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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 which is now the 2018 Update (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 11 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


Presented by Nurse Practitioner Healthcare Foundation, a member of the Collaborative on REMS Education (CO*RE), 11 interdisciplinary organizations working together to improve 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.

Both Updates 2018 & 2016 - video production and editing, website conception and implementation
by PRN Associates, Ltd (A.Agins, Ph.D. - Pharmacology One-on-One)

Website design and development by Villy Toma



Products Covered by this REMS

Brand Name Products

  • Arymo® morphine sulfate ER capsules
  • Belbuca® buprenorphine buccal film
  • 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
  • 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
  • Troxyca ER® oxycodone HCl-naltrexone capsules
  • Vantrela ER hydrocodone bitartrate ER tablets
  • Xtampza ER oycodone ER capsules
  • 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

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. 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. Jody currently serves as the Vice President - President Elect for the Southern Arizona Advanced Practice
Nurse - Nurse Practitioner Society.


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-four years, Dr. Agins has lectured nationally on all topics of pharmacology to more than 90,000 advanced practice clinicians and allied healthcare professionals. He has authored two books, co-authored one book and some textbook chapters and has served as primary reviewer for various journals, CE monographs, textbooks and newsletters. Dr Agins has a continuing education website, Pharmacology One-on-One (pharm1on1.com) which served as 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

Opioid Prescribing: Safe practice, changing lives: 2018 Update Links

Opioid Prescribing: Safe practice, changing lives: Update 2016 Links

2018 Update Slide Handout (pdf)

Keeping Up to Date:

CDC Guideline for Prescribing Opioids for Chronic Pain 2016

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

National Take-Back Initiative - 2017

CO*RE - Fentanyl Deaths Alarmingly High (Sept 2017)

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

General Information
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)


Pain Assessment and Risk Screening Tools
Pain Assessment and Documentation Tool
Brief Pain Inventory - BPI (Short Form)
Assessing Pain in the Nonverbal or Cognitively Impaired
Functional Assessment SF-36 Tool
Mental Health Tool - PHQ9
Opioid Risk Screening and Assessment Instruments
SOAPP® Assessment Tool
The SOAPP® Background and Scoring Instructions
Opioid Risk Tool (ORT)- online calculator
Opioid Risk Tool (ORT) - pdf

Legal Stuff
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 State-by-State Summary (2016)
State-by-state breakdown of opioid regulations (2017)

Opioid Rotation
Equianalgesic calculator (1)
Equianalgesic calculator (2)
Opioid Equivalents and Conversions
Strategies for Opioid Rotation (expired online CME - BUT still great info!)

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)
Patient Counseling Document
Patient Counseling Document Order hard copies (free, including shipping)

Individual State PDMP websites
Compilation of Prescription Monitoring Program Maps
Role of Urine Drug Testing in Chronic Pain Management (Review article)
Interpretation of Opiate Urine Drug Screens
Urine Drug Monitoring - Opioids (comprehensive review)
UDTs - Screening vs Confirmatory Tests
Urine Drug Screening: Things to consider in the office/clinic
Potential False-positive Urine Drug Screens
Minimizing False-Positives and False-Negatives

Substance Abuse / Mental Health Referral
Screening, Brief Intervention, and Referral to Treatment
SAMHSA substance abuse treatment facility locator
SAMHSA mental health treatment facility locator
Drug Rehab - web information guide /addiction treatment facility locator

Discontinuing Opioids
Discontinuing Opioids in Patients With, Without Substance Use Disorders
Pocket Guide: Tapering Opioids for Chronic Pain
Discontinuing Opioids - Action, Reason, Process
Opioid Taper Decision Tool

Opioid Disposal
Disposal of Controlled Substances (Federal Register - Sept 2014)
(Opioid) Disposal Act: General Public Fact Sheet
DEA National Takeback Event (2017)
Controlled Substance Public Disposal Locator

Naloxone (Narcan)
Narcan: Therapeutic Intranasal Drug Delivery
Administer Naloxone - Harm Reduction Coalition
Evzio Auto-Injector Demo . . . Youtube
Naloxone Overdose Prevention Laws Map
Naloxone: Frequently Asked Questions (pdf)
Naloxone: An Opportunity for Another Chance 3/16 (link to JNP online)

Metabolism, Interactions and Adverse Effects
Serious Adverse Effects Reporting (FDA)
Selected Important Safety Information (Abuse and Resp Depression)
Opioid Drug Interactions
Methadone and Buprenorphine drug interactions
Opioid Metabolism chart
Opioid Metabolism chart (active vs inactive metabolites)

ER/LA Opioid Product Information
Medication Guides
ER/LA opioid Product Information sheets

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