JKO DoD Opioid Provider Safety Training Program

Which of the following is NOT an appropriate long-term treatment goal for chronic pain?

Increase dosage of prescription pain medications until pain is eliminated

The supplemental questions in the Defense and Veterans Pain Rating Scale (DVPRS) include a patient report of how pain is impacting all of the following EXCEPT:

Opioid Use

Which of the following is associated with opioid toxicity?

All of the above

Which one of the following patients does NOT have a clear indication for a referral for cognitive behavioral therapy for pain as part of their comprehensive treatment plan?

A patient attending a follow-up appointment for a sprained ankle

How can the Behavioral Health Consultants support the primary care pain treatment plan?

Both B and C

Which of the following is an indication to provide Naloxone to a patient who is prescribed opioids?

All of the above

The DoD Informed Consent for Long Term Opioid Therapy includes which of the following:

All of the above

After prolonged use, opioid medications change reward centers in the brain. This results in the motivation of use moving from ____ to ____.

'To feel good' to 'to avoid feeling bad'

Carefully monitored opioid taper should be considered in which of the following situations?

All of the above

Self-management strategies for pain are designed to achieve the following goals EXCEPT:

Improvement of a patient's marathon running times

The 2020 revision to DoDI 1010.16 directs that, absent a time period specified by the prescriber, controlled substance prescriptions for Active Duty Service Members expire _______

6 months after the last fill date

Which of the following tools is/are available to help assess for opioid-related risks and the indications for prescribing Naloxone?

All of the above

All patients prescribed opioid therapy are required to be enrolled in the MTF Sole Provider Program?

False

The following are DSM-5 diagnostic criteria of Opioid Use Disorder EXCEPT?

Requesting a refill for initial opioid prescription

According to the DHA-PI Pain Management and Opioid Safety, which of the following are NOT indicators for co-prescribing of Naloxone?

None of the above, all of these groups should be prescribed Naloxone

Which of the following are recommended for disposing of expired or unused prescription medications:

Mail-in envelopes distributed at MTF pharmacies
Designated collection receptacles co-located at MTF pharmacies

Which TWO of the following are part of the DoD comprehensive biopsychosocial pain assessment?

Pain Assessment Screening Tool and Outcomes Registry (PASTOR)
The Defense and Veterans Pain Rating Scale (DVPRS)

Which of the following clinician actions is recommended prior to prescribing opioid therapy for treatment of non-cancer, chronic pain? (Opioid Prescribing/Tapering Video)

Verify that non-opioid medications have been considered and optimized prior to prescribing opioids.

Which of the following should be considered for the first line of treatment for chronic pain? (Six Essentials Video)

I, II, and III

Which of the following statements regarding the prevalence of pain in Service members and Veterans is false? (Understanding Pain)

Chronic Pain is medical issue that is unique to the military and Veteran populations.

The DoD strategies and policies for Safe Medication Use, Storage, Disposal, and Take Back were developed to address: (Safe Medication Disposal/Use)

I, III and IV

I. Prescription medication diversion.
III. Use of prescription medication for conditions other than those conditions for which they were prescribed
IV. Environmental harm caused by improper disposal of medications

The first and most important element of good pain care is: (Six Essentials)

Educate the patient

Which of the following components of pain is not incorporated in the biopsychosocial model of pain?

medical

Essential components of Safe Opioid Prescribing includes which of the following: (Opioid Prescribing/Tapering Video )

All of the above

I. Do not prescribe opioids as the first line treatment for chronic pain
II. Start Low and Go Slow
III. After initiation of opioid therapy, assess, taper and discontinue opioids as indicated by ongoing assessment of effectiveness and risk of harm or misuse
IV. Be prepared to treat overdose and addiction

The following statement(s) are true regarding the use of routine drug screening as part of safe opioid prescribing: (Opioid Prescribing/Tapering Video)

I, II and IV

I. Frequency is based on risk assessment and stratification
II. Conducted prior to initiating opioid therapy
III. Routinely conducted at every patient visit
IV. Repeated at least once every 6-12 months for low risk patients

What is the first "step" in the Stepped Care Model of Pain Management? (Stepped Care Model)

Primary Care

Which of the following components of Stepped Care Model of pain management is first introduced in Step 3: (Stepped Care Model)

Advanced pain medicine diagnostics and interventions

Evidence-based treatments for patients with Opioid Use Disorder (OUD) include:

C. 1, 2, and 3

1. Medication-Assisted Treatment (MAT) with buprenorphine or methadone
2. Recovery support services
3. Behavioral therapies
4. Psychoanalytic therapy

True or False: The US Center for Disease Control (CDC) recently released 12 guidelines for prescribing opioids to reduce opioid related patient harm. One of the recommendations is to use urine drug testing before starting opioid therapy and at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.

True

There are certain standards that all providers must remember when treating any patient for any condition, even wounded war heroes. Which of the following statements is incorrect?

5. For confidentiality reasons, do not document care plan in chart.

Physical dependence is a state of adaptation that is manifested by withdrawal syndrome that can be produced by:

D. All of the above

1. Abrupt cessation
2. Rapid dose reduction
3. Decreasing blood level of the drug
4. Administration of an antagonist

True or False: The US Center for Disease Control (CDC) recently released 12 guidelines for prescribing opioids to reduce opioid related patient harm. One of the recommendations is to prescribe immediate-release opioids instead of extended-release/long acting (ER/LA) opioids.

True

According to CDC Guidelines, which of the following statements is incorrect?

C. Opioids should be prescribed based on patients' preference.

In a series of recent surveys, misusers indicated that only about 1 in 5 obtained their misused medications through a legitimate prescription. The majority obtained them through diversion from a friend or relative.

true

There have been several identified risk factors for prescription medication misuse. Which of the following statements is incorrect:

A. Older age, over sixty years old

When it comes to dosing, CDC Guidelines recommend that you carefully reassess evidence of individual benefits and risks when increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day.

True

Which option is the correct choice: Patients who have a history of substance abuse or active psychopathology should be treated as follows:

(Wrong Answer)
D. should only be managed by a multi-disciplinary team consisting of pain management physicians, addiction medicine physicians, and psychiatrists in a highly structured environment.

True or False: Risk Index for Prescription Opioid Overdose and Opioid-induced Serious Respiratory Depression (RIOSORD) is a validated risk stratification tool that defines patient risk classes and predicts probability of a significant adverse event and is helpful when deciding to prescribe Naloxone.

True

There are certain standards that all providers must remember when treating any patient for any condition, even wounded war heroes. Which of the following statements is incorrect?

For confidentiality reasons, do not document care plan in chart

Evidence-based treatments for patients with Opioid Use Disorder (OUD) include:
1. Medication-Assisted Treatment (MAT) with buprenorphine or methadone
2. Recovery support services
3. Behavioral therapies
4. Psychoanalytic therapy

NOT: all of the above

True

Which of the following statements is incorrect? Good prescribing practices by health care providers include:

Ignore aberrant behavior such as provider shopping or early refills

True

For prescribing opioids, treatment agreements with patients should have the following qualities:
1. be readable, reasonable and flexible. They should avoid using absolute terms such as "will" or "shall" and should use "may" in most cases.
2. Identify penalties for misuse or diversion - legal (police report) and medical (forced detox, forced taper, or cessation of medical treatment based on the clinical scenario)
Choose one

Both

Referring a Soldier to the local substance abuse program can be an unpopular move. You'll likely get resistance from the patient and sometimes the chain of command might object to what they feel is unnecessary meddling. Which of the following statements is correct?

2 It's important that you trust your judgment and do the right thing. It could very well be a matter of life and death?

According to CDC Guidelines, which of the following statements is incorrect?

NOT: If opioids are used, they should be combined with non-pharmacologic and non-opioid pharmacologic therapy?

True