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Nurse Practitioner Healthcare Foundation

Continuing Education Program

About Program

There are two continuing education programs available on this website: The original ER/LA opioids REMS program (3 contact hours) and a 2016 Update (2 contact hours).

With respect to the original program:

On July 9, 2012 the Food and Drug Administration (FDA) approved a Risk Evaluation and Mitigation Strategy (REMS) for extended release (ER) and long acting (LA) opioid medications.

Founded in June, 2010, the Collaborative on REMS Education (CO*RE). a multi disciplinary team of 10 partners and 3 cooperating organizations, has designed a core curriculum based on needs assessment, practice gaps, clinical competencies, and learner self assessment to meet the requirements of the FDA REMS Blueprint

About Core

Core Organizations, Staff Disclosures

Please Read all Information Below (for specific information on the New Update 2016 program click on that tab in the menu above)

The ER/LA Opioids REMS Program
This is a continuing education program for APNs that is approved for 3 contact hours in pharmacology.

Release Date: November 1, 2014

Expiration Date: October 31, 2017

The Nurse Practitioner Healthcare Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is also intended to be fully compliant with the ER/LA Opioid Analgesic REMS education requirements issued by the U.S. Food  & Drug Administration (FDA)

CE Requirements
Requirements for successful completion of this CNE activity include downloading the handout (after registering), viewing the introduction and all six unit videos (see video information table at bottom of page), answering the assessment questions embedded at the end of each Unit, and completing an online program evaluation.

Program Objectives

  • Describe appropriate patient assessment for treatment with ER/LA opioid analgesics, evaluating risks and potential benefits of ER/LA therapy,
    as well as possible misuse.
  • Apply proper methods to initiate therapy, modify dose, and discontinue use of ER/LA opioid analgesics, applying best practices including accurate dosing and conversion techniques, as well as appropriate discontinuation strategies.
  • Demonstrate accurate knowledge about how to manage ongoing therapy with ER/LA opioid analgesics and properly use  evidence-based tools while assessing for adverse effects.
  • Employ methods to counsel patients and caregivers about the safe use of ER/LA opioid analgesics, including proper storage and disposal.
  • Review/assess general and product-specific drug information concerning ER/LA opioid analgesics and identifying potential adverse effects of ER/LA opioids.

Faculty Disclosures

  • Alan P. Agins has no conflicts of interest to report
  • Jody Agins has no conflicts of interest to report
  • Wendy Wright is a member of the following companies speaker bureaus: Vivus, Boehringer, Takeda, Merck, GSK and Sanofi

Content Development/Planner/Reviewer Disclosures

  • Available in course handout


The information presented in this program is solely for educational purposes and should not be construed as specific instructions for the diagnosis or treatment of patients. Utilization of any information, derived from this program, in patient care remains strictly the professional responsibility of the health care provider. The health care provider is further advised to: (1) ascertain current FDA status of each drug and (2) consult current drug information guides, manufacturer product information or package inserts regarding the proper use, dosages, dosing schedules, contraindications, warnings and other pertinent prescribing and safety information. The Faculty (Alan Agins, Jody Agins, Wendy Wright) disclaim any liability, loss, injury or damage incurred as a consequence, directly or indirectly, from the use and application of any of the contents of this program. During the "Program" there may be occasional mention of proprietary or brand-name drugs. The mention or appearance of a specific proprietary product name should not be construed by the viewer that the Faculty, NPHF or CO*RE endorse or have specific bias toward that product or its manufacturer. Similarly, the absence of mention of a specific brand name should not imply that the product is deemed inferior to others in its class.

Video Information Table



Presented by Nurse Practitioner Healthcare Foundation, a member of the Collaborative on REMS Education (CO*RE), 10 interdisciplinary organizations working together to imrpove pain management and prevent adverse outcomes.

This educational activity is supported by an independent educational grant from the ER/LA Opioid Analgesics REMS Program Companies (RPC).
Please see www.er-la-opioidREMS.com for a listing of the member companies.

This activity is intended to be fully compliant with the ER/LA Opioid Analgesics REMS education requirements issued by the U.S. Food & Drug Administration.

Video production and editing, website conception and implementation by PRN Associates, Ltd
(A.Agins, Ph.D. - Pharmacology One-on-One)

Update 2016 - course development, script, video, editing, web implementation by PRN Associates, Ltd (A.Agins, Ph.D.)

Website design and development by Black Stone, LLC (Villy Toma, Andrei Velicu )



Products Covered by this REMS

Brand Name Products

  • Avinza® morphine sulfate ER capsules*
  • Belbuca® buprenorphine buccal film NEW
  • Butrans® buprenorphine transdermal system
  • Dolophine® methadone transdermal system
  • Duragesic® fentanyl transdermal system
  • Embeda® morphine sulfate/naltrexone ER capsules
  • Exalgo® hydromorphone hydracloride ER tablets
  • Hysingla® ER (hydrocodone bitartrate) ER tablets
  • Kadian® morphine sulfate R capsules
  • MethadoseTM methadone hydrochloride tablets
  • MorphaBond® morphine sulfate ER tablets NEW
  • MS Contin® morphine sulfate CR tablets
  • Nucynta® ER tapentadol ER tablets
  • Opana® ER oxymorphone hydrachloride ER tablets
  • OxyContin® oxycodone hydrochloride CR tablets
  • Targiniq™oxycodone hydrochloride/naloxone hydrochloride ER tablets
  • Zohydro® hydrocodone bitartrate ER capsules

Generic Products

  • Fentanyl ER transdermal Systems
  • Methadone hydracloride tablets
  • Methadone hydracloride oral concentrate
  • Methadone hydrachloride oral solution
  • Morphine sulfate ER tablets
  • Morphine sulfate ER calsules
  • Oxycodone hydrachloride ER tablets

Wendy Wright

Wendy Wright


Wendy Wright is a 1992 graduate of the Adult Primary Care Nurse Practitioner program at Simmons College in Boston, Massachusetts and completed a family nurse practitioner post-master's program in 1995. She is an adult and family nurse practitioner and the owner of two nurse practitioner owned and operated clinics within New Hampshire named: Wright & Associates Family Healthcare @ Amherst and @ Concord. In addition, she is a Partner with Partners in Healthcare Education, a medical education company. She is the recipient of numerous awards and was chosen by the American Academy of Nurse Practitioners as the 1999 recipient of the New Hampshire State Excellence Award. In addition, she received the 2009 NH Nurse Practitioner of the Year award and in 2005, she was inducted as a Fellow into the American Academy of Nurse Practitioners; a position held by only 400 other nurse practitioners throughout the country.

Jody Agins

Jody Agins


Jody Agins received her MSN/Family Nurse Practitioner from the University of Kansas and is board certified by the ANCC in Family Practice and Gerontology. She is the founder & executive director, and practices as an NP, for Collaborative Medical Provider Group (PLLC), a  consortium of  private-practice clinicians in Tucson, AZ. Jody is also the Clinical Services Director for Agape Hospice and Palliative Care and is a primary care provider for CareMore Touch also in Tucson. In addition, she serves as a clinical preceptor for Family and Geriatric Nurse Practitioner students at a number of universities in Arizona. Mrs Agins is also invited to speak nationally on pain management, geriatric care and a number of other topics for various NP organizations. She is a faculty presenter for the Collaborative on REMS Education programs through the Nurse Practitioner Healthcare Foundation.

Alan Agins

Alan Agins


Alan Agins received a Masters in Pharmacology & Toxicology and a Ph.D. in Pharmaceutical Sciences from the University of Rhode Island. He has held faculty appointments at Brown University Medical School, Northeastern University School of Pharmacy and University of Virginia School of Nursing. During his tenure at Brown, Dr Agins was the recipient of the Dean's Teaching Excellence Award for five consecutive years. Over the past twenty years, Dr. Agins has lectured nationally on all topics of pharmacology to more than 85,000 advanced practice clinicians and allied healthcare professionals. He has authored three books, co-authored textbook chapters and has served as primary reviewer for various journals, CE monographs, textbooks and newsletters. Dr Agins recently developed and launched a continuing education website, Pharmacology One-on-One (pharm1on1.com) which became the blueprint for this NPHF /CO*RE website.

Links from CORE slideset and other useful information

Although most of the resources listed below are current, the reader is reminded that changes or updates do occur regularly. You are advised to use the most current resource when prescribing ER/LA Opioids

ER/LA Opioid REMS program Links
Update 2016 Links


Keeping Up to Date:

CDC Guideline for Prescribing Opioids for Chronic Pain 2016 NEW

Surgeon General's Call to End Opioid Crisis  Turn-the-Tide Org NEW

Naloxone: Frequently Asked Questions (pdf) ( also under Unit 4 below)

Naloxone: An Opportunity for Another Chance 3/16 (link to JNP online)

National Take-Back Initiative - 2016

CO*RE Newsletter 2016 (Feb 2016) (pdf)

Alliance for Balanced Pain Management (AfBPM) "Are You the only one taking your medicine?"  (pdf) - Good handout for patients!

General Information & Downloads

General Information (regarding ER/LA Opioid REMS)
ER/LA OPIOID REMS document - Aug 2014 (pdf)
FDA Blueprint for Prescriber Education for ER/LA Opioids Aug 2014 (pdf)


ER/LA Opioids REMS program

Unit 1
Opioid Risk Screening and Assessment Instruments
Opioid Risk Management
SOAPP® Monitoring Recommendations
The SOAPP® Version 1.0 Tutorial
Opioid Risk Tool (ORT)- online calculator
Opioid Risk Tool (ORT) - pdf

Unit 2
Code of Federal Regulations, Title 21 Section 1306: rules governing the issuance & filling of prescriptions
Controlled Substances Act: Title 21, Section 829: prescriptions
APRN Prescribing Law: A Stete-by-State Summary (July 2013)
Database of Statutes, Regulations, & Other Policies for Pain Management
Equianalgesic calculator

Unit 3
Sample Informed Consent Form (DrugAbuse.gov)
Sample Informed Consent Form (IHS.gov)
Sample PPA - Patient Agreement Form (DrugAbuse.gov)
Sample PPA - Patient Agreement Form (AAFP)
Sample PPA - Patient Agreement Form (IHS.gov)
State-by-State PDMP Information  (National Alliance for Model State Drug Laws - current to July 2014)
Role of Urine Drug Testing in Chronic Pain Management (Review article)
Urine Drug Testing In Chronic Pain (comprehensive review - pdf download)
Interpretation of Opiate Urine Drug Screens
Urine Drug Monitoring - Opioids (comprehensive review)
SAMHSA substance abuse treatment facility locator
SAMHSA mental health treatment facility locator
Drug Rehab - web information guide /addiction treatment facility locator

Unit 4
Patient Counseling Document
Patient Counseling Document Order hard copies (free, including shipping)
Serious Adverse Effects Reporting (FDA)
Disposal of Controlled Substances (Federal Register - Sept 2014)
(Opioid) Disposal Act: General Public Fact Sheet

Narcan: Therapeutic Intranasal Drug Delivery NEW
Administer Naloxone - Harm Reduction Coalition NEW
Evzio Auto-Injector Demo . . . Youtube NEW
Naloxone Overdose Prevention Laws Map NEW

 Unit 5
Opioid Drug Interactions
Methadone and Buprenorphine drug interactions
Opioid Metabolism

Unit 6
Medication Guides (Nov 2014)
Selected Important Safety Information

Additional Links - Opioid Treatment Guidelines

Opioid Prescribing: A Systematic Review and Critical Appraisal of Guidelines for Chronic Pain (Jan 2014)
New Review Gives High Marks to 2 of 13 Opioid Guidelines (Nov 2013)
Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (Canadian - 2010)
Guideline for the Use of Chronic Opioid Therapy in Chronic Non-cancer Pain  (APS-AAPM 2009)

Update 2016 Program - references

A New Abuse-Deterrent Opioid - Xtampza ER | The Medical Letter, Inc.
AANP - State Practice Environment  
Abuse-Deterrent Opioids: A Primer for Pharmacists (good for all clinicians)
Patterns of Drug Addiction and Hidden Pain
Naloxone Accessibility Increases . . .   (good for all clinicians)
Belbuca New FDA Drug Approval | CenterWatch
CDC Guideline for Prescribing Opioids for Chronic Pain
CDC guidelines checklist
CDC Opioid Prescribing Guidelines Misguided, Docs Say
Comprehensive Addiction and Recovery Act (CARA) | CADCA
Drug Overdose Immunity and Good Samaritan Laws
Drugmakers fought state opioid limits amid crisis
First Abuse-Deterrent Oxycodone IR Launched - MPR
Nurse Practitioners and Physician Assistants Prescribing Buprenorphine
Reduce Drug Abuse and Diversion with PDPMs
Questions & Answers - State Prescription Drug Monitoring Programs
PDMP - Prescribers' report card  
State PDMP Websites | The PDMP Training and Technical Assistance Center
States aim to limit opioid prescriptions  
The New Black Horse in the Opioid Crisis: Carfentanil
Surgeon General's Call to End Opioid Crisis  Turn-the-Tide Org