Activity Overview and Instructions

The FDA Risk Evaluation and Mitigation Strategy (REMS) for opioids leverages accredited CE to address the opioid crisis. Offered in collaboration with Area 9 Lyceum and Boston University School of Medicine, this program addresses the FDA Opioid Analgesic REMS 2018 mandate for accredited CME to expand the REMS program to include Immediate-Release (IR) opioids by providing comprehensive prescriber education in the safe use of these medications. This program is funded by an unrestricted educational grant by the Opioid Analgesic REMS Program Companies, known as the REMS Program Companies (RPC).

NEJM Knowledge+ Pain Management and Opioids consists of 62 in-depth, case-based scenarios developed by practicing clinician experts in pain management and addiction. The cases and questions assess the participant’s learning that includes many high-yield learning resources in the form of audio, video, and infographics. The material covers:

  • The latest practices for assessing and managing acute and chronic pain.
  • Current guidelines on the appropriate use of opioids for pain management.
  • Evidence-based strategies for recognizing and treating opioid use disorder.

Learning Objectives

  • Choose the most appropriate pain-management strategy for an individual patient.
  • Recognize the scenarios in which opioid analgesia is and is not appropriate.
  • Recall the importance of routinely assessing pain, function, and adverse effects in patient taking chronic opioid therapy.
  • Identify signs of opioid misuse and opioid use disorder.
  • Choose the most appropriate strategy for tapering or discontinuing opioid analgesics when necessary.
  • Choose the most appropriate intervention when opioid use disorder is suspected.

Disclosure of support

This activity is supported by an independent educational grant from the Opioid Analgesic REMS Program Companies. Please see for a listing of REMS Program Companies. This activity is intended to be fully compliant with the Opioid Analgesic REMS education requirements issued by the US Food and Drug Administration.

Intended Audience

The primary audience for this activity will be US-based internal medicine generalists and subspecialists, hospitalists, family medicine physicians, and emergency medicine physicians. The secondary audience will be pain specialists, surgeons, anesthesiologists, and psychiatrists. The tertiary audience will be all other physicians and allied care providers on the aspirational learning scale.

Medium or Combination of Media Used

This is an adaptive self-assessment tool designed to adjust to the learner’s strengths and areas for growth, and can be accessed from a desktop, laptop, tablet, or smartphone. Learners are presented with a sequence of questions. After each question is answered, the user is provided with the key learning point, detailed feedback that discusses the correct answer as well as each of the wrong answers, and citations to relevant articles.

Method of Participation

For users familiar with other NEJM Knowledge+ modules, the experience is slightly different. In order to maximize exposure to the FDA Opioid Analgesics REMS blueprint, learners must first answer all case-based questions, and the detailed feedback will automatically be shown after your response. After you’ve seen all the cases, the system will adapt to you just as with our other modules, and you can keep learning to obtain mastery and earn all associated CME credits.

All questions are approved for AMA PRA Category 1 Credit™ and ABIM Maintenance of Certification (MOC) points. To receive CME credit and ABIM MOC points, you must answer questions correctly:

  • Six questions answered correctly are designated for 1 AMA PRA Category 1 Credit™.
  • Six questions answered correctly equal 1 MOC point.


Each clinical vignette includes citations and references.

Hardware/Software Requirements


  • Google Chrome 30+, Safari 5.0+, Internet Explorer 11.0+, Mozilla Firefox 10.0+, Microsoft Edge
  • Recommended: Google Chrome 39+, Safari 7+, Internet Explorer 11, or Firefox 32+
  • Windows 7 (32-bit and 64-bit), Windows 8+. Windows 7+ is recommended.
  • Minimum 1 GB of RAM but 2 GB or greater is recommended
  • 2.33 GHz or faster x86-compatible processor, or Intel® Atom™ 1.6 GHz or faster processor for netbooks
  • Display resolution: 1024 × 768 or better

Mac OS

  • Google Chrome 14+, Safari 5.0+, Mozilla Firefox 12.0+
    Recommended: Google Chrome 39+, Safari 7+, or Firefox 32+
  • Mac OS X v10.6+
  • Minimum 1 GB of RAM but 2 GB or greater is recommended
  • Intel Core™ Duo 1.33GHz or faster processor
  • Display resolution: 1024 × 768 or better


NEJM Knowledge+ apps are available for iOS and Android smartphones and tablets; Android phones may access NEJM Knowledge+ through our mobile-optimized browser version.

  • iOS devices running OS 7+(includes iPhone and iPad devices). iOS version 8+ is recommended.
  • Android version 4+ (includes smartphones and tablets). Android version 5+ is recommended. Note: Android phones will also support the browser version of each product (Chrome recommended).

NEJM Knowledge+ Editors and Publishers

A Product of NEJM Group — Owned & Published by the

NEJM Group Editor
Jeffrey M. Drazen, MD

Vice President for Publishing, NEJM Group
Christopher R. Lynch

Education Editor, NEJM Group
Ole-Petter Riksfjord Hamnvik, MB BCh BAO, MMSc

Founding Editor
Graham T. McMahon, MD, MMSc

Senior Reviewer
Daniel P. Alford, MD, MPH

Deputy Reviewers
Daniel Randall, MD, MPH
C. Christopher Smith, MD

Section Editors
Mihir M. Kamdar, MD
Anna Lembke, MD

Thomas M. Best, MD, PhD
John Betjemann, MD
Martha E. Billings, MD
Christopher M. Bono, MD
Megan J. Bray, MD
Allan S. Brett, MD
Melissa Cavaghan, MD
Vincent W. Chiang, MD
Joanne E. Cox, MD
Ahmed Eid, MD, MEd
Paul Gordon, MD
Manu Hegde, MD, PhD
Simon M. Helfgott, MD
Peter W. Kaplan, MD
Amy Keim, MS PA-C
Tia Kostas, MD
Patricia A. Kritek, MD, EdM
Dan L. Longo, MD
Holly Good McNulty, MD
Michael Craig Miller, MD
Paul Monach, MD
Mark T. Nadeau, MD, MBA, FAAFP
Karen A. O’Brien, MD
Mark D. Price, MD, PhD
Jeanine C. Ronan, MD
Shannon E. Scott-Vernaglia, MD
Kaveh G. Shojania, MD
Katherine A. Sparger, MD
Jacob J. Strand, MD
Rebecca Tenney-Soiero, MD
Derrick J. Todd, MD, PhD
David M. Vernick, MD
Andrew J. White, MD
James Song-Jeng Yeh, MD

Soraya Azari, MD
Erica J. Bial, MD, MS
Ethan G. Brown, MD
Jeffrey Bruckel, MD
Patrick K. Cronin, MD
Amy L. Fitzpatrick, MD
Peter D. Friedmann, MD, MPH
Julie Fu, MD, MA
Douglas L. Gourlay, MD, MSc
Ellie Grossman, MD, MPH
Scott E. Hadland, MD, MPH, MS
David B. Hathaway, MD
Lindsey Hayes, MD, PhD
Jeoffrey Hill, MD
Janet J. Ho, MD, MPH
Mohammed A. Issa, MD
Syed Mohammad Ali Kazmi, MD
Amy J. Kennedy, MD
Stacy E. Melanson, MD, PhD
Eli Miloslavsky, MD
Christine Pace, MD
Daniel K. Partain, MD
Michael D. Perloff, MD, PhD
Cara Poland, MD, MEd
Cassandra Pruitt, MD
Shari S. Rogal, MD, MPH
Serena L. Roth, MD
Payel J. Roy, MD
Seddon R. Savage, MD, MS
Daphne A. Scott, MD
Margarita Sergonis, MD
Christine S. Soran, MD, MPH
Scott Steiger, MD
Joji Suzuki, MD
David Tian, MD, MPP
Donald N.S. Unger, MFA, PhD
Lauren VanDam, MD
Sarah E. Wakeman, MD
Jennifer Wang, MD
Melissa B. Weimer, DO, MCR
Zoe M. Weinstein, MD, MS

Editorial Staff
Josette Akresh-Gonzales
Linda Barlow
Steven DeMaio
Ilana T. Hardesty
Kathryn Joy
Spencer Parente
Catherine Tomeo Ryan
Kyle Simmons
Scott D.S. Young

Ole-Petter Riksfjord Hamnvik, MB BCh BAO, MMSc
Daniel P. Alford, MD, MPH
Kristin F. Watson, NP
Ilana T. Hardesty
Danna Muir, MBA
Michelle Haché
Catherine Tomeo Ryan
Kathleen Bellisle

None of the other individuals in a position to control of the content of this activity have any relevant financial relationships with commercial interests to report.

MMS Disclosure Policy

As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Massachusetts Medical Society must ensure balance, independence, objectivity, and scientific rigor in its educational activities. Activity planners, committee members, faculty, (including their spouse or partner) and all others who are in a position to control the content of this educational activity are required to disclose all relevant financial relationships with any ACCME-defined commercial interest related to the subject matter of the educational activity so that the MMS may identify and resolve all conflicts of interest prior to the activity.

Individual Disclosures

During their tenure with NEJM Knowledge+, the following planners, authors, and reviewers have disclosed the following relevant financial relationships with an ACCME-defined commercial interest.

Thomas M. Best, MD, PhD
–    Consultant for Abbot and ZetrOZ

Ethan G. Brown, MD
–    Grant/contract research with Gateway Institute for Brain Research
–    Consultant for Rune Labs

Vincent W. Chiang, MD
–    Financial interest in and advisory board member for AugMI Labs

Peter D. Friedmann, MD, MPH
–    Legal expert consultant for Endo Pharmaceuticals
–    In-kind research support from Alkermes
–    Scientific advisory committee for Indivior

Simon M. Helfgott, MD
–    Consultant for AbbVie and Genentech

Mihir M. Kamdar, MD
–    Scientific advisory board for Amorsa Therapeutics
–    Expert advisory panel for Collegium Pharmaceuticals
–    Consultant for Vivtex and Medtronic

Eli Miloslavsky, MD
–    Fellowship in 2012—2013 from Genentech

Paul A. Monach, MD
–    Grant support from Genentech

Shari S. Rogal, MD, MPH
–    Grant support from Gilead

Derrick J. Todd, MD, PhD
–    Consultant for Kiniksa Pharmaceuticals, Genentech, Optum, and Regeneron

Melissa B. Weimer, DO, MCR
–    Advisory role with Alkermes


The Massachusetts Medical Society (MMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) and must ensure independence, objectivity, balance and scientific rigor in all its educational activities. All individuals in control of the content, including faculty, course directors, and planners (and their spouse/partner) participating in any MMS activity must provide information about potential conflicts of interest that may be relevant to the activity. Listed above is a summary of disclosure information of relevant financial relationships within the past 12 months for individuals (and their spouse/partner) in control of content with any entity producing, marketing, re-selling or distributing health care goods or services consumed by, or used on, patients. All potential conflicts of interest have been identified and resolved prior to the beginning of this activity in accordance with MMS policies.

Accreditation Information

Accreditation Statement

The Massachusetts Medical Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA Credit Designation Statement

The Massachusetts Medical Society designates this enduring material for a maximum of 10 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Risk Management and Pain Management Credits

This activity meets the criteria of the Massachusetts Board of Registration in Medicine for risk management study.

This activity meets the criteria of the Massachusetts Board of Registration in Medicine for opioid education.

Many states have similar requirements. Please check with your Board to determine if this activity will fulfill your state’s specific requirements.

American Board of Internal Medicine MOC Points

NEJM Knowledge+ Pain Management and Opioids (IM) only

ABIM CME MOCSuccessful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 10 MOC points and patient safety MOC credit in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

American Academy of Family Physicians (AAFP)

NEJM Knowledge+ Pain Management and Opioids (FM) only

The AAFP has reviewed NEJM Knowledge+ Pain Management and Opioids and deemed it acceptable for up to 10.00 Enduring Materials, Self-Study AAFP Prescribed credit. Term of Approval is from 04/15/2021 to 04/15/2022. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Board of Medical Specialties Maintenance of Certification Part 2 Credit

Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Continuing Certification Activities through the ABMS Continuing Certification Directory, NEJM Knowledge+ Pain Management and Opioids has met the requirements as an MOC Part II Self-Assessment and/or MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:

MOC Part II Self-Assessment Activity
Physical Medicine and Rehabilitation

MOC Part II CME Activity
Family Medicine
Preventive Medicine
Psychiatry and Neurology

Accreditation Term

Original Release Date: April 15, 2020
Review dates: N/A
Termination Date: April 14, 2023

American Academy of Physician Assistants (AAPA)

This activity has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 10 AAPA Category 1 CME credits. Approval is valid from 4/1/2021 to 4/15/2022 . PAs should only claim credit commensurate with the extent of their participation. AAPA reference number: CME-202472.

American Association of Nurse Practitioners (AANP)

Pharmacology Contact Hours

This activity is approved for 10.0 contact hour(s) of continuing education (which includes 10.0 hours of pharmacology) by the American Association of Nurse Practitioners. Activity ID 20034193. This activity was planned in accordance with AANP Accreditation Standards and Policies

ACPE Credits

ACPE LogoNortheastern University School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.

This application based activity is approved for 8.0 contact hours.

The ACPE universal activity number is: 0027-9999-19-069-H01-P.

The initial release date is July 16, 2019.

The planned expiration date is July 16, 2022.

Contact Information

For all questions and comments, please contact NEJM Knowledge+ by email at or call toll-free 855-318-9303 (within the USA and Canada) or 781-434-7998.

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