licensed disciplines within a state.
Only four states require no pain/opioid CE of any kind: Colorado, Kansas, Missouri, and South Dakota.
Of the 47 jurisdictions that do require pain/opioid CE, the most common reasons that a state requirement
would not be fulfilled by a standard REMS CE program are that the state requires:
• Information on federal and state law and regulations
• Dosage level and duration of prescribing recommendations
• Diversion training
• Prescription drug monitoring program education
• Palliative care and/or end-of-life and/or discipline-specific education

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Following is a summary of highlights related to the sufficiency of REMS CE as compared to state

requirements, by discipline. These findings are summarized in Table 1. Detailed data are presented in
Appendix J.
Doctor of Medicine/Osteopathy
Of the 40 states with physician CE requirements related to pain/opioids, standard REMS CE would totally
fulfill the requirement in 26 states, partially fulfill the requirement in 10 states, and fail to fulfill the
requirement in four states.
Physician Assistant
Of the 35 states with physician assistant CE requirements related to pain/opioids, standard REMS CE would
totally fulfill the requirement in 23 states, partially fulfill the requirement in ten states, and fail to fulfill the
requirement in two states.
Podiatrist
Of the 29 states with podiatrist CE requirements related to pain/opioids, standard REMS CE would totally
fulfill the requirement in 22 states, partially fulfill the requirement in four states, and fail to fulfill the
requirement in three states.
Naturopathic Physician
Of the four states with naturopathic physician CE requirements related to pain/opioids, standard REMS CE
would totally fulfill the requirement in one state, partially fulfill the requirement in two states, and fail to
fulfill the requirement in one state.
It is important to note that there are very few CE requirements related to pain/opioids for naturopathic
physicians because these practitioners are not licensed in every state, nor may they prescribe controlled
substances in every state in which they are licensed. Only 22 states and the District of Columbia have laws
regulating naturopathic doctors, and only six jurisdictions allow naturopathic physicians to prescribe
controlled substances. Two of those jurisdictions have no specific pain/opioid CE requirements for
naturopathic physicians.
Nurse
Of the 46 states with nurse CE requirements related to pain/opioids, standard REMS CE would totally fulfill
the requirement in 35 states, partially fulfill the requirement in five states, and fail to fulfill the requirement in
6 states.
In most cases, though not all, pain/opioid CE requirements will apply to only those nurses who hold
prescriptive authority (most often known as nurse practitioners). Some states have extended their pain/opioid
requirements to all nurses, with or without prescriptive authority.
In some cases, nurses with prescriptive authority are required to take a relatively large number of CE credits
related to pharmacology/pharmacotherapeutics. While these are not specific pain/opioid CE requirements,
these requirements may be fulfilled by standard REMS CE, as opioid education is generally considered a
subset of pharmacology. Thus, pharmacology-specific CE requirements were included for purposes of this
evaluation.
Dentist
Of the 32 states with dentist CE requirements related to pain/opioids, standard REMS CE would totally fulfill
the requirement in 21 states, partially fulfill the requirement in six states, and fail to fulfill the requirement in
5 states.

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Optometrist
Of the 18 states with optometrist CE requirements related to pain/opioids, standard REMS CE would totally
fulfill the requirement in 15 states, partially fulfill the requirement in one state, and fail to fulfill the
requirement in two states.
Pharmacist
Of the 15 states with pharmacist CE requirements related to pain/opioids, standard REMS CE would totally
fulfill the requirement in eight states, partially fulfill the requirement in two states, and fail to fulfill the
requirement in five states.
Table 1: Number of States in Which Standard REMS CE is Sufficient to Meet State Requirements
Requirements Met Requirements Partially Met Requirements Not Met No Requirements
MD/DO 26 10 4 12
Physician Assistant 23 10 2 16
Podiatrist 22 4 3 22
Naturopath 1 2 1 47
Nurse 35 5 6 5
Dentist 21 6 5 19
Optometrist 15 1 2 33
Pharmacist 8 2 5 36

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5. ADDITIONAL CONTINUING EDUCATION PROGRAMS AVAILABLE

FDA requested additional data on continuing education programs, as follows:
“For the year prior to the assessment period through the assessment period, provide an evaluation of
the overall pain/opioid CE landscape including but not limited to…
3. Any additional available data on continuing education programs available during this time
with a focus on pharmacological pain management or safe opioid use.”
This request was interpreted to mean that FDA seeks information about currently available CE programs
focused on the specified topics. Given that there is no central repository of all available CE programs, internet
searches were undertaken seeking CE programs on pain management (including non-pharmacological pain
management if it was presented as a means to reduce opioid use) and/or safe opioid use.
Extensive searching using the Google search engine and the terms “opioid continuing education,” “pain
continuing education,” and “opioid REMS continuing education” identified 273 programs. The titles,
sponsors, and CE credit hours associated with each program are listed in Appendix K. All of these programs
were available during the time frame specified by FDA. While the search strategies used were comprehensive,
it is likely that other programs are available, but were not identified. Additionally, there may have been
programs available during earlier portions of the FDA-designated window that have since closed and been
removed from the internet.

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Appendix A: “Number of Affected Prescribers” Legend for Appendices B-I

The number found in the “Number of Affected Prescribers” column represents the most accurate figure
available regarding the number of prescribers within a state that are subject to the “Pain and Opioid CE
Requirements” column.
The number included in this column is as up to date as possible, with many numbers being reported directly
from licensing boards as the “real-time” number of active licensees in July 2019. In other cases, numbers were
obtained from official state documents, state websites, and/or professional associations.
Numbers that are not qualified with any additional labels (see Legend, below) are figures that are from no
earlier than 2016, are not subject to any specific limitations, and accurately represent the number of
practitioners affected by the “Pain and Opioid CE Requirements” column. However, while the states have
come up with a number of ways to limit who must obtain pain/opioid CE, they don’t often have figures
available for these specific requirements, instead only maintaining records of their total numbers of licensees.
Therefore, a number of labels have been employed to clarify when a number provided will not be an entirely
accurate representation of the number of prescribers affected by the pain/opioid CE requirement.
Legend:
1
While the number provided represents the total number of licensees, only those licensees who actively
prescribe controlled substances must obtain the required pain/opioid CE.
2
While the number provided represents the total number of licensees, only those licensees who actively
prescribe opioids must obtain the required pain/opioid CE.
3
While the number provided represents the total number of licensees, only those licensees who prescribed an
opioid during the last licensure renewal cycle must obtain the required pain/opioid CE.
4
While the number provided represents the total number of licensees, only those licensees who are registered
with the state to prescribe (hold “prescriptive authority”) and/or dispense controlled substances must
obtain the required pain/opioid CE. This additional state-based requirement is not commensurate with DEA
registration.
5
While the number provided represents the total number of licensees, only those licensees who practice in a
pain management clinic and/or qualify as pain management specialists must obtain the required
pain/opioid CE.
6
The number provided represents the total number of licensees, and all licensees are subject to at least one
requirement related to pain/opioids/controlled substances/pharmacology/etc. However, there is an additional
pain/opioid requirement which will only apply to the subset of those licensees who prescribe controlled
substances.
7
The number represents the total number of licensees from 2015, as more recent data was unavailable.
8
While the number provided represents the total number of licensees, those licensees who qualify as pain
specialists are exempt from obtaining the required pain/opioid CE.
9
No number was available from a reliable state-based source, so data from the United States Department of
Labor's Bureau of Labor Statistics’ Occupational Employment Statistics query system was utilized. Figures
are from 2018 and represent the number of employed practitioners, not the number of licensed
practitioners.

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Appendix B: State Pain and Opioid CE Requirements-Medical Doctors and Doctors of Osteopathy

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State Pain and Opioid CE Requirements-Medical Doctors and Doctors of Osteopathy
State Boards Total CME Hours (CMEs) Required
Alabama 25 AMA PRA Category 1 CMEs every
year
Alaska 50 AMA PRA Category 1 CMEs every 2
years, or Category 1 or 2 AOA every two
years
Arizona For MDs, 40 CMEs every 2 years. For
DOs, not more than 8 hours of annual
CMEs may be obtained by completing
AMA PRA Category 1 (they need 24
AOA CMEs).
Arkansas 20 CMEs every year. 50% must be
Category 1 and in the physician's primary
area of practice.
California MD requires 50 AMA PRA Category 1
CMEs every 2 years; DO requires 100
AMA PRA Category 1 CMEs every 2
Number of
Affected
Pain and Opioid CME Requirements Prescribers
All Alabama Controlled Substance Certificate 7,160 4,5,9
holders must obtain 2 AMA PRA Category 1 or
equivalent CMEs every 2 years beginning in 2018.
Acceptable programs confer Category 1 CMEs in
the areas of: (1) controlled substance prescribing
practices, (2) recognizing signs of the abuse or
misuse of controlled substances, or (3) controlled
substance prescribing for chronic pain
management. No course pre-approval is required.
Medical Directors of pain management clinics can
qualify by completing 40 in-person; live
participatory AMA PRA Category 1 CEs in pain
management within 3 years prior to serving as a
medical director.
For license renewals for those with a DEA 1,310 9
registration, at least 2 of the total CMEs required to MD
qualify for renewal must be specific to pain
management and opioid use and addiction. AMA 446
PRA Category 1 education qualifies.
DO
A.R.S. § 32-3248.02 requires all healthcare 12,030 9
professionals who hold Drug Enforcement
Administration certifications to complete a
minimum 3 CMEs in an opioid related, substance-
use disorder related, or addiction related course
each renewal cycle as part of the annual continuing
education requirement for licensure.
For physicians who primarily treat pain, at least 10 6,567 5,6
CMEs annually must relate to pain. MD
Physicians operating a pain management program
should meet the following: 3 years’ experience in 438 5,6
the interdisciplinary management of persons with
DO
chronic pain; participation in active education on
pain management at a local or national level; Board
certification in a medical specialty or completion of
training sufficient to qualify for examinations by
members of the American Board of Medical
Specialties; 2 years’ experience in the medical
direction of an interdisciplinary Chronic Pain
Program or at least 6 months of pain fellowship.
The physician must have completed at least one of
the following: attendance at one meeting per year
of a regional and national pain society; presentation
of an abstract to a regional or national pain society;
publication on a pain topic in a peer-reviewed
journal; membership in a pain society at a regional
or national level.
There is a one-time requirement of 12 CMEs in 64,140 9
pain management and care of the terminally ill
(except for Pathologists and Radiologists) that must
be completed by the physician's second license
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State Boards Total CME Hours (CMEs) Required
years, but 40 credits must be AOA1-A or
AOA1-B.
Connecticut 50 CMEs (AMA PRA Category 1, AOA,
etc.) every 2 years. One CME means a
minimum of 50 minutes of continuing
education activity. Continuing medical
education shall be in an area of the
physician’s practice.
Florida 40 AMA PRA Category 1 CMEs every 2
Medical years
Florida 40 CMEs every 2 years
Osteopathic
Georgia 40 AMA PRA Category 1 CMEs every 2
years
Number of
Affected
Pain and Opioid CME Requirements Prescribers
renewal date or within 4 years, whichever comes
first. The 12 CMEs may be divided in any way that
is relevant to the physician's specialty and practice
setting. The Medical Board will accept any
combination of the two topics totaling 12 hours.
For physicians and surgeons licensed on or after 01
January 2019, the course must include the subject
of risks of addiction associated with the use of
Schedule II drugs. As an alternative to the above
12-hour requirement, a physician or surgeon may
complete a one-time continuing education course
of 12 CMEs in the subjects of treatment and
management of opiate-dependent patients,
including 8 hours of training in buprenorphine
treatment, or other similar medicinal treatment, for
opioid use disorders.
During the first renewal period and not less than 17,418
every six years thereafter, there is a 1-hour “risk MD
management” requirement. This requirement can
be fulfilled with a CME on prescribing controlled
substances and pain management. CME shall be in 808
an area of the physician’s practice. DO
2 hours of AMA Category 1 or AOA Category 1-A 78,050
CMEs on prescribing controlled substances, every
2 years
2 hours of AMA Category 1 or AOA Category 1-A 8,644
CMEs on prescribing controlled substances, every
2 years
Every physician not subject to Rule 360-15-.01(3) 15,110 1,6,8,9
who maintains an active DEA certificate and
prescribes controlled substances, except those
holding a residency training permit, shall complete
at least one time 3 or more hours of AMA/AOA
PRA Category 1 CME that is designed specifically
to address controlled substance prescribing
practices. The controlled substance prescribing
CME shall include instruction on controlled
substance prescribing guidelines, recognizing signs
of the abuse or misuse of controlled substances,
and controlled substance prescribing for chronic
pain management. The certification of such
completion must occur at the first renewal
following January 1, 2018 or the first renewal
following licensure. Completion of this
requirement may count as three hours toward the
CME requirement for license renewal. Rule 360-
15-.01(3) states: “Physicians who do not hold a
certification in pain management or palliative
medicine, and whose opioid pain management
patients comprise 50% or more of the patient
population must demonstrate competence by
biennially obtaining 20 (twenty) hours of
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State Boards Total CME Hours (CMEs) Required
Illinois 150 CMEs every 3 years, 60 of which
must be AMA PRA Category 1
Indiana No CME requirement for MDs and DOs,
except for new requirement for opioids
Iowa 40 AMA PRA Category 1 CMEs every
two years
Kentucky 60 CMEs every 3 years. Of the 60 CMEs,
30 must be AMA PRA Category 1 or
AOA Category 1 by an organization
accredited by the Accreditation Council
on Continuing Medical Education or the
AOA Council on Continuing Medical
Education.
Louisiana 20 AMA PRA Category 1 CMEs every
year
Maine 100 CMEs every 2 years. For MDs, 40
CMEs must be AMA Category 1. For
DOs, 40 CMEs must be AOA Category 1.
All must be Category 1 if an osteopathic
specialist.
Maryland 50 AMA PRA Category 1 CMEs every 2
years
Massachusetts 100 CMEs every 2 years. Of that 100, 40
must be AMA PRA Category 1 or AOA.
Number of
Affected
Pain and Opioid CME Requirements Prescribers
continuing medical education (“CME”) pertaining
to pain management or palliative medicine.”
Beginning in 2020, 3 CMEs on safe opioid 23,250 9
prescribing practices offered or accredited by a
professional association, state government agency,
or federal agency every licensing period
Beginning in 2019, 2 CMEs addressing the topic of 14,700 9
opioid prescribing and opioid abuse every licensing
period
2 CMEs in Chronic Pain Management every 5 5,560 9
years
Minimum of 4.5 hours of HB1 (House Bill 1) 6,060 9
approved CMEs for physicians authorized to
prescribe or dispense controlled substances every
licensing period. The education must relate to the
use of KASPER, pain management, addiction
disorders, or a combination of two or more of those
subjects. The requirement may be met with one,
4.5 hour course or multiple courses totaling 4.5
hours.
One time requirement: Effective 01 January 2018, 17,664
as a condition to license renewal, all practitioner MD
licensed to prescribe controlled substances are
required to obtain CMEs pertaining to drug
diversion training, best practices regarding 563
prescribing of controlled substances, appropriate DO
treatment of addiction, and any other matters
pertaining to the prescribing of controlled
substances that are deemed appropriate by the
board.
Effective 31 December 2017, 3 CMEs of opioid 3,840 2,9
prescribing required every 2 years for all clinicians
who prescribe opioids. 3 CMEs of any Category 1
AMA approved program on the prescribing of
opioids suffice.
1 CME every 2 years on opioid prescribing 37,853
MD
1,764
DO
10 CMEs on Risk Management (Minimum of 4, 27,340 9
Category 1 CMEs); 3 CMEs on opioid education
and pain management for renewals. Risk
management study must include instruction in
medical malpractice prevention such as risk
identification, patient safety, and loss prevention. It
may include courses in medical ethics, quality
assurance, medical-legal issues, patient relations,
non-economic aspects of practice management, or
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Number of
Affected
State Boards Total CME Hours (CMEs) Required Pain and Opioid CME Requirements Prescribers
courses designed to reduce the likelihood of
medical malpractice through means other than
increasing the licensee's medical education and
technical competence. Risk management study also
includes review of the Board's Patient Care
Assessment regulations (243 CMR 3.01-3.16) and
participation on designated peer review committees
dealing with quality assurance. Effective 01
February 2012, physicians applying to renew a
license or obtain a new license must complete at
least 3 CMEs in pain management and opioid
education. The requirement applies to all
physicians who prescribe controlled substances
(Schedules I through VI). According to state
regulations, such education includes training in
effective pain management, identification of
patients at high risk for substance abuse,
counseling patients about side effects, and the
addictive nature and proper storage and disposal of
prescription drugs. These CEUs will qualify as
either Category 1 or Category 2, and may be
counted as risk management credits.
Michigan 150 CMEs every 3 years. Of those, a 3 CME (of the 150) must be earned in the area of 34,559
Medical minimum of 75 must be AMA PRA pain and symptom management
Category 1
Michigan 150 CMEs every 3 years; 60 must be 3 CME (of the 150) must be earned in the area of 8,281
Osteopathic Category 1 pain and symptom management

Minnesota 75 AMA PRA Category 1 CMEs every 3 Effective 01 January 2020, licensees with the 15,438 7
years authority to prescribe controlled substances must
obtain at least 2 CMEs on best practices in
prescribing opioids and controlled substances,
including nonpharmacological and implantable
device alternatives for treatment of pain and
ongoing pain management, as part of the
continuing education requirements for licensure
renewal.
Mississippi 40 AMA PRA Category 1 CMEs every 2 5 CME related to prescribing medications, with 3,330 9
years emphasis on controlled substances required for
licensees with active DEA certificates
Nebraska 50 AMA PRA Category 1 CMEs every 2 Effective 01 October 2018, 3 hours every 2 years 9,500 1
years regarding prescribing opiates. This may include MD
education regarding prescribing and administering
opiates, risks and indicators regarding opiate
addiction development and emergency opiate 1,328 1
situations. 1/2 hour of the 3 shall cover the PDMP. DO
Nevada 40 AMA PRA Category 1 CMEs every 2 2 CME relating specifically to the misuse and 4,050 9
years for MDs. 35 AMA PRA Category 1 abuse of controlled substances, the prescribing of
(or AOA 1-A) CMEs every year (10 must opioids or addiction during each period of
be AOA 1-A) for DOs. licensure.

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Number of
Affected
State Boards Total CME Hours (CMEs) Required Pain and Opioid CME Requirements Prescribers
New 100 CMEs every 2 years. 40 must be 3 opioid CMEs for physicians with a DEA license 7,496
Hampshire AMA PRA Category 1. every 2 years. This requirement is not waived for
anyone (even if his or her other CME requirements
are waived). There is an approval process for this
education.
New Jersey 100 CMEs every 2 years. 40 must be Effective with 2019 and subsequent renewals, for 22,800 9
AMA PRA Category 1. all prescribers, 1 CME concerning prescription
opioid drugs, including responsible prescribing
practices, alternatives to opioids for managing and
treating pain, and the risks and signs of opioid
abuse, addiction, and diversion.
New Mexico 75 AMA PRA Category 1 CMEs every 2 5 CME in pain management. Appropriate courses 3,300 9
Medical years should include a review of NM Medical Board
Rule 16.10.14 NMAC on pain management; an
understanding of the pharmacology and risks of
controlled substances, a basic awareness of the
problems of abuse, addiction and diversion, and
awareness of state and federal regulations for the
prescription of controlled substances.
New Mexico 75 Category 1 CMEs every 2 years 6 CME in pain management. Appropriate courses 654
Osteopathic should include a review of 16.17.5 NMAC,
management of the treatment of pain, an
understanding of the pharmacology and risks of
controlled substances, a basic awareness of the
problems of abuse, addiction and diversion, and
awareness of state and federal regulations for the
prescription of controlled substances.
New York No general CME requirement. All prescribers licensed to treat humans who have a 59,140 9
DEA registration to prescribe controlled
substances, as well as medical residents who
prescribe controlled substances under a facility
DEA registration, must complete at least 3 hours of
course work or training in pain management,
palliative care, and addiction. The following 8
topic areas must be included: New York State and
federal requirements for prescribing controlled
substances; pain management; appropriate
prescribing; managing acute pain; palliative
medicine; prevention, screening, and signs of
addiction; responses to abuse and addiction; end of
life care.
North 60 Category 1 CMEs that are “relevant to Every physician who prescribes controlled 19,180 1,9
Carolina the physician's current or intended substances, except those with residency status,
specialty or area of practice” every 3 shall complete at least 3 Category 1 CMEs (counts
years toward the overall 60) that are specifically
designed to address controlled substance
prescribing practices. The course shall include
instruction on controlled substances prescribing
practices, recognizing signs of the abuse or misuse
of controlled substances, and controlled substance
prescribing for chronic pain management.

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Number of
Affected
State Boards Total CME Hours (CMEs) Required Pain and Opioid CME Requirements Prescribers
Ohio 100 CMEs every 2 years. 40 must be Each physician owner of a pain management clinic 30,400 5,9
AMA PRA Category 1. shall complete at least 20 hours of category I
CMRs in pain medicine every 2 years, to include
one or more courses addressing the potential for
addiction. The courses completed in compliance
with this rule shall be accepted toward meeting the
Category I requirement for certificate of
registration renewal for the physician.
Oklahoma For MD, 60 AMA PRA Category 1 CMEs For MDs, 1 CME in pain management or 1 CME in 6,070 9
every 3 years; for DOs, 16 AOA 1-A or B opioid use or addiction each year preceding
CMEs every year. renewal of a license, if holding a DEA registration.
For DOs, 1 CME every other year on prescribing,
dispensing, and administering controlled
substances.
Oregon 60 AMA PRA Category 1 CMEs every 2 Within the first year of licensure, licensees must 13,113
years. CMEs must be relevant to the complete CMEs on pain management. A 1-hour MD
provider's current practice. course provided by the Oregon Pain Management
Commission is required plus at least 6 more CMEs
in pain management or the treatment of terminally 1,382
ill and dying patients. Those 6 CMEs may be made DO
up of any combination of CME coursework
focusing on pain management and/or treatment of
terminally ill and dying patients. This is a one-time
requirement, but licensees may choose to obtain
additional hours on these topics throughout their
careers. The topic of pain management is legally
considered relevant for all licensees, regardless of
their specialty.
Pennsylvania 100 CMEs every 2 years. At least 20 of 4 Board-approved CMEs consisting of 2 CMEs in 48,463
Medical the 100 CMEs must be AMA PRA pain management or the identification of addiction
Category 1. and 2 CMEs in the practices of prescribing or
dispensing of opioids; subsequent renewals require
2 CMEs on pain management, identification of
addiction, or prescribing practices.
Pennsylvania 100 CMEs every 2 years. At least 20 of 4 Board-approved CMEs consisting of 2 CMEs in Not
Osteopathic the 100 CMEs must be Category 1. pain management or the identification of addiction available
and 2 CMEs in the practices of prescribing or
dispensing of opioids; subsequent renewals require
2 CMEs on pain management, identification of
addiction, or prescribing practices.
Rhode Island 40 AMA PRA Category 1 (or AOA 1-A) 8 CMEs on topics such as: appropriate prescribing 5,019
CMEs every 2 years for pain, pharmacology, potential for dependence, MD
and alternatives to opioids for pain management.
Those who have taken DATA 2000 training to
prescribe buprenorphine will be exempt from the 8- 400
hour continuing education requirement. Training DO
must be completed at least once per career and
must occur before the next renewal of your
controlled substance registration in June of 2018.
South 40 AMA PRA Category 1 CMEs every 2 2 CMEs related to approved procedures of 22,000 5,6
Carolina years. At least thirty CMEs must be prescribing and monitoring controlled substances

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State Boards Total CME Hours (CMEs) Required
related directly to the licensee's practice
area.
Tennessee For MDs, 40 hours AMA PRA Category
1 CMEs every 2 years. For DOs, 40 hours
AOA 1A or 2A CMEs every 2 years.
Texas 48 CMEs every 2 years.
Of the 48, at least 24 must be
AMA/PRA/ACCME/AOA courses.
Utah Medical 40 CMEs every 2 years. 34 CMEs must
be AMA PRA Category 1. 6 CMEs may
be from Division of Occupational and
Professional Licensing.
Utah 40 CMEs every 2 years. 34 CMEs must
Osteopathic be AMA PRA Category 1. 6 CMEs may
be from Division of Occupational and
Professional Licensing.
Number of
Affected
Pain and Opioid CME Requirements Prescribers
listed in Schedules II, III, and IV for all licensees.
Further, at least 30 of the general CMEs must be
related directly to the licensee's practice area, so
pain specialists need 30+ pain-related CMEs.
2 CMEs that must include instruction in: the 9,900 8,9
Department's treatment guidelines on opioids,
benzodiazepines, barbiturates, and carisoprodol;
topics such as medicine addiction, risk
management tools, and other topics approved by
the Board. Providers of intractable pain treatment
must have specialized CMEs in pain management.
If you do not have a DEA registration and do not
prescribe, at least 2 of the 40 required hours shall
be in a course or courses designated specifically to
address prescribing practices.
Medical doctors and osteopathic physicians who
are board certified by the American Board of
Medical Specialties, American Osteopathic
Association or the American Board of Physician
Specialties in 1 or more of the following specialties
or subspecialties do not have to complete the 2
CME on controlled substance prescribing: Pain
management, Anesthesiology, Physical medicine
and rehabilitation, Neurology, or Rheumatology.
Per Board rule 195.4(e), the medical director of a 45,250 5,9
pain management clinic must, on an annual basis,
ensure that all personnel (including the medical
director) are properly licensed, and if applicable,
trained to include 10 CMEs related to pain
management. This CME requirement applies to all
personnel providing medical services to the
patients (including, but not limited to: PAs, x-ray
techs, phlebotomists, RNs, MAs, etc.).
3.5 CMEs every 2 years on controlled substance 5,620 9
prescribing. The 3.5 CMEs shall include: the scope
of the controlled substance abuse problem in Utah
and the nation; all elements of the FDA Blueprint
for Prescriber Education under the FDA's
Extended-Release and Long-Acting Opioid
Analgesics Risk Evaluation and Mitigation
Strategy, as published 09 July 2012, or as it may be
subsequently revised; the national and Utah-
specific resources available to prescribers to assist
in appropriate controlled substance and opioid
prescribing; patient record documentation for
controlled substance and opioid prescribing; and
office policies, procedures, and implementation.
3.5 CMEs every 2 years on controlled substance 1,183
prescribing. The 3.5 CMEs shall include: the scope
of the controlled substance abuse problem in Utah
and the nation; all elements of the FDA Blueprint
for Prescriber Education under the FDA's
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State Boards Total CME Hours (CMEs) Required
Vermont 30 AMA PRA Category 1 CMEs every 2
Medical years
Vermont 30 CMEs every 2 years; a minimum of 12
Osteopathic CMEs must be osteopathic medical
education
Virginia 60 CMEs every 2 years. At least 30 must
be AMA PRA Category 1.
Washington For MDs, 200 CMEs every 4 years, at
least 120 must be Category 1 credits
(AMA PRA Category 1). For DOs, 150
CMEs every 3 years, at least 60 must be
Category 1 (AMA PRA Category 1
accepted).
Number of
Affected
Pain and Opioid CME Requirements Prescribers
Extended-Release and Long-Acting Opioid
Analgesics Risk Evaluation and Mitigation
Strategy, as published 09 July 2012, or as it may be
subsequently revised; the national and Utah-
specific resources available to prescribers to assist
in appropriate controlled substance and opioid
prescribing; patient record documentation for
controlled substance and opioid prescribing; and
office policies, procedures, and implementation.
1 CME every licensing period for all licensees shall 3,739 2,6
be on the topic of hospice care, palliative care, or
pain management services, or a combination of
these. One additional CME on the appropriate use
of opioids, including the use of complementary and
alternative therapies instead of opioid controlled
substances to treat chronic pain is required by
licensees who prescribe or are likely to prescribe
opioid controlled substances, as determined by the
Board, every licensing period.
2 hours of continuing education for each full 260
licensing period on the topics of: the abuse and
diversion, safe use, and appropriate storage and
disposal of controlled substances; the appropriate
use of the Vermont Prescription Monitoring
System; risk assessment for abuse or addiction;
pharmacological and nonpharmacological
alternatives to opioids for managing pain;
medication tapering and cessation of the use of
controlled substances; and, relevant State and
federal laws and regulations concerning the
prescription of opioid controlled substance.
2 CME related to pain management, proper 44,844
prescribing of controlled substances, and the
diagnosis and management of addiction every 2
years.
For MDs: WSMA's one-hour webinar, “Preparing 12,470 9
for New State Opioid Prescribing Rules”, fulfills
the state CMEs on opioid prescribing. This activity
has been approved for AMA PRA Category 1
Credit. Also, allopathic physician and PA
prescribers should note that simply reading the new
rules will meet the new state requirement for opioid
continuing medical education.
For DOs: In order to prescribe an opioid in
Washington state, an osteopathic physician
licensed to prescribe opioids shall complete a one-
time CME regarding best practices in the
prescribing of opioids and the current opioid
prescribing rules in this chapter. The continuing
education must be at least one hour in length. WAC
246-853-685
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State Boards Total CME Hours (CMEs) Required
West Virginia For MDs, 50 AMA PRA Category 1
CMEs every 2 years, 30 of which must be
related to the provider's area or areas of
specialty. For DOs, 32 CMEs every 2
years, 16 of which must be AOA 1-A or
1B.
Wisconsin 30 AMA PRA Category 1 or AOA
Category 1 CMEs every 2 years
Number of
Affected
Pain and Opioid CME Requirements Prescribers
Pain specialists need to have 30 pain-related CMEs 3,220 5,6,9
every 2 years. Further, for all providers, unless they
have completed and timely provided to the Board a
Board-developed certification form and waiver
request attesting that he or she has not prescribed,
administered, or dispensed a controlled substance
during the entire previous reporting period, every
physician as a prerequisite to license renewal shall
complete a minimum of 3 CMEs of drug diversion
training and best practice prescribing of controlled
substances training during the previous reporting
period, of which 3 such CMEs may be provided
only by a Board-approved program
2 CMEs on the Wisconsin Medical Examining 10,170 9
Board Opioid Prescribing Guideline during the
2016-2017 and 2018-2019 CME cycles
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Appendix C: State Pain and Opioid CE Requirements-Physician Assistants

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CE: Pain Management and Opioid Prescribing
State Pain and Opioid CE Requirements-Physician Assistants
Total CE Hours (CEs)
State Boards Required
Alabama 25 AMA PRA Category 1
CEs annually
Alaska 50 AMA PRA Category 1
CEs every 2 years
Arizona 40 CEs every 2 years
Arkansas 20 CEs annually. CEs hours
do not have to be in a
particular category.
Connecticut 100 CEs every 2 years, 50 of
which must be Category 1
(This mirrors the CE
requirement of the National
Commission on Certification
of Physician Assistants
(NCCPA)).
Florida 100 CEs every 2 years
Number of
Affected
Pain and Opioid CE Requirements Prescribers
To renew a Qualified Alabama Controlled Substances 750 4,9
Certificate: Must have 4 AMA PRA Category 1 CEs every 2
years (after original 12 hours of state-sponsored CEs). The
courses must be pre-approved by the Board. The initial 12 CEs
include: 8 AMA PRA Category 1 CEs from “Prescribing
Controlled Drugs; Critical Issues and Common Pitfalls”; and, 4
AMA PRA Category 1 CEs that include advanced
pharmacology and prescribing trends relating to controlled
substances.
For license renewals, at least 2 of the required CEs for renewal 623
must be specific to pain management and opioid use and
addiction. AMA PRA Category 1 CEs qualify. For a physician
assistant, it may instead be earned in a NCCPA-approved
continuing medical education program.
A.R.S. § 32-3248.02 requires all healthcare professionals who 2,100 9
hold Drug Enforcement Administration certifications to
complete a minimum 3 CEs in an opioid-related, substance-use
disorder related, or addiction related course each renewal cycle
as part of the annual continuing education requirement for
licensure.
PAs authorized to prescribe Schedule II hydrocodone 511
combination products reclassified from Schedule III to Schedule
II (in 2014) must complete at least five (5) CE hours in the area
of pain management. Each year, each physician and physician
assistant shall obtain at least one (1) hour of CME credit
specifically regarding the prescribing of opioids and
benzodiazepines. Within the first two (2) years of licensure, a
prescriber shall obtain a minimum of three (3) hours of
prescribing education approved by the Arkansas State Medical
Board.
Connecticut licensed physician assistants must complete not less 2,300 9
than 1 CE in prescribing controlled substances and pain
management during each two-year renewal period.
Prescribing PAs must have 3 CEs every 2 years on safe and 9,762
effective prescribing of controlled substances.
In addition to the above requirements, prescribing physician
assistants must complete 10 hours of CEs in each specialty area
of the supervising physician. These hours are included in the
general CEs. Effective 01 January 2017, 3 of the 10 specialty
hours must consist of a course on the safe and effective
prescribing of controlled substance medications given by a
statewide professional association of physicians in this state
accredited to provide educational activities designated for the
American Medical Association Physician’s Recognition Award
Category I credit or designated by the American Academy of
Physician Assistants as a Category I credit.
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Total CE Hours (CEs)
State Boards Required
Indiana 100 CEs every 2 years
Iowa 100 AMA PRA Category 1
CEs every two years
Kentucky 60 CEs every 3 years. Of the
60 CEs required, 30 must be
AMA PRA Category 1 or
AOA Category 1 by an
organization accredited by
the Accreditation Council on
Continuing Medical
Education or the AOA
Council on Continuing
Medical Education.
Louisiana 100 CEs every 2 years
Maine 100 CEs every 2 years
Maryland 50 CEs every 2 years or
maintenance of NCCPA
certification
Massachusetts 100 CEs every 2 years, 40 of
which must be Category 1
Number of
Affected
Pain and Opioid CE Requirements Prescribers
Effective 01 July 2019, pursuant to Senate Enrolled Act 225- 1,550 9
2018, a practitioner, licensed by a board and applying for
registration or re-registration to distribute or dispense a
controlled substance, must have completed 2 CEs during the
previous 2 years addressing the topic of opioid prescribing and
opioid abuse.
A licensee who has prescribed opioids to a patient during the 1,000 3
renewal cycle shall complete a minimum of 2 CEs regarding the
guidelines for prescribing opioids for chronic pain, as issued by
the Centers for Disease Control and Prevention of the United
States Department of Health and Human Services, including
recommendations on limitations on dosages and the length of
prescriptions, risk factors for abuse, and nonopioid and
nonpharmacologic therapy options, as a condition of license
renewal. These CEs may count toward the 100 CEs required for
license renewal. The licensee shall maintain documentation of
these hours, which may be subject to audit.
Minimum of 4.5 CEs of HB1 (House Bill 1) approved CEs for 1,070 9
physicians authorized to prescribe or dispense controlled
substances. The education must relate to the use of KASPER
(their prescription monitoring program), pain management,
addiction disorders, or a combination of two or more of those
subjects. The requirement may be met with one 4.5 CE course
or multiple courses totaling 4.5 CEs.
Practitioners with a Controlled Dangerous Substance (CDS) 1,291
license are required to complete at least 3 Board-approved CEs
on the best practices for the prescribing of CDS, drug diversion
training, appropriate treatment for addiction, and the treatment
of chronic pain.
Effective 31 December 2017, 3 CEs of opioid prescribing 720 2,9
required every 2 years for all clinicians that prescribe opioids. 3
CEs of any Category 1 AMA approved program on the
prescribing of opioids will suffice
One-time requirement for 2 CEs if holding a CDS registration, 7,268
starting 01 October 2018. Must relate to prescribing or
dispensing controlled substances. Must be recognized by the
provider's professional board or accredited by ACCME.
If prescribing controlled substances, must complete 4 CEs in the 3,720 1,9
following topics: effective pain management; the risks of abuse
and addiction associated with opioid medication; identification
of patients at risk for substance use disorders; counseling
patients about the side effects, addictive nature and proper
storage and disposal of prescription medications; appropriate
prescription quantities for prescription medications that have an
increased risk of abuse; and opioid antagonists, overdose
prevention treatments and instances in which a patient may be
advised on both the use of and ways to access opioid antagonists
and overdose prevention treatments.
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Number of
Total CE Hours (CEs) Affected
State Boards Required Pain and Opioid CE Requirements Prescribers
Minnesota 50 AMA PRA Category 1 Effective 01 January 2020, licensees with the authority to 1,980 9
CEs every 2 years or prescribe controlled substances must obtain at least 2 CEs on
maintenance of NCCPA best practices in prescribing opioids and controlled substances,
certification including nonpharmacological and implantable device
alternatives for treatment of pain and ongoing pain
management, as part of the continuing education requirements
for licensure renewal.
Mississippi 50 CEs annually. Of the 50 10 CEs of AMA, AOA, or AAPA Category 1 CEs related to 200 9
CEs required, 20 must be prescribing medications, with emphasis on controlled
AMA PRA Category 1. substances, required for PA authorized to prescribe controlled
NCCPA certification waives substances.
requirement
Nebraska 50 CEs of ACCME, AOA, or Effective 01 October 2018, 3 hours every 2 years regarding 1,454 2
AAPA Category 1 CEs every prescribing opiates. This may include education regarding
2 years, or maintenance of prescribing and administering opiates, risks and indicators
NCCPA certification regarding opiate addiction development and emergency opiate
situations. 1/2 hour of the 3 shall cover the PDMP
Nevada 40 AMA PRA Category 1 2 CEs relating specifically to the misuse and abuse of controlled 650 9
CEs every 2 years. substances, the prescribing of opioids, or addiction during each
period of licensure.
New Must maintain NCCPA All prescribers required to register with the program who 889
Hampshire certification possess a U.S. Drug Enforcement Administration (DEA) license
number shall complete 3 CEs of free, appropriate prescriber's
regulatory board-approved online continuing education or pass
an online examination, in the area of pain management and
addiction disorder or a combination, as a condition for license
renewal.
New Jersey 50 CEs every 2 years; must Effective with 2019 and subsequent renewals, for all 2,810 9
be Category 1 AMA, AAPA, prescribers, 1 CE concerning prescription opioid drugs,
AOA, or ACCME including responsible prescribing practices, alternatives to
opioids for managing and treating pain, and the risks and signs
of opioid abuse, addiction, and diversion.
New Mexico Must maintain NCCPA 5 CEs in pain management. Appropriate CEs should include: a 680 9
certification review of NM Medical Board Rule 16.10.14 NMAC on pain
management; an understanding of the pharmacology and risks
of controlled substances; a basic awareness of the problems of
abuse, addiction, and diversion; and awareness of state and
federal regulations for the prescription of controlled substances.
New York No general CE requirement; All prescribers licensed to treat humans who have a DEA 12,060 9
see Pain/Opioid CE. registration to prescribe controlled substances, as well as
medical residents who prescribe controlled substances under a
facility DEA registration, must complete at least 3 CEs in pain
management, palliative care, and addiction. The following 8
topic areas MUST be included: New York State and federal
requirements for prescribing controlled substances; pain
management; appropriate prescribing; managing acute pain;
palliative medicine; prevention, screening, and signs of
addiction; responses to abuse and addiction; and end of life care.
All 8 topics must be completed prior to attestation; the topics
can be completed in a single presentation or in individual
segments for a total of at least 3 hours. The coursework may be

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Total CE Hours (CEs)
State Boards Required
North 50 CEs of AAPA Category 1
Carolina CE every 2 years; active
NCCPA certification waives
requirement; NCCPA
certification waives this
requirement, but not the
controlled substance
requirement
Ohio 100 CEs every 2 years + 12
pharmacology every 2 years
plus NCCPA certification
Oklahoma 20 CEs annually
Oregon 60 CEs of AMA, APMA,
AAPA, or AOA Category 1
or AOA Category 1A or 2A
every 2 years
Pennsylvania Must hold current NCCPA
certification.
Rhode Island 20 CEs every 2 years
South No requirement, except as
Carolina noted for those prescribing
controlled substances
Tennessee 100 CEs every 2 years
Texas 40 CEs every 2 years
Number of
Affected
Pain and Opioid CE Requirements Prescribers
live, online, or obtained from a publication or journal. There is
no minimum amount of time that must be spent on each of the
eight topics. The CE does not have to be pre-approved, as
prescribers merely complete an attestation saying that they
completed the appropriate work.
Beginning 01 July 2017, 2 hours of CEs specifically designed to 5,010 9
address controlled substance prescribing practices. The CEs
shall include instruction on controlled substances prescribing
practices, recognizing signs of the abuse or misuse of controlled
substances, and controlled substance prescribing for chronic
pain management.
12 pharmacology-specific CEs over and above the required 100 4,430 9
CEs in order to renew a Certificate to Prescribe.
1 CE each year shall be concerning the topic of substance abuse 1,390 9
Within the first licensure year, licensees must complete CEs on 2,152
pain management. A 1-hour course provided by the Oregon Pain
Management Commission is required plus at least 6 more CEs
in the subjects of pain management or the treatment of
terminally ill and dying patients. This is a 1-time requirement,
but licensees may choose to obtain additional hours on these
topics throughout their careers. Furthermore, the topic of pain
management is legally considered relevant for all licensees,
regardless of their specialty.
4 Board-approved CEs consisting of 2 CEs in pain management 8,832
or the identification of addiction and 2 CEs in the practices of
prescribing or dispensing of opioids; subsequent renewals
require 2 CEs on pain management, identification of addiction,
or prescribing practices.
8 CEs on topics such as: appropriate prescribing for pain, 588
pharmacology, dependence, potential, and alternatives to
opioids for pain management. Those who have taken DATA
2000 training to prescribe buprenorphine will be exempt from
the 8 CEs. Training must be completed at least once per career
and must occur before the next renewal of your controlled
substance registration in June of 2018.
4 CEs every 2 years related to approved procedures of 1,430 9
prescribing and monitoring controlled substances in Schedules
II, III, and IV.
2 CEs related to controlled substance prescribing, which must 2,010 9
include instruction in the Department’s treatment guidelines
(i.e., Tennessee Chronic Pain Guidelines) on opioids,
benzodiazepines, barbiturates, and carisoprodol and may include
topics such as medicine addiction, risk management tools, and
other topics approved by the PA Committee.
Per Board rule 195.4(e), the medical director of a pain 7,930 5,9
management clinic must, on an annual basis, ensure that all
personnel (including the medical director) are properly licensed,
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Total CE Hours (CEs)
State Boards Required
Utah 40 CEs every 2 years;
NCCPA certification waives
requirement
Vermont 100 CEs every 2 years, 50 of
which must be Category 1;
NCCPA certification waives
this requirement
Virginia Must maintain NCCPA
certification
Washington 100 CEs every 2 years. A
minimum of 40 CEs must be
Category 1. NCCPA
certification waives this
requirement
West Virginia 100 CEs every 2 years; at
least 50 must be Category 1
Number of
Affected
Pain and Opioid CE Requirements Prescribers
and if applicable, trained to include 10 CEs related to pain
management. This CE requirement applies to all personnel
providing medical services to the patients (including, but not
limited to: PAs, x-ray techs, phlebotomists, RNs, MAs, etc.).
3.5 CEs every 2 years on controlled substance prescribing. The 1,090 9
3.5 CEs shall include: the scope of the controlled substance
abuse problem in Utah and the nation; all elements of the FDA
Blueprint for Prescriber Education under the FDA's Extended-
Release and Long-Acting Opioid Analgesics Risk Evaluation
and Mitigation Strategy, published 09 July 2012, or as it may be
revised; the national and Utah-specific resources available to
prescribers to assist in appropriate controlled substance and
opioid prescribing; patient record documentation for controlled
substance and opioid prescribing; and office policies,
procedures, and implementation.
2 CEs on controlled substances prescribing. The activity must 425
be accredited as AMA PRA Category 1 CEs or American
Academy of Physician Assistants Category 1 training. Required
topics include: abuse and diversion, safe use, and appropriate
storage and disposal of controlled substances; appropriate use of
the Vermont Prescription Monitoring System; risk assessment
for abuse or addiction; pharmacological and
nonpharmacological alternatives to opioids for managing pain;
medication tapering and cessation of the use of controlled
substances; and, relevant State and federal laws and regulations
concerning the prescription of opioid controlled substance. Each
licensee who is registered with the D.E.A. and who holds a
D.E.A. number to prescribe controlled substances, or who has
submitted a pending application for one, is presumed to
prescribe controlled substances and must meet this requirement.
2 AMA/PRA Category 1 CEs related to pain management, 3,958
proper prescribing of controlled substances, and the diagnosis
and management of addiction every 2 years. There is no
exemption from this CE requirement for doctors of medicine,
osteopathy, podiatry, physician assistants, and nurse
practitioners who hold active licenses.
If the practitioner prescribes opioids in Washington, they must 2,470 2,9
complete a CE. The course is one-time for at least one hour. It
must be completed by the end of your first full CE reporting
period after 01 January 2019. WSMA's one-hour webinar,
“Preparing for New State Opioid Prescribing Rules”, fulfills the
new state requirement for CE on opioid prescribing. This
activity has been approved for AMA PRA Category 1 Credit.
Also, allopathic physician and PA prescribers should note that
simply reading the new rules will meet the new state
requirement for opioid continuing medical education.
A physician assistant who has prescribed, administered, or 770 1,9
dispensed any controlled substance pursuant to a West Virginia
license during the reporting period shall complete a Board-
approved CE activity for a minimum of 3 hours of drug
diversion training and best practice prescribing of controlled
substances training.
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Appendix D: State Pain and Opioid CE Requirements-Podiatrists

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CE: Pain Management and Opioid Prescribing

State Pain and Opioid Requirements-Podiatrists

Number of
Total CE Hours (CEs) Affected
State Boards Required Pain and Opioid CE Requirements Prescribers
Alabama 12 CEs annually All Alabama Controlled Substance Certificate holders must 155
obtain 2 AMA PRA Category 1 or equivalent CEs every 2
years beginning in 2018. Acceptable CEs confer Credit in the
areas of: controlled substance prescribing practices,
recognizing signs of the abuse or misuse of controlled
substances, or controlled substance prescribing for chronic
pain management. No pre-approval of the courses is required.
Alaska 50 AMA PRA Category For license renewals for those with a DEA registration, at least 29
1 CEs every 2 years. 2 of the total CEs required to qualify for renewal must be
Podiatrist credits may specific to pain management and opioid use and addiction.
instead be earned in a CE AMA PRA Category 1 education qualifies.
program from a provider
that is approved by the
Council on Podiatric
Medical Education
(CPME).
Arizona 25 CEs annually A.R.S. § 32-3248.02 requires all healthcare professionals who 429
hold Drug Enforcement Administration certifications to
complete a minimum 3 CEs in an opioid-related, substance-use
disorder related, or addiction related course each renewal cycle
as part of the annual continuing education requirement for
licensure.
Florida 40 CEs every 2 years 2 CEs on prescribing controlled substances if holding DEA 1,787
registration
Iowa 40 CEs every 2 years A licensee who has prescribed opioids to a patient during a 243 3
renewal cycle shall have obtained a minimum of 1 CE
regarding the United States Centers for Disease Control and
Prevention guideline for prescribing opioids for chronic pain,
including recommendations on limitations on dosages and the
length of prescriptions, risk factors for abuse, and nonopioid
and nonpharmacologic therapy options.
Kentucky 20 CEs annually Beginning on 01 July 2012, and annually thereafter, each 204
podiatrist licensed by the board shall complete at least 1.5 CEs
related to the use of the Kentucky All-Schedule Prescription
Electronic Reporting System (KASPER), pain management, or
addiction disorders.
Louisiana 20 CEs annually 3 CEs on opioid management required one time in career, 190
starting in 2018, if prescribing, administering, or dispensing a
controlled substance; otherwise exempt
Maine 25 CEs every 2 years 3 Category 1 CEs every 2 years on the prescribing of opioid 83
medication as a condition of prescribing opioid medication.
Maryland 50 CEs every 2 years 1 CE per renewal cycle on prescribing pain medications 460
(starting 2018-2019).
Massachusetts 15 CEs annually At least 1 CE in the previous one year shall be in pain 544
management training, pursuant to St. 2010, c. 283. Pain
management training shall include, but not be limited to:
training how to identify patients at high risk for substance
abuse, training how to counsel patients on the side effects,

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Number of
Total CE Hours (CEs) Affected
State Boards Required Pain and Opioid CE Requirements Prescribers
addictive nature, and proper storage and disposal of
prescription medicines.
Michigan 150 CEs every 3 years 5 CEs in pain and symptom management in each renewal 806
period pursuant to section 16204(2), MCL 333.16204(2), of
the code. Courses in pain and symptom management may
include, but are not limited to, courses in: behavior
management, pharmacology, behavior modification, stress
management, clinical applications, and drug interventions as
they relate to professional practice.
Minnesota 40 CEs every 2 years Effective 01 January 2020: Licensees with the authority to 250
prescribe controlled substances must obtain at least 2 CEs on
best practices in prescribing opioids and controlled substances,
including nonpharmacological and implantable device
alternatives for treatment of pain and ongoing pain
management, as part of the continuing education requirements
for licensure renewal.
Mississippi 40 CEs every 2 years If the podiatrist has a current DEA certificate, 5 CEs must be 96
in the prescribing of controlled substances.
Nebraska 48 CEs every 2 years Effective 01 October 2018, 3 CEs every 2 years regarding 109 1
prescribing opiates. This may include education regarding
prescribing and administering opiates, risks and indicators
regarding development of addiction to opiates, and emergency
opiate situations. 1/2 hour of the 3 shall cover the PDMP.
Nevada 50 CEs every 2 years Each holder of a license to practice podiatry who is registered 148 4
to dispense controlled substances pursuant to NRS 453.231
shall complete at least 2 CEs relating specifically to the misuse
and abuse of controlled substances, the prescribing of opioids
or addiction during each period of licensure.
New Jersey 100 CEs every 2 years Effective with 2019 and subsequent renewals, for all 1,220
prescribers, 1 CE concerning prescription opioid drugs,
including responsible prescribing practices, alternatives to
opioids for managing and treating pain, and the risks and signs
of opioid abuse, addiction, and diversion.
New Mexico 16 CEs annually 2 CEs in appropriate courses: an understanding of the 369
pharmacology and risks on controlled substances; a basic
awareness of the problems of abuse, addiction and diversion;
awareness of state and federal regulations for the prescription
of controlled substances; and management of the treatment of
pain. Courses may also include a review of this rule (16.21.9
NMAC).
New York 50 CEs every 3 years All podiatrists (and any other person licensed under Title 8) 2,448
who have a DEA registration number and all residents
prescribing with a facility DEA registration number will be
required to take 3 CEs approved by the DOH in pain
management, palliative care and addiction.
North 25 CEs annually At least 1 CE consists of a course designed specifically to 415
Carolina address prescribing practices. The course shall include, but not
be limited to, instruction on controlled substance prescribing
practices and controlled substance prescribing for chronic pain
management.

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Number of
Total CE Hours (CEs) Affected
State Boards Required Pain and Opioid CE Requirements Prescribers
Oregon 60 CEs every 2 years By 2009 or within the first year of licensure, licensees must 173
complete CEs on pain management. The requirements and
exemptions are detailed in OAR 847-008-0075. 1 CE provided
by the Oregon Pain Management Commission is required plus
at least 6 CEs in the subjects of pain management or the
treatment of terminally ill and dying patients.
Pennsylvania 50 CEs every 2 years 2 CEs in pain management, the identification of addiction, or 1,602
the practices of prescribing or dispensing of opioids.
South 24 CEs every 2 years If a podiatrist is authorized pursuant to state and federal law to 200
Carolina prescribe controlled substances, 2 of the requisite biennial CEs
must be related to approved procedures of prescribing and
monitoring controlled substances listed in Schedules II, III,
and IV of the schedules provided for in Sections 44-53-210,
44-53-230, and 44-53-250.
Tennessee 15 CEs annually 1 of the 15 required CEs shall, every other calendar year, be a 230
course designed specifically to address prescribing practices
Texas 50 CEs every 2 years Per Board rule 195.4(e), the medical director of a pain 1,152 5
management clinic must, on an annual basis, ensure that all
personnel (including the medical director) are properly
licensed, and if applicable, trained, to include 10 hours of
continuing medical education related to pain management.
This requirement applies to all personnel providing medical
services to the patients (including, but not limited to: PAs, x-
ray techs, phlebotomists, RNs, MAs, etc.).
Utah 40 CEs every 2 years 3.5 CEs every 2 years on controlled substance prescribing. The 244
3.5 CEs shall include: the scope of the controlled substance
abuse problem in Utah and the nation; all elements of the FDA
Blueprint for Prescriber Education under the FDA's Extended-
Release and Long-Acting Opioid Analgesics Risk Evaluation
and Mitigation Strategy, as published 09 July 2012, or as it
may be subsequently revised; the national and Utah-specific
resources available to prescribers to assist in appropriate
controlled substance and opioid prescribing; patient record
documentation for controlled substance and opioid prescribing;
and office policies, procedures, and implementation.
Vermont 30 CEs every 2 years All podiatry licensees who prescribe controlled substances 35
shall certify at the time of each renewal that they have
completed at least 2 CE activities on controlled substances
prescribing. The CE must be accredited as AMA PRA
Category 1 Credit training or Council on Podiatric Medical
Education approved training. The following topics must be
covered, as required by Vermont law: abuse and diversion,
safe use, and appropriate storage and disposal of controlled
substances; the appropriate use of the Vermont Prescription
Monitoring System; risk assessment for abuse or addiction;
pharmacological and nonpharmacological alternatives to
opioids for managing pain; medication tapering and cessation
of the use of controlled substances; and relevant State and
federal laws and regulations concerning the prescription of
opioid controlled substances. Each licensee who is registered
with the U.S. Drug Enforcement Agency (D.E.A.) and who

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CE: Pain Management and Opioid Prescribing

Number of
Total CE Hours (CEs) Affected
State Boards Required Pain and Opioid CE Requirements Prescribers
holds a D.E.A. number to prescribe controlled substances, or
who has submitted a pending application for one, is presumed
to prescribe controlled substances and must meet this
requirement. Any podiatrist who is required to certify
completion of this CE to renew, but who cannot, will be
subject to the provisions regarding makeup of missing CE in
22.3 and 22.4.
Virginia 60 CEs every 2 years Every 2 years, licensees with prescriptive authority must 543
complete 2 CEs in pain management, proper prescribing of
controlled substances, and the diagnosis and management of
addiction.
West Virginia 50 CEs every 2 years Unless a podiatrist has completed and timely provided to the 115 1
Board a Board-developed certification waiver form attesting
that he or she has not prescribed, administered, or dispensed a
controlled substance during the entire previous reporting
period, every podiatrist as a prerequisite to license renewal
shall complete a minimum of 3 CEs of drug diversion training
and best practice prescribing of controlled substances training
during the previous reporting period. The 3 CEs shall be part
of the 50 total hours of continuing education required and not
3 additional hours.
Wisconsin 50 CEs every 2 years 2 of the 50 podiatric CEs required under sub.(1) shall be an 384
educational course or program related to opioid prescribing;
only required if podiatrist holds DEA registration

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Appendix E: State Pain and Opioid CE Requirements-Naturopaths

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CE: Pain Management and Opioid Prescribing

State Pain and Opioid CE Requirements-Naturopaths

Number of
Total CE Hours (CEs) Affected
State Boards Required Pain and Opioid CE Requirements Prescribers
Arizona 30 CEs annually 3 CEs in opioid-related substance use disorder or addiction 1,020
California 60 CEs every 2 years There is a one-time requirement of 12 CEs in pain management 915
and care of the terminally ill (except for Pathologists and
Radiologists) that must be completed by the physician's second
license renewal date or within four years, whichever comes first.
The 12 CEs may be divided in any way that is relevant to the
physician's specialty and practice setting. The Medical Board will
accept any combination of the two topics totaling 12 CEs. For
physicians and surgeons licensed on or after 01 January 2019, the
course must include the subject of risks of addiction associated
with the use of Schedule II drugs. As an alternative to the above
12-CE requirement, a physician or surgeon may complete a 1-time
CE of 12 hours in the subjects of treatment and management of
opiate-dependent patients, including 8 hours of training in
buprenorphine treatment, or other similar medicinal treatment, for
opioid use disorders.
Oregon 32 CEs annually 7 CEs on pain management, within the first 2 years of licensure 1,090
Vermont 30 CEs every 2 years 2 CEs for each full licensing period beginning on or after 08 June 337
2016 on the topics of: the abuse and diversion, safe use, and
appropriate storage and disposal of controlled substances; the
appropriate use of the Vermont Prescription Monitoring System;
risk assessment for abuse or addiction; pharmacological and
nonpharmacological alternatives to opioids for managing pain;
medication tapering and cessation of the use of controlled
substances; and, relevant State and federal laws and regulations
concerning the prescription of opioid controlled substance.

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Appendix F: State Pain and Opioid CE Requirements-Nurses

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CE: Pain Management and Opioid Prescribing
State Pain and Opioid CE Requirements-Nurses
Total CE Hours (CEs)
State Boards Required
Alabama 24 CEs every 2 years
Alaska 30 CEs every 2 years
Arizona 0 CEs every 4 years
Arkansas 15 CEs (or National
Certification) every 2 years
California 30 CEs every 2 years
Connecticut 50 CEs every 2 years
Delaware National Certification plus
10 pharmacology CEs for
APRN every 2 years
Number of
Affected
Pain and Opioid CE Requirements Prescribers
As a part of the 24 Board-approved or -recognized CEs for license 3,680 4,9
renewal [610-X-4-.08], Certified Registered Nurse Practitioners
(CRNP) and Certified Nurse Midwives (CNM) with prescriptive
authority shall earn 6 CEs of pharmacology content specific to
prescriptive practice in the approved area for collaborative
practice. Certified Registered Nurse Anesthetists (CRNA) shall
earn 6 CEs of pharmacology.
For APRNs with general prescriptive authority, 15 CEs in 440 6,9
advanced pharmacotherapeutics are required each licensing period.
For those with Controlled Substances Prescriptive Authority (those
holding a DEA registration), 2 additional CEs (beyond the 15) are
required in pain management and opioid use each licensing period.
A.R.S. § 32-3248.02 requires all healthcare professionals who 3,510 6.9
hold Drug Enforcement Administration certifications to complete
a minimum 3 of CEs in an opioid-related, substance-use disorder
related, or addiction related courses each renewal cycle as part of
the annual continuing education requirement for licensure.
Initial Applicants: APRNs issued a certificate of prescriptive 1,900 4,9
authority after 31 December 2015 shall obtain a minimum of 3
CEs of prescribing education, which include information on
maintaining professional boundaries and the prescribing rules,
regulations and laws that apply to APRNs in the state of Arkansas
within 2 years of issuance of the prescriptive authority certificate.
Renewals: APRNs with prescriptive authority shall complete 5
pharmacotherapeutics CEs in the APRN’s area of certification
each biennium prior to license renewal. Effective 01 January 2017,
2 of the 5 hours must contain information related to maintaining
professional boundaries and the prescribing rules, regulations and
laws that apply to APRNs in the State of Arkansas.
Nurse Practitioners (NPs) with Schedule II furnishing privileges 13,420 4,9
must complete a 3-hour online Schedule II course through the CA NP
Association for Nurse Practitioners. Certified Nurse Midwives
(CNMs) with Schedule II furnishing privileges must complete a 2-
hour online Schedule II course through the CA Association for 700 4,9
Nurse-Midwives. CNM
CEs shall: be in an area of the APRN’s practice; reflect the 5,382
professional needs of the licensee in order to meet the health care
needs of the public; include at least 5 contact hours of training or
education in pharmacotherapeutics; and include at least 1 contact
hour of training or education in substance abuse, including, but not
limited to, prescribing controlled substances and pain
management.
3 hours related to substance abuse for all nurses (not just those 760 9
with prescriptive authority). APRNs with authority to prescribe APRN
controlled substances must complete the 1-hour Mandatory
training on Delaware law, regulation and programs on prescribing
and distribution of controlled substances, and 10 CEs in 11,840 9
pharmacology/pharmacotherapeutics in the past 2 years. RN
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CE: Pain Management and Opioid Prescribing
Total CE Hours (CEs)
State Boards Required
District of 24 CEs every 2 years
Columbia
Florida 24 CEs (or National
Certification) every 2 years
Hawaii 30 CEs every 2 years
Idaho 30 CEs every 2 years
Illinois 20 CEs for RN and LPN;
80 CEs for APN every 2
years
Indiana 0 hours for RNs; 30 hours
for APRNs every year
Iowa 36 CEs for RN or LPN;
National Certification for
APRN every 3 years
Kentucky 14 CEs or National
Certification every 1 year
Louisiana For RN, 5-15 CEs
(depending on hours spent
practicing); for APRNs
whose role and population
focus does not provide for
certification/recertification,
30 contact hours related to
advanced practice nursing
every 1 year
Number of
Affected
Pain and Opioid CE Requirements Prescribers
APRNs must complete 15 CEs related to pharmacology (of the 24 840 9
required hours)
3 CEs of Safe and Effective Prescription of Controlled Substances 31,183
for APRNs each licensing period. (Must be offered by a statewide
professional association of physicians in this state accredited to
provide educational activities designated for the American
Medical Association Physician’s Recognition Award Category 1
credit, the American Nurses Credentialing Center, the American
Association of Nurse Anesthetists, or the American Association of
Nurse Practitioners and may be offered in a distance-learning
format.)
For APRN with prescriptive authority, 8 contact hours in 410 4,9
pharmacology related to clinical practice specialty area and
approved by a Board-recognized certifying body each licensing
period.
For APRN with prescriptive authority, 10 contact hours in 750 9
pharmacology for license renewal. All new initial applicants must
provide documentation of 30 hours of pharmacotherapeutic
coursework (either formal academic education or CE).
APRNs shall obtain, each 2-year licensing period, no less than 20 5,540 9
CEUs of pharmacotherapeutics, including 10 hours of opioid
prescribing or substance abuse education.
APRNs with prescriptive authority must include 8 hours in 7,560
pharmacology. Effective 01 July 2019, a practitioner who is
licensed by a board and applies for controlled substance
registration or re-registration must have completed 2 hours of
CEUs during the previous 2 years addressing the topic of opioid
prescribing and opioid abuse.
For ARPN who prescribed opioids to a patient during the renewal 4,869 3
cycle: a minimum of 2 CEs regarding the CDC guideline for
prescribing opioids for chronic pain (at each renewal).
5 contact hours of approved pharmacology CEs must be earned by 3,572 6
all APRNs each licensure period. CE certificates should reflect
specific pharmacology contact hours awarded. For APRNs with
prescriptive authority for controlled substance, of the 5 approved
pharmacology contact hours required for renewal, 1.5 of approved
contact hours must be on the use of KASPER, pain management,
or addiction disorders each licensure period. These hours may
count as part of the required 5 pharmacology hours.
Each year an APRN with prescriptive authority shall obtain 6 3,322 4
contact hours of CEs in pharmacotherapeutics in their advanced
nursing role and population foci.
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CE: Pain Management and Opioid Prescribing
Total CE Hours (CEs)
State Boards Required
Maine 0 CEs for RN and LPN; 75
CEs for APRN every 2
years
Maryland 0 CEs for RNs; National
Certification for APRN
every 2 years
Massachusetts 15 CEs for RN and LPN;
National Certification for
APRN every 2 years
Michigan 25 CEs for RNs; National
Certification for APRN
every 2 years
Minnesota 24 CEs for RN; 12 CEs for
LPN; National
Certification for APRN
every 2 years
Mississippi 0 CEs for RN; 40 CEs for
APRN every 2 years
Montana 24 CEs every 2 years
Nebraska 20 CEs for RN and LPN;
40 CEs for APRN-NP
/every 2 years
Nevada 30 CEs for RNs; 45 CEs
for APRNs every 2 years
New 30 CEs for RN and LPN;
Hampshire 30 additional CEs (60
total) related to specialty
for APRN every 2 years
Number of
Affected
Pain and Opioid CE Requirements Prescribers
15 contact hours of CEs in pharmacology every two years 1,240 9
1-time requirement for 2 hours if holding a CDS registration, 3,710 4,9
starting 01 October 2018. Must relate to prescribing or dispensing
of controlled substances. Must be recognized by the provider's
professional board or accredited by ACCME.
To apply for prescriptive authority from MA Controlled Substance 6,200 1,9
Registration (MCSR) and to renew APRN authorization every 2
years, all prescribers must complete education relative to: effective
pain management; risks of abuse and addiction associated with
opioid medication; identification of patients at risk for substance
use disorders; counseling patients about the side effects, addictive
nature and proper storage and disposal of prescription
medications; appropriate prescription quantities for prescription
medications that have an increased risk of abuse; and, opioid
antagonists, overdose prevention treatments and instances in
which a patient may be advised on both the use of and ways to
access opioid antagonists and overdose prevention treatments.
M.G.L. c. 94C s.18 (e) does not specify a minimum number of
contact hours to comply with this education requirement.
Each licensing period, every nurse (both with and without 22,596
prescriptive authority) must complete at least two 2 CE in pain and APRN
symptom management, in courses or programs approved by the
Board. These count toward the 25 CE requirement.
155,436
RN
Effective 01 January 2020: Licensees with the authority to 7,780
prescribe controlled substances obtain at least 2 CEs on best
practices in prescribing opioids and controlled substances,
including nonpharmacological and implantable device alternatives
for treatment of pain and ongoing pain management, as part of the
CE requirements for licensure renewal.
For APRNs, 2 of the 40 CEs must be related to the prescribing of 6,703
controlled substances.
For APRNs with prescriptive authority, 12 (of the 24) CEs must be 640 4,9
in the area of pharmacotherapeutics.
10 CEs related to pharmacology for APRN-NP. Effective 01 2,288 6
October 2018, 3 CEs every 2 years regarding prescribing opiates.
This may include education regarding prescribing and
administering opiates, risks and indicators regarding development
of addiction to opiates, and emergency opiate situations. 1/2 hour
of the 3 shall cover the PDMP.
APRNs that have dispensing or prescribing privileges must 710 4,9
complete 2 CEs related to the use and misuse of controlled
substances also within each renewal period.
For all APRNs, 5 CEs must be related to pharmacology. For 1,140 6,9
APRNs with an active DEA number for prescribing, 3 of the 5
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CE: Pain Management and Opioid Prescribing
Total CE Hours (CEs)
State Boards Required
(For APRN, current
certification in specialty
will meet requirements for
30 CEs for RN licensure)
New Jersey 30 CEs for RN and LPN;
National Certification for
APN every 2 years
New Mexico 30 CEs for RN and LPN;
50 CEs for APRN every 2
years
New York 0 CEs for RN; National
Certification for APRN
every 2 years
North 15-30 CEs for RNs
Carolina (depending on other
activities) every 2 years.
50 CEs for APRNs
(depending on other
activities) every 2 years.
North Dakota 12 CEs every 2 years, plus
National Certification for
APRN
Ohio 24 CEs for RNs; 48 CEs
(36 for those with National
Certification) for APRNs
Oklahoma RNs must meet 1 of 5
options for license
renewal. One option is 24
CEs every 2 years.
National Certification for
APRNs.
Oregon National certification for
APRN. If not certified,
then 45 CEs every 2 years;
for CNS who isn't
certified, 40 CEs every 2
years.
Number of
Affected
Pain and Opioid CE Requirements Prescribers
CEs must address opioid prescribing, pain management, or
substance abuse disorder.
All professional nurses, practical nurses, and certified nurse 4,000
midwives: 1 CE each licensing period related to prescription
opioid drugs, including alternatives to opioids for managing and
treating pain, and the risks and signs of opioid abuse, addiction,
and diversion. Advanced Practice Nurses: 6 CEs in pharmacology
related to controlled substances, including pharmacologic therapy,
addiction prevention and management, and issues concerning
prescription opioid drugs, including responsible prescribing
practices, alternatives to opioids for managing and treating pain,
and the risks and signs of opioid abuse, addiction, and diversion.
15 CEs related to pharmacology for all APRNs each licensing 980 6,9
period. For APRNs with DEA registration and prescriptive
authority, 5 of 15 pharmacology hours must be related to
management of non-cancer or chronic pain.
All NY practitioners with a DEA registration number to prescribe 13,710 9
controlled substances are required to complete at least 3 CEs of
course work or training in pain management, palliative care, and
addiction by 01 July 2017, and once every 3 years thereafter.
For those Nurse Practitioners who prescribe controlled substances, 4,760 1,9
at least 1 CE (of the 50) shall address controlled substance
prescribing practices, signs of the abuse or misuse of controlled
substances, and controlled substance prescribing for chronic pain
management.
15 CEs related to pharmacology for APRN with prescriptive 1,183
authority (fulfills the 12 CE renewal requirement)
For an APRN-CNP, APRN-CNS, or APRN-CNM, at least 12 of 16,760
the total required CEs must include CE in advanced
pharmacology.
15 contact hours or 1 academic credit hour related to 1,590 4,9
pharmacology for CNP, CNM, CNS with prescriptive authority
each licensing period.
1-time requirement of 7 CEs related to pain management for RN, 5,559
LPN, and APRN (1 hour must be a course to be provided by the APRN
Oregon Pain Management Commission. The remaining six hours
can be nurse's choice of pain management topics.). Of the 45 hours
64,093
required for an APRN, 15 must be focused on
RN
pharmacotherapeutic content.
5,728
LPN
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Number of
Total CE Hours (CEs) Affected
State Boards Required Pain and Opioid CE Requirements Prescribers
Pennsylvania 30 CEs for RN, CNS, and 16 CEs related to pharmacology for CRNP with Prescriptive 7,280 4,9
CRNP every 2 years Authority each licensing period. CRNPs with prescriptive
authority approval must complete a one-time requirement of 2 CE
in pain management, the identification of addiction and 2 CE in
the practices of prescribing or dispensing of opioids.
Rhode Island 10 CEs for RN and LPN; 2 of the 10 CEs required must be about substance abuse. 13,320 9
National Certification for
APRN every 2 years
South 0 CEs every 2 years for APRNs with prescriptive authority will need 45 contact hours of 2,260 4,9
Carolina APRN, plus National pharmacotherapeutics at initial licensure (15 of which must be in
Certification. controlled substance pharmacology for NPs wishing to prescribe
these drugs).
Tennessee 0 CEs every 2 years for 2 CEs designed specifically to address controlled substance 7,010 4,9
APRN, plus National prescribing practices including the Tennessee Chronic Pain
Certification. Guidelines.
Texas 20 CES every 2 years or Per Board rule 195.4(e), the medical director of a pain 12,020 5,6,9
National Certification. management clinic must, on an annual basis, ensure that all
personnel (including the medical director) are properly licensed,
and if applicable, trained to include 10 hours of continuing
medical education (CE) related to pain management. This CE
requirement applies to all personnel providing medical services to
the patients (including, but not limited to: PAs, x-ray techs,
phlebotomists, RNs, MAs, etc.). Furthermore, Advance Practice
Nurses (APNs) are required to complete CE within their advanced
specialty area and role recognized by the BON. APNs with limited
prescriptive authority must also complete an additional five
contact hours in pharmacotherapeutics. APRNs that have
prescriptive authority and prescribe controlled substances must
complete at least 3 additional contact hours of continuing
education related to prescribing controlled substances.
Utah 30 CEs, or 200 practice 3.5 CEs every 2 years on controlled substance prescribing. The 3.5 2,158 7
hours and 15 CEs, or 400 CEs shall include: the scope of the controlled substance abuse
practice hours every 2 problem in Utah and the nation; all elements of the FDA Blueprint
years for Prescriber Education under the FDA's Extended-Release and
Long-Acting Opioid Analgesics Risk Evaluation and Mitigation
Strategy, as published 09 July 2012, or as it may be subsequently
revised; the national and Utah-specific resources available to
prescribers to assist in appropriate controlled substance and opioid
prescribing; patient record documentation for controlled substance
and opioid prescribing; and office policies, procedures, and
implementation.
Vermont 0 CEs every 2 years; 2 CEs for each full licensing period beginning on or after 08 June 992
National Certification for 2016 on the topics of: abuse and diversion, safe use, and
APRN appropriate storage and disposal of controlled substances;
appropriate use of the Vermont Prescription Monitoring System;
risk assessment for abuse or addiction; pharmacological and
nonpharmacological alternatives to opioids for managing pain;
medication tapering and cessation of the use of controlled
substances; and, relevant state and federal laws and regulations
concerning the prescription of opioid controlled substance.

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Total CE Hours (CEs)
State Boards Required
Virginia 15 CEs and 640 practice
hours (or 30 contact hours)
every 2 years for RN and
LPN; National certification
for Nurse Practitioner
licensed after 08 May 2002
(if licensed as an NP
before 08 May 2002,
certification or 40 contact
hours related to specialty
area is required)
Washington 531 practice hours and 45
contact hours every 3 years
for RN and LPN; National
Certification, 30 contact
hours, and 250
independent clinical
practice hours for ARNP
West Virginia 12 CEs per 1 year for RN;
24 CEs and 400 practice
hours every 2 years for
LPN; 24 CEs every 2 years
for APRNs
Wisconsin 0 CEs every 2 years
Wyoming 30 hours, or 15 hours and
200 hours of employment,
or 400 hours of
employment; In addition,
for APRN, either National
Certification, or 60 contact
hours of CEs in practice
area and 400 hours of
employment.
Number of
Affected
Pain and Opioid CE Requirements Prescribers
2 CEs related to pain management, proper prescribing of 10,038 4
controlled substances, and the diagnosis and management of
addiction every 2 years. There is no exemption from this CE
requirement for doctors of medicine, osteopathy, podiatry,
physician assistants, and nurse practitioners who hold active
licenses. APRNs with prescriptive authority must also have 8 CEs
in pharmacology or pharmacotherapeutics for each biennium.
15 additional contact hours in pharmacotherapeutics for all 3,430 9
ARNPs with prescriptive authority each licensing period. Under
new law (WAC 246-840-4655), in order to prescribe an opioid, an
ARNP licensed to prescribe opioids shall complete a 1-time
continuing education requirement regarding best practices in the
prescribing of opioids that is at least 4 hours in length. The 1-time
continuing education requirement by the end of the first full
continuing education reporting period after 01 January 2019, or
during the first full continuing education reporting period after
initial licensure, whichever is later.
3 CEs initially and then 1 contact hour, thereafter, annually of CE 1,080 4,9
for best prescribing and drug diversion training if you prescribe,
administer or dispense controlled substances. APRNs must obtain
12 hours in pharmacotherapeutics (out of the 24 total required).
Advanced Practice Nurse Prescribers: 16 contact hours per 3,030 9
biennium in clinical pharmacology or therapeutics relevant to the
area of practice, including at least 2 contact hours in responsible
prescribing of controlled substances.
APRNs with prescribing authority must obtain 15 CE in 568 7
pharmacology and clinical management of drug therapy or
pharmacotherapeutics per biennium.
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Appendix G: State Pain and Opioid CE Requirements-Dentists

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State Pain and Opioid CE Requirements-Dentists

Number of
Total CE Hours (CEs) Affected
State Boards Required Pain and Opioid CE Requirements Prescribers
Alabama 20 CEs annually Effective 02 March 2019: 2 CEs on prescribing controlled substances 1,160 9
every 4 years
Alaska 32 CEs every 2 years For those with a DEA registration, at least 2 of the total CEs required 787
to qualify for renewal must be specific to pain management and
opioid use and addiction. AMA PRA Category 1 education qualifies.
Arizona 72 CEs every 3 years A.R.S. § 32-3248.02 requires all healthcare professionals who hold 2,520 9
DEA registrations to complete a minimum of 3 CEs in an opioid-
related, substance-use disorder related, or addiction related course
each renewal cycle as part of the annual continuing education
requirement for licensure.
Connecticut 25 CEs every 2 years The 25 CEs shall include not less than 1 CE in any 3 of the 10 3,460
mandatory topics for continuing education activities prescribed by the
Commissioner; infection control in a dental setting; and prescribing
controlled substances and pain management. The 10 mandatory CE
topics are: prescribing controlled substances and pain management,
record keeping/risk management, infection control, access to care,
HIPAA compliance, medical emergencies in the dental office
(including current training in CPR), sexual assault and domestic
abuse, cultural competence, mental health conditions common to
veterans, and diagnostic technology.
Florida 30 CEs every 2 years 2 CEs every 2 years on the safe and effective prescribing of 15,552
controlled substance medications
Georgia 40 CEs every 2 years 1 CE on the impact of opioid abuse and/or the proper prescription 5,888
writing and use of opioids in dental practice
Iowa 30 CEs every 2 years If prescribing opioids, must complete at least 1 CE in the area of 2,170 2
opioids. The training shall include the following: guidelines for
prescribing opioids, including recommendations on limitations of
dosages and the length of prescriptions; risk factors for abuse; and
nonopioid and nonpharmacologic therapy options.
Kentucky 30 CEs every 2 years 3 CEs related to the use of KASPER, pain management, or addiction 3,869
disorders
Louisiana 30 CEs every 2 years Starting in 2018, 3 CEs on opioid management required one time in 2,750 1
career if prescribing, administering, or dispensing a controlled
substance; otherwise exempt
Maine 40 CEs every 2 years 3 CEs mandatory for dentists who prescribe opioids 470 2,9
Maryland 30 CEs every 2 years 2 Board-approved CEs on proper prescribing and dispensing of 2,720 9
prescription drugs every other renewal cycle starting 2018-2019.
Massachusetts 40 CEs every 2 years 3 CEs mandated each renewal cycle. Practitioners who prescribe 3,160 9
controlled substances, are required, to obtain or renew their
professional licenses, to complete appropriate training relative to:
effective pain management; the risks of abuse and addiction
associated with opioid medication; identification of patients at risk for
substance use disorders; counseling patients about the side effects,
addictive nature and proper storage and disposal of prescription
medications; appropriate prescription quantities for prescription
medications that have an increased risk of abuse; and opioid
antagonists, overdose prevention treatments, and instances in which a

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Number of
Total CE Hours (CEs) Affected
State Boards Required Pain and Opioid CE Requirements Prescribers
patient may be advised on both the use of and ways to access opioid
antagonists and overdose prevention treatments.
Michigan 60 CEs every 3 years 3 Board-approved CEs in pain and symptom management related to 7,943
the practice of dentistry. CEs in pain and symptom management, as
they relate to the practice of dentistry, may include, but are not
limited to: behavior management, psychology of pain, pharmacology,
behavior modification, stress management, clinical applications, and
drug interactions.
Minnesota 30 CEs every 2 years Effective 01 January 2020: Licensees with the authority to prescribe 1,800 9
controlled substances obtain at least 2 CEs on best practices in
prescribing opioids and controlled substances, including
nonpharmacological and implantable device alternatives for treatment
of pain and ongoing pain management, as part of the continuing
education requirements for licensure renewal.
Mississippi 40 CEs every 2 years 3 CEs every 2 years regarding the prescription of opioids. 1,612
Nebraska 30 CEs every 2 years Effective 01 October 2018, 3 CEs every 2 years regarding prescribing 1,584 1
opiates. This may include education regarding prescribing and
administering opiates, risks and indicators regarding development of
addiction to opiates, and emergency opiate situations. 1/2 hour of the
3 CEs shall cover the PDMP.
Nevada 20 CEs annually 2 CEs relating specifically to the misuse and abuse of controlled 1,220 9
substances, the prescribing of opioids or addiction during each
licensure period
New 40 CEs every 2 years Dentists who have a DEA number associated with New Hampshire 906
Hampshire and who prescribe Schedule II-IV controlled substances, shall
complete 3 Board-approved CEs or pass an online examination, in the
area of pain management and addiction disorder or a combination, as
a condition for initial licensure and license renewal.
New Jersey 40 CEs every 2 years Effective in 2019 and for subsequent renewals, for all prescribers, 1 3,670 9
CE concerning prescription opioid drugs, including responsible
prescribing practices, alternatives to opioids for managing and
treating pain, and the risks and signs of opioid abuse, addiction, and
diversion.
New Mexico 60 CEs every 3 years 3 CEs every 3 years. CEs must include: an understanding of the 1,510
pharmacology and risks on controlled substances; a basic awareness
of the problems of abuse, addiction and diversion; awareness of state
and federal regulations for the prescription of controlled substances;
and management of the treatment of pain
New York 60 CEs every 3 years All prescribers licensed to treat humans who have a DEA registration 18,224
to prescribe controlled substances, as well as medical residents who
prescribe controlled substances under a facility DEA registration,
must complete at least 3 CEs in pain management, palliative care, and
addiction. The following 8 topic areas must be included: New York
State and federal requirements for prescribing controlled substances;
pain management; appropriate prescribing; managing acute pain;
palliative medicine; prevention, screening, and signs of addiction;
responses to abuse and addiction; end of life care. All 8 topics must
be completed prior to attestation; the topics can be completed in a
single presentation or in individual segments for a total of at least 3
hours. CEs may be live, online, or obtained from a publication or

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Number of
Total CE Hours (CEs) Affected
State Boards Required Pain and Opioid CE Requirements Prescribers
journal. There is no minimum amount of time that must be spent on
each topic. The CEs do not have to be pre-approved (NY Dept. of
Health does not pre-approve individual CEs). Courses must be
accredited.
North 15 CEs annually All licensees who have a current DEA registration must complete 1 5,386
Carolina CE annually that shall include, but not be limited to, instruction on
controlled substance prescribing practice and controlled substance
prescribing for chronic pain management.
Oregon 40 CEs every 2 years All dentists licensed by the Oregon Board of Dentistry will complete 3,821
a one-time 1 CE pain management course specific to Oregon
provided by the Oregon Pain Commission of the Oregon Health
Authority.
Pennsylvania 30 CEs every 2 years 2 CEs in pain management, the identification of addiction or the 9,514
practices of prescribing or dispensing of opioids, if holding current
DEA registration or using someone else's DEA registration to
prescribe controlled substances
Rhode Island 40 CEs every 2 years 8 CEs on topics such as appropriate prescribing for pain, 635 6
pharmacology, potential for dependence, and alternatives to opioids
for pain management. One-time requirement for dentists with a
Schedule II DEA registration
Tennessee 40 CEs every 2 years 2 CEs in the area of prescribing of controlled substances education 3,992
that includes instruction in the Tennessee Chronic Pain Guidelines.
Utah 30 CEs every 2 years 3.5 CEs every 2 years on controlled substance prescribing. The 3.5 1,660 9
CEs shall include: the scope of the controlled substance abuse
problem in Utah and the nation; all elements of the FDA Blueprint for
Prescriber Education under the FDA's Extended-Release and Long-
Acting Opioid Analgesics Risk Evaluation and Mitigation Strategy, as
published 09 July 2012, or as it may be subsequently revised; the
national and Utah-specific resources available to prescribers to assist
in appropriate controlled substance and opioid prescribing; patient
record documentation for controlled substance and opioid prescribing;
and office policies, procedures, and implementation.
Vermont 30 CEs every 2 years Effective 08 June 2016: 2 CEs for each full licensing period on the 585
topics of: abuse and diversion, safe use, and appropriate storage and
disposal of controlled substances; the appropriate use of the Vermont
Prescription Monitoring System; risk assessment for abuse or
addiction; pharmacological and nonpharmacological alternatives to
opioids for managing pain; medication tapering and cessation of the
use of controlled substances; and, relevant State and federal laws and
regulations concerning prescription of opioid controlled substance.
Virginia 15 CEs annually 2 CEs on pain management 7,112
Washington 63 CEs every 3 years 3 CEs on opioid prescribing required one time 6,708
West Virginia 35 CEs every 2 years 3 CEs regarding drug diversion training and best practice prescribing 470 9
of controlled substances training and training on prescribing and
administration of an opioid antagonist every licensing period
Wisconsin 30 CEs every 2 years 2 CEs in the topic of responsible prescribing of controlled substances 1,930 9
for the treatment of acute dental pain every licensing period

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Appendix H: State Pain and Opioid CE Requirements-Optometrists

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State Pain and Opioid CE Requirements-Optometrists

Number of
State Total CE Hours Affected
Boards (CEs) Required Pain and Opioid CE Requirements Prescribers
Alaska 40 CEs every 2 years 2 CEs must be on pain management, opioid use, and addiction if licensee 7
holds a DEA registration; must be AMA Category 1 or AOA Category 1
or 2; must include all three topics
Arizona 32 CEs every 2 years 3 CEs on opioid-related, substance use disorder-related, or addiction- 1,200 4
related topics each cycle (for those authorized to prescribe C-II;
optometrists can prescribe C-II hydrocodone products only)
Florida 30 CEs every 2 years 2 CEs on prescribing controlled substances if holding a DEA registration 466
Kentucky 15 CEs annually for Those with a DEA registration must complete a 2-CE course annually in 373
therapeutic licenses; 8 pain management/addiction disorders.
CEs for non-
therapeutic licenses
Michigan 40 CEs every 2 years 2 Board-approved CEs in pain and symptom management related to the 1,773
practice of optometry. May include: ethics and health policy related to
pain; pain definitions; basic sciences related to pain, including
pharmacology, psychology, sociology, and anthropology; clinical
sciences related to pain, including specific pain conditions and pain in
special contexts and settings; clinician-patient communications related to
pain; management of pain, including evaluation and treatment and non-
pharmacological and pharmacological management; ensuring quality
pain care; and Michigan programs and resources relevant to pain.
Minnesota 40 CEs every 2 years Effective 01 January 2020: Licensees with the authority to prescribe 900 9
controlled substances must obtain 2 CEs on best practices in prescribing
opioids and controlled substances, including nonpharmacological and
implantable device alternatives for treatment of pain and ongoing pain
management, as part of the continuing education requirements for
licensure renewal. This requirement was mandated via statute, and board
rules have not yet been promulgated.
Nevada 30 hours annually for 2 CEs annually related to misuse and abuse of controlled substances, 294
TPA certified; 18 prescribing of opioids, or addiction
hours for DPA
certified
New 50 CEs annually; 15 3 CEs annually, completed online 292
Hampshire CEs annually for non-
TPA certified
New Jersey 50 CEs every 2 years Of the 50 CEs biennially required under this section, at least 1 CE shall 1,160 9
be for educational programs or topics that concern the prescription of
hydrocodone, or the prescription of opioid drugs in general, including
responsible prescribing practices, the alternatives to the use of opioids
for the management and treatment of pain, and the risks and signs of
opioid abuse, addiction, and diversion.
New Mexico 22 CEs annually 1 hour annually in pain management or a related topic 302
North 25 CEs annually 2 hours in a Board-approved opioid course 1,404
Carolina
Oklahoma 25 CEs annually 1 hour in judicious prescribing annually 630 9

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Number of
State Total CE Hours Affected
Boards (CEs) Required Pain and Opioid CE Requirements Prescribers
Pennsylvania 30 CEs every 2 years Effective 01 July 2017, 2 CEs in pain management or identification of 2.660
addiction and 2 CEs in practices in prescribing or dispensing of opioids
each licensing period
Rhode Island 60 CEs every 3 years Any practitioner who prescribes a C-II opioid is required to successfully Not
if TPA certified; 48 if complete 8 CEs of Category 1 CE in any or all of the following topics: available
not TPA certified appropriate prescribing of opioids for pain; pharmacology; adverse
events; potential for dependence; tolerance; addiction; and alternatives to
opioids for pain management. Although no one specific course is
required, the Drug Addiction Treatment Act of 2000 (DATA 2000)
waiver training course qualifies for the above requirement. This specific
training requirement is required only once and must be completed before
renewal of controlled substance registration or two (2) years, whichever
is longer.
Tennessee 30 hours every 2 years 2 hours every 2 years 1,310
Utah 30 CEs every 2 years 3.5 CEs every 2 years on controlled substance prescribing. The 3.5 CEs 470 9
shall include: the scope of the controlled substance abuse problem in
Utah and the nation; all elements of the FDA Blueprint for Prescriber
Education under the FDA's Extended-Release and Long-Acting Opioid
Analgesics Risk Evaluation and Mitigation Strategy, as published 09
July 2012, or as it may be subsequently revised; the national and Utah-
specific resources available to prescribers to assist in appropriate
controlled substance and opioid prescribing; patient record
documentation for controlled substance and opioid prescribing; and
office policies, procedures, and implementation.
Vermont 40 CEs for TPA; 20 Effective 08 June 2016: 2 CEs for each full licensing period on the topics 117
CEs for non-TPA of: abuse and diversion, safe use, and appropriate storage and disposal of
controlled substances; appropriate use of the Vermont Prescription
Monitoring System; risk assessment for abuse or addiction;
pharmacological and nonpharmacological alternatives to opioids for
managing pain; medication tapering and cessation of the use of
controlled substances; and, relevant state and federal laws and
regulations concerning the prescription of opioid controlled substance.
West 43 CEs every 2 years 3 CEs in drug diversion training and best practice controlled substance 180 1,9
Virginia prescribing within 1 year of initial licensing; 3 CEs on same topic every
2 years if prescribing, dispensing, or administering controlled
substances; if not prescribing, administering, or dispensing controlled
substances, either 3 CEs on drug diversion and best practice prescribing
or the licensee must certify that he/she has not prescribed, administered,
or dispensed controlled substances during entire 2-year renewal cycle.

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Appendix I: State Pain and Opioid CE Requirements-Pharmacists

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State Pain and Opioid CE Requirements-Pharmacists

Number of
Total CE Hours (CEs) Affected
State Boards Required Pain and Opioid CE Requirements Pharmacists
Arizona 30 CEs every 2 years 3 CEs must be opioid related, substance-use related or addiction 7,812
related
Delaware 30 CEs every 2 years At least 2 CEs every 2 years must relate to medication safety/errors. 1,060 9
At least two 2 CEs every 2 years must relate to the distribution,
dispensing, or delivery of controlled substances; or, the detection and
recognition of abuse or illegal use of controlled substances.
District of 40 CEs every 2 years At least two 2 CEs every 2 years must relate to medication/dispensing 1,070 9
Columbia errors.
Florida 30 CEs every 2 years 2 CEs (of the 30) must be board-approved controlled substance CE 34,157
Michigan 30 CEs every 2 years 1 CE in pain and symptom management each licensing period 15,500
Mississippi 15 CEs annually 5 CEs each year must be related to opioid abuse and prevention or 2,280 9
some other drug of abuse or addiction-related issue.
New Jersey 30 CEs every 2 years 1 CE (of the 30) in topics concerning prescription opioid drugs, 9,280 9
including alternatives to opioids for managing and treating pain, and
the risks and signs of opioid abuse, addiction, and diversion
New Mexico 30 CEs every 2 years 2 (of the 30) CEs in the safe use of opioids. These 2 CEs in the safe 3,078
use of opioids may also be used for New Mexico’s patient safety CE
requirement if indicated by the ACPE number.
Oregon 30 CEs every 2 years One-time requirement to complete 7 CEs on pain management within 4,360 9
24 months of first license renewal; 1 CE must be the module from the
Oregon Pain Management Commission.
Pennsylvania 30 hours every 2 years 4 CEs of Board-approved education consisting of 2 CEs in pain 23,738
management or the identification of addiction and 2 CEs in the
practices of prescribing or dispensing of opioids
South 15 CEs annually 1 CE (of the 15) must be related to approved procedures for 8,600
Carolina monitoring controlled substances listed in Schedules II, III, and IV
Texas 30 CEs every 2 years 1 CE (of the 30) must be related to opioid abuse 21,250 9
Vermont 30 CEs every 2 years 2 CEs for each full licensing period beginning on or after 08 June 808
2016 on the topics of: abuse and diversion, safe use, and appropriate
storage and disposal of controlled substances; appropriate use of the
Vermont Prescription Monitoring System; risk assessment for abuse
or addiction; pharmacological and nonpharmacological alternatives to
opioids for managing pain; medication tapering and cessation of the
use of controlled substances; and, relevant state and federal laws and
regulations concerning the prescription of opioid controlled
substance.
Virginia 15 CEs annually In 2017, all pharmacists were required to obtain at least 1 CE in any 15,424
of the following subject areas: proper opioid use, opioid overdose
prevention, or naloxone administration. The minimum requirement
was part of the 15 hours of CE that was required during 2017. This
was a one-time requirement; further action of the Board would be
required to mandate CE in a specific topic in future years.

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Number of
Total CE Hours (CEs) Affected
State Boards Required Pain and Opioid CE Requirements Pharmacists
West Virginia 30 CEs every 2 years 3 CEs of drug diversion training and best practice prescribing of 2,180 9
controlled substances training unless verifying he/she has not
administered or dispensed controlled substances during the entire
previous reporting period. “Drug diversion training and best practice
prescribing of controlled substances training” means a training course
of at least 3 CPE hours which includes, at a minimum, all of the
following: Drug diversion, including West Virginia statistics on
prescription drug abuse and resulting deaths; Epidemiology of
chronic pain and misuse of opioids; Indication for opioids in chronic
pain treatment including, at a minimum, general characteristics,
toxicities, and drug interactions; Patient evaluation and risk
assessment and tools to assess risk and monitor benefits. Initiation
and ongoing-management of chronic pain in patients treated with
opioid based therapies, including, at a minimum: treatment
objectives; medication therapy management and collaborative
practice; prescription of controlled substance agreements; urine
screens and pill counts; patient education on safe use, storage and
disposal of opioids; discontinuation of opioids; and documentation
and medical records; Case study of a patient with chronic pain;
Identification of diversion and drug seeking tactics and behaviors;
Best practice methods for working with patients, prescribers, law
enforcement, and others as appropriate, concerning patients suspected
of drug seeking behavior and diversion; Compliance with controlled
substances laws and rules; and How to Register with and use the
West Virginia Controlled Substances Monitoring Program.

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Appendix J: Sufficiency of REMS Education, by State

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Sufficiency of REMS Education, by State

Physician
State MD/DO Assistant Podiatrist Naturopath Nurse Dentist Optometrist Pharmacist
Alabama Meets Partially Meets Meets No State CE Does Not Meet Meets No State CE No State CE
Requirement Requirement Requirement
Alaska Meets Meets Meets No State CE Meets Meets Meets No State CE
Requirement Requirement
Arizona Meets Meets Meets Meets Meets Meets Meets Meets
Arkansas Partially Meets Meets No State CE No State CE Does Not Meet No State CE No State CE No State CE
Requirement Requirement Requirement Requirement Requirement
California Partially Meets No State CE No State CE Partially Meets Does Not Meet No State CE No State CE No State CE
Requirement Requirement Requirement Requirement Requirement
Colorado No State CE No State CE No State CE No State CE No State CE No State CE No State CE No State CE
Requirement Requirement Requirement Requirement Requirement Requirement Requirement Requirement
Connecticut Meets Meets No State CE No State CE Meets Partially Meets No State CE No State CE
Requirement Requirement Requirement Requirement
Delaware No State CE No State CE No State CE No State CE Does Not Meet No State CE No State CE Does Not Meet
Requirement Requirement Requirement Requirement Requirement Requirement
District of No State CE No State CE No State CE No State CE Meets No State CE No State CE Does Not Meet
Columbia Requirement Requirement Requirement Requirement Requirement Requirement
Florida Meets Meets Meets No State CE Meets Meets Meets Does Not Meet
Requirement
Georgia Meets No State CE No State CE No State CE No State CE Meets No State CE No State CE
Requirement Requirement Requirement Requirement Requirement Requirement
Hawaii No State CE No State CE No State CE No State CE Meets No State CE No State CE No State CE
Requirement Requirement Requirement Requirement Requirement Requirement Requirement
Idaho No State CE No State CE No State CE No State CE Meets No State CE No State CE No State CE
Requirement Requirement Requirement Requirement Requirement Requirement Requirement
Illinois Meets No State CE No State CE No State CE Meets No State CE No State CE No State CE
Requirement Requirement Requirement Requirement Requirement Requirement
Indiana Meets Meets No State CE No State CE Meets No State CE No State CE No State CE
Requirement Requirement Requirement Requirement Requirement

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Physician
State MD/DO Assistant Podiatrist Naturopath Nurse Dentist Optometrist Pharmacist
Iowa Meets Does Not Meet Does Not Meet No State CE Does Not Meet Does Not Meet No State CE No State CE
Requirement Requirement Requirement
Kansas No State CE No State CE No State CE No State CE No State CE No State CE No State CE No State CE
Requirement Requirement Requirement Requirement Requirement Requirement Requirement Requirement
Kentucky Partially Meets Partially Meets Meets No State CE Partially Meets Meets Meets No State CE
Requirement Requirement
Louisiana Does Not Meet Partially Meets Meets No State CE Meets Meets No State CE No State CE
Requirement Requirement Requirement
Maine Meets Meets Meets No State CE Meets Meets No State CE No State CE
Requirement Requirement Requirement
Maryland Meets Meets Meets No State CE Meets Meets No State CE No State CE
Requirement Requirement Requirement
Massachusetts Partially Meets Meets Meets No State CE Meets Meets No State CE No State CE
Requirement Requirement Requirement
Michigan Meets No State CE Meets No State CE Meets Does Not Meet Does Not Meet Meets
Requirement Requirement
Minnesota Meets Meets Meets No State CE Meets Meets Meets No State CE
Requirement Requirement
Mississippi Meets Meets Meets No State CE Meets Meets No State CE Meets
Requirement Requirement
Missouri No State CE No State CE No State CE No State CE No State CE No State CE No State CE No State CE
Requirement Requirement Requirement Requirement Requirement Requirement Requirement Requirement
Montana No State CE No State CE No State CE No State CE Meets No State CE No State CE No State CE
Requirement Requirement Requirement Requirement Requirement Requirement Requirement
Nebraska Partially Meets Partially Meets Partially Meets No State CE Partially Meets Partially Meets No State CE No State CE
Requirement Requirement Requirement
Nevada Meets Meets Meets No State CE Meets Meets Meets No State CE
Requirement Requirement
New Meets Meets No State CE No State CE Meets Meets Meets No State CE
Hampshire Requirement Requirement Requirement

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Physician
State MD/DO Assistant Podiatrist Naturopath Nurse Dentist Optometrist Pharmacist
New Jersey Meets Meets Meets No State CE Meets Meets Meets Meets
Requirement
New Mexico Partially Meets Partially Meets Meets No State CE Meets Partially Meets Meets Meets
Requirement
New York Partially Meets Partially Meets Does Not Meet No State CE Meets Partially Meets No State CE No State CE
Requirement Requirement Requirement
North Carolina Meets Meets Meets No State CE Meets Meets Meets No State CE
Requirement Requirement
North Dakota No State CE No State CE No State CE No State CE Meets No State CE No State CE No State CE
Requirement Requirement Requirement Requirement Requirement Requirement Requirement
Ohio Meets Meets No State CE No State CE Meets No State CE No State CE No State CE
Requirement Requirement Requirement Requirement Requirement
Oklahoma Meets Meets No State CE No State CE Meets No State CE Meets No State CE
Requirement Requirement Requirement Requirement
Oregon Partially Meets Partially Meets Partially Meets Partially Meets Partially Meets Does Not Meet No State CE Partially Meets
Requirement
Pennsylvania Meets Meets Meets No State CE Meets Meets Meets Meets
Requirement
Rhode Island Meets Meets No State CE No State CE Meets Meets Meets No State CE
Requirement Requirement Requirement
South Carolina Meets Meets Meets No State CE Meets No State CE No State CE Does Not Meet
Requirement Requirement Requirement
South Dakota No State CE No State CE No State CE No State CE No State CE No State CE No State CE No State CE
Requirement Requirement Requirement Requirement Requirement Requirement Requirement Requirement
Tennessee Does Not Meet Partially Meets Meets No State CE Partially Meets Partially Meets Meets No State CE
Requirement Requirement
Texas Meets Meets Meets No State CE Meets No State CE No State CE Meets
Requirement Requirement Requirement
Utah Partially Meets Partially Meets Partially Meets No State CE Partially Meets Partially Meets Partially Meets No State CE
Requirement Requirement
Vermont Partially Meets Does Not Meet Does Not Meet Does Not Meet Does Not Meet Does Not Meet Does Not Meet Does Not Meet

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Physician
State MD/DO Assistant Podiatrist Naturopath Nurse Dentist Optometrist Pharmacist
Virginia Meets Meets Meets No State CE Meets Meets No State CE Meets
Requirement Requirement
Washington Does Not Meet Meets No State CE No State CE Meets Meets No State CE No State CE
Requirement Requirement Requirement Requirement
West Virginia Meets Partially Meets Partially Meets No State CE Meets Meets Meets Partially Meets
Requirement
Wisconsin Does Not Meet No State CE Meets No State CE Meets Does Not Meet No State CE No State CE
Requirement Requirement Requirement Requirement
Wyoming No State CE No State CE No State CE No State CE Meets No State CE No State CE No State CE
Requirement Requirement Requirement Requirement Requirement Requirement Requirement

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Appendix K: Continuing Education Programs

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Continuing Education Programs

Course Source Hours
REMS-Compliant Programs Funded by REMS Program Companies
(RPC)
ASA Pain: Anesthesiologists Tailored Approach to Patient Safety American Society of 3
Considerations When Using Opioid Analgesics - Georgia Anesthesiologists
SCOPE of Pain: Safer/Competent Opioid Prescribing Education Boston University School of 2
Medicine
SCOPE of Pain: Safe and Competent Opioid Prescribing Education Boston University School of 2
Medicine
Pain Management and Opioids: Balancing Risks and Benefits CO*RE & American 2.5
Academy of Hospice and
Palliative Medicine
Pain Management and Opioids: Balancing Risks and Benefits CO*RE & American 3
Association of Nurse
Practitioners
Pain Management and Opioids: Balancing Risks and Benefits CO*RE & American 3
Academy of Physician
Assistants
Pain Management and Opioids: Balancing Risks and Benefits CO*RE & American 3
Osteopathic Association
Pain Management and Opioids: Balancing Risks and Benefits CO*RE & American Society 2
of Addiction Medicine
Pain Management and Opioids: Balancing Risks and Benefits CO*RE & California 3
Academy of Family
Physicians
Pain Management and Opioids: Balancing Risks and Benefits CO*RE & Nurse Practitioner 3
Healthcare Foundation
Pain Management and Opioids: Balancing Risks and Benefits CO*RE & Interstate 2.5
Postgraduate Medical
Association
Opioid Analgesics Risk Evaluation and Mitigation Strategy (REMS): Global Education 3
Education for Healthcare Providers Group and Rockpointe
Get SMART - Module 1: Basics of Pain & Pain Management Johns Hopkins University, 1
School of Medicine;
DKBmed, & Postgraduate
Institute for Medicine
Get SMART - Module 2: Principles of Opioids Johns Hopkins University, 1
School of Medicine;
DKBmed, & Postgraduate
Institute for Medicine
Get SMART - Module 3: Initiating Treatment and Ongoing Management Johns Hopkins University, 1
School of Medicine;
DKBmed, & Postgraduate
Institute for Medicine
NEJM Knowledge+: Pain Management and Opioids Massachusetts Medical 10
Society
Get SMART - Safe Means of Administering the Right Therapy (Get Postgraduate Institute for 1
SMART REALCME) Tier 1 Medicine
Get SMART - Safe Means of Administering the Right Therapy (Get Postgraduate Institute for 1
SMART REALCME) Tier 2 Medicine
SAFE Opioid Prescribing PRI-Med 3.5
Get SMART - Safe Means of Administering the Right Therapy Module 1 University of Kentucky 1
College of Medicine,
DKBmed & Postgraduate
Institute for Medicine

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Course Source Hours

Get SMART - Safe Means of Administering the Right Therapy Module 2 University of Kentucky 1
College of Medicine,
DKBmed & Postgraduate
Institute for Medicine
Opioid Analgesic: Risk Evaluation and Mitigation Strategy (REMS) and University of North Texas
the New FDA Blueprint Health Science Center
REMS Activity 2 University of North Texas 1
Health Science Center
REMS 3 University of North Texas 1
Health Science Center
Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) USF Health, Potomac Center 2.25
for Medical Education, and
Rockpointe
Programs Funded by Other Entities
Pathways in Pain Management: Chronic Low Back Pain American Academy of 0.75
Physician Assistants,
California Academy of
Family Physicians,
Healthcare Performance
Consulting, Interstate
Postgraduate Medical
Association & Nurse
Practitioner Healthcare
Foundation
Advancements in Cancer Management Academy for Continued 3.25
Health Learning
Adult Medicine 8th Edition: 08 Chronic Pain Management American Academy of 1
Family Physicians
Care of Chronic Conditions 3rd Edition American Academy of 1
Family Physicians
Navigating the Challenges in an Era of Opioid Deprescribing: Behavioral American Academy of Pain 1
Strategies for Patient Engagement and Success Medicine
Pain Management for Women with Rheumatoid and Other Arthritic American Academy of Pain 1
Conditions Medicine
Preparing for 2019: Update on Coding and CMS Policy Changes Webinar American Academy of Pain 1
Medicine
Managing Aberrant Drug Taking Behaviors and Opioid Use Disorder American Association of 1.25
Nurse Practitioners
Neuropathic Pain: Pathophysiology, Diagnosis, and Treatment of Common American Association of 1.25
Conditions Nurse Practitioners
Non-Opioid Pharmacology for Pain Management American Association of 1.25
Nurse Practitioners
NP/PA 16-Hour Buprenorphine Waiver Training Part II Only American Association of 16
Nurse Practitioners
NP/PA 24-Hour Buprenorphine Waiver Training American Association of 24
Nurse Practitioners
Opioid Prescribers: Avoiding Practice Breakdown and Disciplinary Action American Association of 1
Nurse Practitioners
Opioid Prescribers: Avoiding Practice Breakdown and Disciplinary Action American Association of 1.25
Nurse Practitioners
Prescription Drug Monitoring Program: Past, Present and Future American Association of 1.25
Nurse Practitioners
Research-Based Clinical Strategies to Prevent and Address Adolescent American Association of 0.5
Substance Use and Prescription Medication Misuse: Being Part of the Nurse Practitioners
Solution, Part 1

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Course Source Hours

Research-Based Clinical Strategies to Prevent and Address Adolescent American Association of 0.5
Substance Use and Prescription Medication Misuse: Being Part of the Nurse Practitioners
Solution, Part 2
Safe Opioid Prescribing Series: How to Safely and Effectively Treat Pain American Association of 2.25
in Primary Care Nurse Practitioners
Take ACTION: Opioid Overdose Prevention Education Training for Nurse American Association of 1
Practitioners Nurse Practitioners
ABFM Pain Management Clinical Self-Assessment American Board of Family 4
Medicine
ABFM Pain Management Knowledge Self-Assessment American Board of Family 8
Medicine
SAFE Opioid Prescribing American College of 3.5
Physicians
Safe and Responsible Prescribing of Opioid Analgesics American Dental Association 2
A Primer on the Opioid Morbidity and Mortality Crisis: What Every American Medical 0.75
Prescriber Should Know Association
Treating Common Pain Conditions: Practical Guidance for Pain American Medical 1.75
Management Association
Treating Older Adults: Practical Guidance for Pain Management American Medical 1
Association
Using Opioids Safely: Practical Guidance for Pain Management American Medical 2.5
Association
Addiction Medicine-Advanced Essentials American Osteopathic 16.5
Academy of Addiction
Medicine
Medication Assisted Treatment in The Emergency Room Setting American Psychiatric 1
Association
Recovery Support for Young People with Opioid Use Disorders American Psychiatric 1
Association
Rethinking Withdrawal Management American Psychiatric 1
Association
Telepsychiatry’s Role in Medication Assisted Treatment American Psychiatric 1
Association
The Clinical and Public Health Utility of Mutual Aid Organizations in American Psychiatric 1
Addressing Addiction: What Does the Science Tell Us? Association
Tracking Drug Use Patterns American Psychiatric 1
Association
Vaccines for Opioid Use Disorder: Focusing on the Fentanyl Epidemic American Psychiatric 1
Association
Drug Diversion and Best Practice Prescribing of Controlled Substances Berkeley Medical Center, 3
WVU Medicine and Hospice
of the Panhandle
Pediatric Pain and Opioid Education Boston Children's Hospital & 5.5
Harvard Medical School
Safe Opioid Prescribing for Acute Dental Pain Boston University Henry M. 1
Goldman School of Dental
Medicine
A Patient-Centered Approach to Opioid Tapering Boston University School of 0.5
Medicine
Emergency Response: Safer Opioid Prescribing in the Emergency Boston University School of 1.5
Department Medicine
Managing Pain and Opioid Use: An Educational Program on Compliance Boston University School of 1
with NYS Prescribing Laws Medicine
Overdose Prevention and Naloxone Rescue Kits for Prescribers Boston University School of 1.25
and Pharmacists Medicine

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Course Source Hours

Safe and Competent Opioid Prescribing for Providers Working with Boston University School of 1.75
Veterans and Military Service Personnel Medicine
Safe and Competent Opioid Prescribing: Optimizing Office Systems Boston University School of 0.5
Medicine
Safer Opioid Prescribing for Pain in Adolescents and Young Adults in Boston University School of 1
Outpatient Settings Medicine
Safer Post-Operative Prescribing of Opioids Boston University School of 0.5
Medicine
From Prescription Drug Abuse to Street Heroin...The Tale of West CAMC Health Education and 3
Virginia’s Drug Abuse Epidemic Research Institute
Shifting Perspectives on Pain Management in Oral Surgery CME Outfitters & American 0.5
Optometric Association
The Role that Gender Plays in Pain Perception, Treatment, and Addiction CME Outfitters & Interstate 0.25
Postgraduate Medical
Association
Laboratory Director Continuing Education Program: The Toxicology COLA 2
Laboratory's Role in Pain Management
A Multidisciplinary Approach to the Care of Pregnant and Parenting Dartmouth-Hitchcock 1
Women with Opioid Use Disorders
An Infectious Disease Perspective: Opioid Use Disorder and Commonly Dartmouth-Hitchcock 1
Co-Occurring Conditions in Pregnant Women
Changing Opioid Medication Paradigms for Effective Living (COMPEL) Dartmouth-Hitchcock 1
Collaborative Care Approach to Treating Opioid Use Disorder in Primary Dartmouth-Hitchcock 1
Care
From Hospital to Community: Responding to the Epidemic of Opioid Dartmouth-Hitchcock 1
Overdose and Addiction
Improving Care for Opioid-Exposed Newborns using the Eat, Sleep, Dartmouth-Hitchcock 1
Console (ESC) Care Approach
Initiating Treatment for Alcohol and Opioid Use Disorder in the Dartmouth-Hitchcock 1
Emergency Department
Integrating Opioid Use Disorder Treatment in HIV Clinical Care Dartmouth-Hitchcock 1
Medicine Grand Rounds - Cannabis and Opioids in Pain Management: Dartmouth-Hitchcock 1
Alternatives? Complements? Pipe dream?
Opioid Prescribing for Acute Pain after Surgery Dartmouth-Hitchcock 1
Opioid Use for Headache Treatment Dartmouth-Hitchcock 1
Opioid Use in Orthopaedics Dartmouth-Hitchcock 1
Perioperative Pain Control for the Opioid Tolerant Patient Dartmouth-Hitchcock 1
Prescription Opioids: Social Policy Gone Awry Dartmouth-Hitchcock 1
Screening for Opioid Use Disorder in the Oncology Setting Dartmouth-Hitchcock 1
Screening, Brief Intervention and Referral for Treatment for Substance Use Dartmouth-Hitchcock 1
Disorder in the Oncology Setting
The Opioid Crisis and Women’s Health Dartmouth-Hitchcock 1
The Opioid Epidemic in Northern New England: The Story and Response Dartmouth-Hitchcock 1
Outside
Emergency Medicine Practice: Pain in the Emergency Department: EB Medicine 4
Management Beyond Opioids
Drug Diversion Training and Best Practice Prescribing of Control Family Medicine Foundation 3
Substances Workshop of WV
Florida Mandatory Opioid Prescribing CME Speaker: David Koo, MD Florida Academy of Family 2
Physicians
GOLD Neonatal Conference 2019: Clinical Pain Management in the Gold Learning 1
Neonate
Opioid Use Disorder Education Program - Collaborative Care Approaches Harvard Medical School 8
for Mgmt. of OUD
Opioid Use Disorder Education Program - Identification, Counseling, and Harvard Medical School 8
Treatment of OUD

68

RKT Consulting
CE: Pain Management and Opioid Prescribing

Course Source Hours

Opioid Use Disorder Education Program - Understanding Addiction Harvard Medical School 8
Project ECHO: Tele-mentoring Program for Treatment of OUD Indiana State Medical 1
Association
2019 Legal Update: Understanding the Most Recent Indiana Laws for Indiana State Medical 1
Prescribers and How to Comply Association
Changing the Culture of Prescribing: Providing Safe & Compassionate Indiana State Medical 1
Care to the Opioid Tolerant Patient Association
Changing the Game: Sports Medicine and the Opioid Crisis Indiana State Medical 1
Association
Chronic Pain Management and Integrative Treatment Methods Indiana State Medical 1
Association
Difficult Conversations with Patients Seeking Opioids Indiana State Medical 1
Association
INSPECT Integration: Data for Critical Prescribing Decisions Indiana State Medical 1
Association
Legislative & Legal Update on Opioid Prescribing Indiana State Medical 1
Association
Medication Assisted Treatment for Opioid Use Disorders Indiana State Medical 1
Association
Opioid Epidemic: Medical Societies' Views/Clinical Realities Indiana State Medical 1
Association
Psychological Considerations in Assessment and Treatment of Patients Indiana State Medical 1
with Chronic Pain Association
Screening & Treating Adolescents with Substance Use Disorder Indiana State Medical 1
Association
Strategies for Safe and Compassionate Opioid Weaning: Developing a Path Indiana State Medical 1
to Success Association
The Least, Last and Lost: Caring for Pregnant Women & Newborns Indiana State Medical 1
Affected by Opioid Use Disorder Association
The Opioid Epidemic: Impact on Peri-Operative Care Indiana State Medical 1
Association
Treating Controlled Substance Use & Abuse in the ED Indiana State Medical 1
Association
Responsible Opioid Prescribing Interstate Postgraduate 2.5
Medical Association
Association of Pharmacological Treatments with Long-term Pain Control JAMA 1
in Patients with Knee Osteoarthritis: A systematic Review and Meta-
analysis
Medical Marijuana for Treatment of Chronic Pain and Other Problems JAMA 0.5
Opioid Prescribing: Rising to the Challenge JAMA 0.5
Opioids for Chronic Noncancer Pain: A systematic Review and Meta- JAMA 1
analysis
Urine Drug Screens to Monitor Opioid Use for Managing Chronic Pain JAMA 1
Opioid Use by Patients After Rhinoplasty JAMA Facial Plastic Surgery 1
Postoperative Opioid Use Among Patients Undergoing Plastic and JAMA Facial Plastic Surgery 1
Reconstructive Surgery
Association of Medical and Adult-Use Marijuana Laws With Opioid JAMA Internal Medicine 1
Prescribing for Medicaid Enrollees
Association of Opioid Prescriptions from Dental Clinicians for US JAMA Internal Medicine 1
Adolescents and Young Adults With Subsequent Opioid Use and Abuse
Improving Adherence to Long-term Opioid Therapy Guidelines to Reduce JAMA Internal Medicine 1
Opioid Misuse in Primary Care: A Cluster-Randomized Clinical Trial
Association of Long-term Opioid Therapy With Functional Status, Adverse JAMA Neurology 1
Outcomes, and Mortality Among Patients With Polyneuropathy
Effect of Intranasal Ketamine vs. Fentanyl on Pain Reduction for Extremity JAMA Pediatrics 1
Injuries in Children: The PRIME Randomized Clinical Trial

69

RKT Consulting
CE: Pain Management and Opioid Prescribing

Course Source Hours

Opioid Use Disorder After Self-medicating Pain From Traumatic Brain JAMA Psychiatry 1
Injury
Association Between Long-term Opioid Use in Family Members and JAMA Surgery 1
Persistent Opioid Use After Surgery Among Adolescents and Young
Adults
Defining Optimal Length of Opioid Pain Medication Prescription After JAMA Surgery 1
Common Surgical Procedures
Incidence and Predictors of Opioid Prescription at Discharge After JAMA Surgery 1
Traumatic Injury
Legal Advisor: Identifying Drug Dependence Massachusetts Medical 1
Society
New Opioid Prescribing Guidelines in Practice Massachusetts Medical 1
Society
Mayo Clinic Talks Podcast: Opioid Edition Mayo Clinic School of 3
Continuous Professional
Development
Principles of Pain Management and Palliative Care: Essential Tools for the Mayo Clinic School of 29
Clinician 2019 Continuous Professional
Development
Opioid Prescribing: Safe Practice, Changing Lives Medscape 2
Treating Pain and Addiction Michigan Center for Clinical 6
Systems Improvement
Prescribing Opioids, Providing Naloxone, and Preventing Drug Diversion: NetCE 3
The West Virginia Requirement
ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care Northern West Virginia Rural 3
Health Education Center
Pathways in Pain Management: Chronic Low Back Pain Nurse Practitioner Healthcare 0.75
Foundation
Pathways in Pain Management: Effectively Addressing Osteoarthritis Nurse Practitioner Healthcare 0.75
Foundation
Pain Management and Opioids: Balancing Risks and Benefits Nurse Practitioner Healthcare 2
Foundation & California
Association for Nurse
Practitioners
Pain Management and Opioids: Balancing Risks and Benefits Nurse Practitioner Healthcare 2.5
Foundation & Gerontological
Advanced Practice Nurses
Association
Pathways in Pain Management: Osteoarthritis and Chronic Low Back Pain Nurse Practitioner Healthcare 1.5
Foundation & Gerontological
Advanced Practice Nurses
Association
Pain Management and Opioids: Balancing Risks and Benefits Nurse Practitioner Healthcare 2
Foundation & Horizon CME
Advanced Practice Providers
Oncology Summit
Pain Management and Opioids: Balancing Risks and Benefits Nurse Practitioner Healthcare 2
Foundation & Horizon CME
Advanced Practice Providers
Oncology Summit
Pathways in Pain Management: Osteoarthritis and Chronic Low Back Pain Nurse Practitioner Healthcare 1
Foundation & Iowa Nurse
Practitioner Society
Pain Management and Opioids: Balancing Risks and Benefits Nurse Practitioner Healthcare 1.5
Foundation & National

70

RKT Consulting
CE: Pain Management and Opioid Prescribing

Course Source Hours

Conference for Nurse
Practitioners
Pathways in Pain Management: Osteoarthritis and Chronic Low Back Pain Nurse Practitioner Healthcare 1.5
Foundation & National
Conference for Nurse
Practitioners
Pain Management and Opioids: Balancing Risks and Benefits Nurse Practitioner Healthcare 2
Foundation & National Nurse
Practitioner Symposium
Pathways in Pain Management: Osteoarthritis and Chronic Low Back Pain Nurse Practitioner Healthcare 1.5
Foundation & National Nurse
Practitioner Symposium
Pathways in Pain Management: Osteoarthritis and Chronic Low Back Pain Nurse Practitioner Healthcare 1
Foundation & Nurse
Practitioner Associates for
Continuing Education
Pathways in Pain Management: Osteoarthritis and Chronic Low Back Pain Nurse Practitioner Healthcare 1
Foundation & Nurse
Practitioner Associates for
Continuing Education
Pathways in Pain Management: Osteoarthritis and Chronic Low Back Pain Nurse Practitioner Healthcare 1
Foundation & Nurse
Practitioner Associates for
Continuing Education
Pathways in Pain Management: Osteoarthritis and Chronic Low Back Pain Nurse Practitioner Healthcare 1.5
Foundation & Pain Care for
Primary Care
Pain Management and Opioids: Balancing Risks and Benefits Nurse Practitioner Healthcare 3
Foundation and the
Collaborative on REMS
(CO*RE) Education
Children in Pain Nurse.com 1
Chronic Pain: How Do We Treat It in an Era of Increasing Prescription Nurse.com 1
Medication Misuse and Abuse?
Complex Regional Pain Syndrome — Type I Nurse.com 1
Controlled Substance Prescribing for Chronic Pain Management Nurse.com 1
Controlled Substances Prescribing Practices Nurse.com 1
Effective Pain Management is More Than Just a Number, Part 1 Nurse.com 0.5
Effective Pain Management is More Than Just a Number, Part 2 Nurse.com 0.5
Evidence-Based Approaches to Pain Control Nurse.com 2.5
Getting Started in Hospice Care Nurse.com 6.5
Heroin: The Illegal Opioid Nurse.com 1.5
Identifying Pain in the Hospice Patient Nurse.com 1
Interprofessional Guide to Pain Management Nurse.com 8
Knocking Out Pain Safely with PCA Nurse.com 1
Medication Reconciliation: Avoiding Dangerous Errors Nurse.com 1
Meeting the Challenge of Pediatric Pain Management Nurse.com 2.9
Pain Management and Ethics, Part 1: What’s the Right Thing To Do? Nurse.com 0.5
Pain Management and Ethics, Part 2: What’s the Right Thing To Do? Nurse.com 0.5
Pain Management Basics Nurse.com 1
Recognizing Signs of the Misuse or Abuse of Controlled Substances Nurse.com 1
Recognizing, Diagnosing and Managing Emergent Causes of Low Back Nurse.com 1
Pain
Reducing Pain During Minor Procedures for Pediatric Patients Nurse.com 1
Responsible Opioid Prescribing, Chronic Pain, and Addiction Nurse.com 1.5

71

RKT Consulting
CE: Pain Management and Opioid Prescribing

Course Source Hours

Responsible Opioid Prescribing: Balancing Effective Chronic Pain Nurse.com 2.5
Management in an Era of Prescription Medication Misuse and Abuse
Opioid Prescribing Practices - PART 1: Managing Opioid Therapy in High- Oakstone Publishing & 8.5
Risk Patients - PART 2: Opioid Epidemic Practical Reviews
Pathways to Safer Opioid Use Office of Disease Prevention 1
and Health Promotion &
American Public Health
Association
Ohio Pain Management Toolkit Ohio State Medical 1
Association and the Medical
Advantage Group
Gettysburg CME Conference: Pain Management and Best Practices Pennsylvania Academy of 1
Family Physicians
Addressing PA's Opioid Crisis: What the Health Care Team Needs to Pennsylvania Medical 5.5
Know (CME) Society
Evidence-Based Complimentary/Integrative Medicine Techniques for Pain Postgraduate Institute for 1
Management Medicine
Knee Pain in the Primary Care Setting: Evaluation, Treatment Options, and Postgraduate Institute for 1
When to Refer Medicine
Mitigating the Risk of Prescription Opioid Misuse in the Management of Postgraduate Institute for 1
Acute and Chronic Painful Conditions: Part 1 - Introduction, History, and Medicine
Shared Guidelines
Mitigating the Risk of Prescription Opioid Misuse in the Management of Postgraduate Institute for 1
Acute and Chronic Painful Conditions: Part 2 - Wisconsin-Specific Medicine
Guidelines and Risk Management Tools
Safe and Appropriate Opioid Prescribing: A Systems-Based Approach, Part Postgraduate Institute for 1
I: Pathophysiology and Assessment of Pain Medicine
Developing an Effective Treatment Plan: Opioid- and Nonopioid-based Potomac Center for Medical 3.5
Treatment Options for Acute and Chronic Pain Management Education
ON THE FRONT LINE OF A CRISIS: Improving the Care and Education Potomac Center for Medical 1
of Patients with Opioid Use Disorder Education
Tired, Inflamed, and in Pain: Best Practices, Future Therapies and Primary Care Network Inc. 12
Integrative Medicines
How to Perform Urine Drug Testing and Interpret Results Part 2 - PRI-Med 0.5
Prescription Drug Monitoring in Chronic Opioid Therapy: Employing
Urine Drug Testing to Optimize Patient Outcomes
Office Rheumatology (Recorded at Pri-Med West) PRI-Med 1
Optimizing Non-Opioid Pain Management in Primary Care (Recorded at PRI-Med 0.75
Pri-Med West)
Prescription Drug Monitoring in Chronic Opioid Therapy: Employing PRI-Med 1
Urine Drug Testing to Optimize Patient Outcomes
Weaning Off Chronic Opioids (Recorded at Pri-Med East) PRI-Med 0.75
Opioid Use Disorder: Expanding Access to Treatment ReachMD 0.25
Opioid Prescribing: Safe Practice, Changing Lives Southeastern Area Health 3
Education Center
Pain Management & Opioids: Balancing the Risks & Benefits Southern WV Area Health 3
Education Center
Tennessee Rx Safety Part 1: Addiction St. Thomas Health CME 1
Tennessee Rx Safety Part 2: Federal and State Controlled Substance Laws St. Thomas Health CME 1
and Guidelines
An Evidence-Based Approach to the Diagnosis and Management of Stanford University School 1
Migraines in Adults in the Primary Care and General Neurology Setting of Medicine
How to Taper Patients Off of Chronic Opioid Therapy Stanford University School 1.25
of Medicine
Prescription Drug Misuse and Addiction: Compassionate Care for a Stanford University School 2
Complex Problem of Medicine

72

RKT Consulting
CE: Pain Management and Opioid Prescribing

Course Source Hours

Addiction Tennessee Medical 1
Association
Appropriate Prescribing in Tennessee Tennessee Medical 2
Association
Assessment and Medications for Pain Tennessee Medical 1
Association
Examination of a Chronic Pain Patient Tennessee Medical 1
Association
Hot Topics in Addressing Pain Tennessee Medical 1
Association
Medical Decision Making and Weaning of the Pain Patient Tennessee Medical 0.75
Association
Tennessee Pain Laws Tennessee Medical 1
Association
Keynote Address – An Epidemic of Addiction: Responding to the UK Healthcare & CE Central 0.75
Prescription Opioid and Heroin Crisis
Laws and Regulations Applicable to Prescribing Controlled Substances – UK Healthcare & CE Central 0.75
Kentucky Board of Dentistry
Peer Assistance for the Dental Team Member with Opioid Dependency UK Healthcare & CE Central 0.5
Stoners, Dragon Chasers, Tweakers and Drunks – Not in My UK Healthcare & CE Central 1
Practice…Yeah Right!!!
Buprenorphine for Opioid Use Disorder University at Buffalo 2
Dispensing Naloxone Via a Non-Patient Specific Prescription Update: The University at Buffalo 2
Role of the Community Pharmacist
Naloxone Pharmacy Continuing Education Program University at Buffalo 2
Opioid Prescriber Training Program Update Part 1 University at Buffalo 2
Opioid Prescriber Training Program Update Part 2 University at Buffalo 2
Pharmacist's Response to the Opioid Epidemic: Advanced, Opioid-Specific University at Buffalo 1.5
Counseling
Improving Outcomes in Chronic Pain University of Arizona 1 - 14.5
College of Medicine
Introduction to Safe Prescribing of Opioids for Pain Management University of Arizona 1
College of Medicine
Introduction to the Practice of Palliative Medicine University of Arizona 1
College of Medicine
Managing Opioid Misuse Disorder in Pregnancy and Neonatal Care University of Arizona 1
College of Medicine
Opioid Issues in Youth Pain Management for Orthopedic Injuries University of Arizona 1
College of Medicine
Safe and Effective Opioid Prescribing While Managing Acute and Chronic University of Arizona 3
Pain College of Medicine
Palliative Care: It's Not Just Hospice Anymore Specialization: Course 2: University of Colorado 15
Pain Management Department of Family
Medicine
Chronic Opiate Analgesic Therapy (COAT) in a Primary Care Outpatient University of Kentucky 0.75
Clinic: Patient Perspective on Quality Improvement College of Medicine
Improving Treatment of Opioid Use Disorder Through Development of University of Kentucky 0.5
Novel Formulations of Buprenorphine College of Medicine &
Kentucky Office of Drug
Control Policy
Opioid Use Disorder in Pregnancy: Where We Are, What We Know, What University of Kentucky 0.75
We Are Doing at UK College of Medicine &
Kentucky Office of Drug
Control Policy
Reducing Stigma: The Past, Present and Future of Recovery University of Kentucky 0.75
College of Medicine &

73

RKT Consulting
CE: Pain Management and Opioid Prescribing

Course Source Hours

Kentucky Office of Drug
Control Policy
Responding to the Prescription Opioid and Heroin Crisis: An Epidemic of University of Kentucky 1.25
Addiction College of Medicine &
Kentucky Office of Drug
Control Policy
Surviving Dreamland and Challenges of Opioids in Front Line Medicine University of Kentucky 0.5
College of Medicine &
Kentucky Office of Drug
Control Policy
Tips for Prescribing/Dispensing Controlled Substances Within the Law University of Kentucky 0.5
College of Medicine &
Kentucky Office of Drug
Control Policy
Treating Women with Opioid Use Disorders: A Focus on Pregnant and University of Kentucky 1
Parenting Women College of Medicine &
Kentucky Office of Drug
Control Policy
An Update on the Kentucky All Schedule Prescription Electronic Reporting University of Kentucky 1
System (KASPER) College of Medicine &
University of Kentucky
College of Nursing
Best Practice Nursing Care for Patients with Substance Abuse in Acute University of Kentucky 1
Care College of Nursing
Chronic Opiate Analgesic Therapy (COAT) in a Primary Care Outpatient University of Kentucky 1
Clinic: Patient Perspective on Quality Improvement College of Nursing
Laws and Regulations Applicable to APRN Prescribing of Controlled University of Kentucky 1
Substances College of Nursing
Opioid Use in Hospice and Palliative Care Settings University of North Texas 1
Health Science Center
Pain Assessment and Principles of Management University of North Texas 1
Health Science Center
Opioid Prescribing: Pain Management in a New Era University of Virginia School 2
of Medicine
Applying CDC's Guideline for Prescribing Opioids: Module 1: Addressing US Centers for Disease 1
the Opioid Epidemic: Recommendations from CDC Control and Prevention
Applying CDC's Guideline for Prescribing Opioids: Module 2: Treating US Centers for Disease 1
Chronic Pain Without Opioids Control and Prevention
Applying CDC's Guideline for Prescribing Opioids: Module 3: US Centers for Disease 1
Communicating With Patients Control and Prevention
Applying CDC's Guideline for Prescribing Opioids: Module 4: Reducing US Centers for Disease 1
the Risks of Opioids Control and Prevention
Applying CDC's Guideline for Prescribing Opioids: Module 5: Assessing US Centers for Disease 1
and Addressing Opioid Use Disorder Control and Prevention
Applying CDC's Guideline for Prescribing Opioids: Module 6: Dosing and US Centers for Disease 1
Titration of Opioids: How Much, How Long, and How and When to Stop? Control and Prevention
Applying CDC's Guideline for Prescribing Opioids: Module 7: US Centers for Disease 1
Determining Whether to Initiate Opioids for Chronic Pain Control and Prevention
Applying CDC's Guideline for Prescribing Opioids: Module 8: US Centers for Disease 1
Implementing CDC’s Opioid Prescribing Guideline into Clinical Practice Control and Prevention
Applying CDC's Guideline for Prescribing Opioids: Module 9: Opioid Use US Centers for Disease 1
and Pregnancy Control and Prevention
Applying CDC's Guideline for Prescribing Opioids: Module 10: US Centers for Disease 1
Motivational Interviewing Control and Prevention

74

RKT Consulting
CE: Pain Management and Opioid Prescribing

Course Source Hours

Applying CDC's Guideline for Prescribing Opioids: Module 11: Fostering US Centers for Disease 1
Collaborative Patient-Provider Relationships in Pain Management and Control and Prevention
Opioid Prescribing
Addressing the Opioid Epidemic: A Call to Action to Save Our USF Health & CME 1
Communities Outfitters
Fatal Attraction: Why Are Opioids So Addicting? USF Health & CME 0.25
Outfitters
How PAs are Improving Skill Sets to Approach Opioid Use USF Health & CME 0.25
Outfitters
Managing the Complexity of Chronic Pain in the Primary Care Setting USF Health & CME 0.5
Outfitters
Migraine Milestones: When Translational Research Transforms Patient USF Health & CME 1
Care Outfitters
New Perspectives and Approaches from Orthopedic Surgeons for the USF Health & CME 0.5
Management of Acute Pain Outfitters
Providing the Right Expectations: Understanding the Pathophysiology of USF Health & CME 0.25
Pain Outfitters
Putting Pressure on Opioid Prescribing: Novel Approaches to Pain USF Health & CME 1.5
Management Outfitters
Understanding the Big Picture of Pain and Pain Assessment USF Health & CME 0.25
Outfitters
Chronic Pain Guidelines and Controlled Substance Efforts Vanderbilt University & 2.75
Tennessee Department of
Health
Safe Opiate Prescribing Virginia Commonwealth 2
University Health Continuing
Medical Education
Appalachian Addiction and Prescription Drug Abuse Conference West Virginia Medical 3
Professionals Health Program
& West Virginia State
Medical Association
WV PainCare West Virginia Society of 3
Interventional Pain
Physicians
Pain and Addiction, Best Practices and Proper Prescribing West Virginia University 3
Health Sciences Continuing
Education
The Treatment of Pain and Addiction Utilizing Education and Proper West Virginia University 3
Prescribing the new Paradigm Continued Office of Continuing
Education, West Virginia
Medical Professionals Health
Program, West Virginia State
Medical Association and
West Virginia Osteopathic
Medical Association
Wisconsin Responsible Opioids Prescribing - Live Series Wisconsin Academy of 2.25
Family Physicians

75

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