MAP-PC: An Addiction Medicine Training Course for Primary Care Pain Treatment

DESCRIPTION (provided by applicant): This Fast Track proposes the development of an online Continuing Medical Education (CME) program for primary care physicians called Managing Addiction and Pain in Primary Care (MAP-PC). Multiple studies have confirmed the usefulness of opioids in the treatment of acute pain and pain related to cancer, but they continue to be under-prescribed by physicians. Many physicians are concerned about possible abuse by patients (e.g., diversion, drug-related overdoses, and death), potential liability, and censure by regulatory agencies. The reluctance to prescribe opioids is particularly evident among primary care physicians (PCPs), who treat a high proportion of pain patients. An improvement in the ability of primary care physicians to adopt addiction medicine principles would lead to more appropriate use of opioids, along with more successful pain treatment outcomes in patients, especially those with potential or past substance abuse. Unfortunately, there is a lack of addiction medicine training for physicians treating pain patients. Physicians receive limited exposure to such information during their training and current CME courses focus on opioid prescribing, diagnosis, and pain management issues rather than providing a comprehensive understanding of addiction medicine in the pain treatment context. In addition, the great majority of these courses are not tested, offer an experience that is simply text-based with limited or no interactivity, and are focused simply on knowledge change rather than behavior change. With the advent of the Internet, there is technology available to engage and educate physicians seeking to build addiction medicine skills. The goal of Managing Addiction and Pain in Primary Care (MAP-PC) is to help primary care physicians learn addiction medicine skills through an online, interactive, skill- building CME course for treating chronic non-cancer pain patients. Using virtual patient technology, MAP-PC will: (1) increase addiction medicine skills, e.g., identification, management, treatment, and referral for pain patients at risk of or evidencing addiction, (2) help physicians make informed decisions about the use of opioids for their patients, and (3) manage clinical challenges that arise during the course of pain treatment with opioids, e.g., breakthrough pain, acute pain, opioid misuse, and illicit substance use. PUBLIC HEALTH RELEVANCE: Pain is often under-treated primarily due to primary care physician's ambivalence to prescribing opioid medications for fear that the patient might abuse or become addicted to the medication. This is particularly true for patients with potential or past substance abuse. This research project will culminate in the development of an interactive Continuing Medical Education (CME) course that teaches primary care physicians ongoing pain management techniques, including the safe and responsible use of opioids. The course will place an emphasis on how to manage cases where the patient has a history of substance abuse, or is at high risk of becoming addicted.