Course Title: Identification and Intervention in Opioid Induced Depressive Disorder
Release date: July, 2020
Expiration date: July, 2022
Estimated time to complete activity: 2 hours
Hardware / Software Requirements: Compatible with Internet Explorer 6 and up, Mozilla Firefox 3 and up, Safari 4.0, and Google Chrome 10 and up.
If you have any questions, please contact MER at (800)-421-3756, http://www.cmepartner.org/contact
This activity is jointly provided by Medical Education Resources and Symptom Media.
Licensed clinical nursing professionals, physician’s assistants, and medical prescribers that encounter patients facing impending opioid withdrawal, patients currently in opioid withdrawal, or patients in post-withdrawal recovery programs. Clinical health care professionals that provide services in inpatient acute withdrawal settings, outpatient and intensive outpatient medical opiate withdrawal settings, and non-medical opioid abuse recovery and rehabilitation programs.
Underlying Need for this Course
This activity provides clinical and research information, combined with demonstration, to increase the learner’s ability to identify cognitive and behavioral signs of opioid induced depression during or following discontinuation of opioid use. The activity helps clarify the differences between comorbid mood disorder and opioid induced mood disorder, reducing ambiguity that can lead to incorrect diagnosis and treatment. The activity also broadens learners’ knowledge of the spectrum of evidenced-based treatments described in peer-reviewed studies from current professional literature.
- Clinical health providers lack clear understanding of the link between opioid substances and their neurochemical relationship with depressive symptoms.
- Clinical health providers underpredict the risks to both relapse and patient safety associated with the appearance of depression symptoms during withdrawal.
- The lack of accurate identification and diagnosis of a mental health disorder concurrent with substance withdrawal limits clinical health providers’ provision of treatment resources necessary for mental health recovery.
General Practice Physician’s account for approximately 48 percent of Opioid prescriptions in the United States, and prescription rates are higher among physicians from lower-ranked medical schools.(Schnell & Currie, 2018). Approximately 51 percent of Opioid prescriptions are to persons who also have symptoms of depressed mood, complicating both initial prescribing or ending prescriptions. (Brackett, 2017) The Comorbidity between Mood and Substance Withdrawal is complex, and increases risk of both re-prescribing and poorer recovery from mood symptoms. (Quello, et. Al.)
- Need to increase knowledge of mental health symptoms of substance induced depression in clinical health workers in contact with patients in impending opioid withdrawal or recovery from substance abuse.
- Need to improve performance in accurate identification and diagnosis of mental health mood diagnoses typically seen in opioid dependent and withdrawal population.
- Need to increase competency in clinical use of diagnostic criteria of substance induced mood disorder as specified in the DSM 5 Diagnostic Manual.
- Need to improve performance in provision of recommendations commonly identified in evidenced-based intervention research.
By the end of this course learners will be able to:
- Participant will recognize key features and criteria of Opioid Induced Depression during acute withdrawal and period following prescription.
- Participant will be able to identify clinical presentation of subacute depressive symptoms within context of opiate withdrawal.
- Participant will recognize adjunctive care resources consistent with practice guildelines for managing mood in context of opioid withdrawal.
Meet your instructor: Dr. David Paltin is a licensed psychologist maintains an active clinical practice, and teaches psychology courses at Chapman University, National University, and Columbia College. He has authored books and articles on behavioral health topics ranging from ADHD to Violence Prediction and Borderline Personality Disorder. Dr. Paltin has specialization in pediatric mental health diagnosis and treatment, sleep disorders, and has helped design systems of care delivery in pediatric, adult, and educational settings.
The activity supports learners’ understanding of the neurobiological connection between Opioid withdrawal and the emergence of depressive symptoms. The activity demonstrates the identification of demographic risk-factors in certain patients. The activity familiarizes learners with the DSM 5 criteria for Substance Induced Mood Withdrawal disorder, and its important distinction from Major Depression co occurring with Opioid abuse. Video analysis of a case example supports learners’ ability to gather patient data sufficient to support a clear diagnostic decision. The activity encourages case risk management in specific areas of risk of relapse and harm to self in patients. Learners are also updated on evidenced-based intervention practices ranked by peer-reviewed research support.
Clinical lecture with slide presentation delivers key topic knowledge with points of emphasis and narrative enhancement in preparation for clinical case application. Videotaped clinical interview demonstration with narrated start-stop analysis guides learners through application of lecture information to clinical practice in a heath care, mental health, or substance rehabilitation setting.
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Medical Education Resources (MER) and Symptom Media. MER is accredited by the ACCME to provide continuing medical education for physicians.
Medical Education Resources designates this enduring material for a maximum of 2 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Medical Education Resources is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
This CE activity provides 2 contact hours of continuing nursing education.
Medical Education Resources is a provider of continuing nursing education by the California Board of Registered Nursing, Provider #CEP 12299, for 2 contact hours.
Disclosure of Conflicts of Interest
Medical Education Resources ensures balance, independence, objectivity, and scientific rigor in all our educational programs. In accordance with this policy, MER identifies conflicts of interest with its instructors, content managers, and other individuals who are in a position to control the content of an activity. Conflicts are resolved by MER to ensure that all scientific research referred to, reported, or used in a continuing education activity conforms to the generally accepted standards of experimental design, data collection, and analysis. MER is committed to providing its learners with high-quality activities that promote improvements or quality in health care and not the business interest of a commercial interest.
The faculty reported the following financial relationships with commercial interests whose products or services may be mentioned in this activity:
The content managers reported the following financial relationships with commercial interests whose products or services may be mentioned in this activity:
Method of Participation
There are no fees for participating in and receiving credit for this activity (or insert fee amount if applicable). During the period July, 2020 through July, 2022, participants must 1) read the learning objectives and faculty disclosures, 2) study the educational activity, 3) complete the posttest by recording the best answer to each question, 4) complete the evaluation.
A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.
- M. Schnell, Currie, J. (2018) Addressing the Opioid Epidemic: Is There A Role for Physician Education? Am. J. Health Econ. 2018 Summer (4)3: 383-410
- Brackett, C. (2017) Primary Care Based MAT for OUD, CLINICAL PRACTICE GUIDELINE. Dartmouth-Hitchcock Knowledge Map™.
- Quello, S.B., Brady, K.T., Sonne, S.C. (2005) Mood Disorders and Substance Use Disorder: A Complex Comorbidity. Sci. Pract. Perspect. Dec. (3)1.
- U.S. Dept. HHS (2010) Substance Abuse Treament Advisory, v.9(1).
- U.S. Health and Human Services, 2018.
- Diagnostic and statistical manual of mental disorders: DSM-5, Washington D.C., American Psychiatric Association, 2013.
- APA Practice Guidelines (2006) Treatment of Patients with Substance Use Disorders.
- Woody GE, Luborsky L, McLellan AT, O’Brien CP, Beck AT, Blaine J, Herman I, HoleA: Psychotherapy for opiate addicts: does it help? Arch Gen Psychiatry 1983; 40:639–645 Am J Psychiatry. 1987 May;144(5):590-6.
- Woody, GE, McLellan AT, Luborsky, L, O’Brien, CP. Twelve-month follow-up of psychotherapy for opiate dependence. Am J Psychiatry. 1987 May;144(5):590-6.
- Miller, W.R., and Rollnick, S. Motivational Interviewing: Preparing People To Change Addictive Behavior. New York: Guilford Press, 1991
- Lundahl, B. W., Kunz, C., Brownwell, C., Tollefson, D., Burke, & B.L. (2010). A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Welfare Practice, 20(2), 137-160.
- Jones, J., Mateus, C., Malcom, R., et al (2018). Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review. Frontiers in Psychiatry, July, 2018.
- APS, Evidence-Based Psychological Interventions In the Treatment of Mental Disorders. Australian Psychological Society, 2018.
- ASAM (2015) National Practice Guideline for the Use of Medications in the Treatment of Addiction involving Opioid Use, American Society of Addiction Medicine.
- Pani, P., Vacca, R. Trogu, E. et al. (2010) Use of medication to Treat Depression in People with Opioid Dependence. Cochrane.org.
- Dadiomov, D; Feiful, D; Lee, K, (2018) Real-World Effects of Long-term Use of Ketamine for Depression. Journal of Pharmacy Practice, 31(5), 525-593.
- FDA Drug Safety Communication (2016) FDA warns about several safety issues with opioid pain medicines; requires label changes Safety Announcement [3-22-2016]
The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of Medical Education Resources and/or Symptom Media. The authors have disclosed if there is any discussion of published and/or investigational uses of agents that are not indicated by the FDA in their presentations. Before prescribing any medicine, primary references and full prescribing information should be consulted. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. The information presented in this activity is not meant to serve as a guideline for patient management.