Benzodiazepine Use and Opioid Use: A Deadly Combination

Learning Objectives:   

1. Describe epidemiology of benzodiazepine and opioid related overdose deaths in Maine and the United States  
2. Review clinical use of benzodiazepines including indications for short term use, safety and tolerability, monitoring, and risk of physiological dependency and/or development of sedative use disorder.  
3. Identify compassionate and safe benzodiazepine tapering durations and strategies, as well as factors that would influence taper speed and duration  
4. Recall first-line and alternative non-benzodiazepine treatment for insomnia, agitation, and anxiety   

Module Structure:

This module is self-paced and available to any user who registers with the Maine Medical Association, Center for Quality Improvement Learning Lab. The estimated time to complete is approximately 90 minutes. The module consists of multiple sub-sections or units and will contain various elements, including hyperlinks to readings and web resources, video lessons, and pre-and post-assessments needed to obtain a CME Certificate or a CME Certificate of Participation.

The Maine Medical Education Trust designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™.  Physicians should only claim credit commensurate with the extent of their participation in the activity.

This activity qualifies for 1.5 credits of the 3 CME credit requirement for opioid medication education found in P.L. 2015, Chapter 488, Maine’s legislation to address the opioid drug crisis.

This activity qualifies for 1.5 hours of the 8 hours of training on opioid or other substance use disorders and the appropriate treatment of pain required by the MATE Act.

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 the Maine Medical Education Trust and Maine Medical Association, Center for Quality Improvement. The Maine Medical Education Trust is accredited by the Maine Medical Association Committee on Continuing Medical Education and Accreditation to provide continuing medical education for physicians.

None of the planners or presenters for this activity have relevant financial relationships to disclose.

Duration & Fee:  FREE for Maine Clinicians 

Estimated Time to Complete: 90 minutes

(note: the module is divided into short digestible units [10-20 mins] which can be completed in small increments)

Hardware/Software Requirements:

• Computer with Internet connection
• Current version of Chrome, Firefox or Safari browser. You must have JavaScript enabled.
• The quiz tool within the online modules are not fully compatible with smartphones or tablets. To avoid issues, such as answers not being recorded, we recommend using a computer to complete the pre- and post-tests.

Assessment and Grading:

This learning module begins with a Pre-Test that will test your knowledge and allow you to gauge your baseline understanding of the topics to be covered. Your pre-test score will not count toward your overall grade. At the end of the module, there is a Post-Test that will determine your final grade. A comparison of your Pre-Test score and Post-Test score will help to assess how much knowledge you’ve gained. You will have three attempts to complete the Post-Test. Your score must be 75% or better in order to receive the 1.5 AMA PRA Category 1 Credits™. Please complete the evaluation survey at the conclusion of the learning module.

To Obtain a CME Certificate or a CME Certificate of Participation:

• Complete the entire learning module.
• Complete the pre-test, post-test, and Survey Monkey evaluation at the end of the module.
• Earn a score of 75% or higher on the post-test in order to receive a certificate.

Upon completion of the evaluation in Survey Monkey, including the required demographic information, a CME Certificate will be emailed to M.D.s and D.O.s and a CME Certificate of Participation will be emailed to all other learners. These certificates will be emailed within 10 business days of completing the evaluation.

Table of Contents:  The units will consist of the following:

1. Introduction
2. Pre-Assessment
3. Understanding Prescribing Trends
4. Rationale of Avoiding Use of Benzodiazepine and Opioids together
5. Benzodiazepine Indications and place in therapy
6. Short- and long-term benzodiazepine adverse effects
7. Evidence-based alternatives to benzodiazepines
8. Practical pearls for reducing benzodiazepine prescriptions
9. Post-Assessment

Disclosures: The planners and presenters for this module have no relevant financial relationships to disclose.

Stephanie Nichols, Pharm. D., BCPS, BCPP, FCPP 
University of New England School of Pharmacy 

Amy Carter, BSHA-M
Director
Maine Medical Association, Center for Quality Improvement

Marshall McLaughlin
Project Coordinator
Maine Medical Association, Center for Quality Improvement

Funding: This module is made possible by the generous support and funding from our partners at the Maine Board of Licensure in Medicine.