Activity Overview and Instructions

The FDA Risk Evaluation and Mitigation Strategy (REMS) for opioids leverages accredited CE to address the opioid crisis. In July 2012, the first REMS was approved by the FDA to incorporate accredited CME into the Extended-Release and Long-Acting (ER/LA) Opioid Analgesics REMS.

Offered in collaboration with Area 9 Group 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).

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 be 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.

All questions are approved for AMA PRA Category 1 Credit™ and MOC points. To receive CME credit and 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 Edg
    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
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
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
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
Jeffrey Bruckel, MD
Amy L. Fitzpatrick, MD
Peter D. Friedmann, MD, MPH
Julie Fu, MD, MA
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
Syed Mohammad Ali Kazmi, MD
Amy J. Kennedy, MD
Eli Miloslavsky, MD
Christine Pace, MD
Daniel K. Partain, MD
Cara Poland, MD, MEd
Cassandra Pruitt, MD
Shari S. Rogal, MD, MPH
Payel J. Roy, MD
Daphne A. Scott, MD
Margarita Sergonis, MD
Christine S. Soran, MD, MPH
Scott Steiger, MD
David Tian, MD, MPP
Lauren VanDam, MD
Sarah E. Wakeman, MD
Jennifer Wang, MD
Melissa B. Weimer, DO

Editorial Staff
Josette Akresh-Gonzales
Steven DeMaio
Ilana T. Hardesty
Catherine Tomeo Ryan
Kyle Simmons

Ole-Petter Riksfjord Hamnvik, MB BCh BAO, MMSc
Daniel P. Alford, MD, MPH
Ilana T. Hardesty
Matthew O’Rourke
Catherine Tomeo Ryan
Danna G. Muir, MBA

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

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

Ole-Petter Riksfjord Hamnvik, MB BCh BAO, MMSc
–    Consultant for Fusion Pharmaceuticals

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

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, and Regeneron

Melissa B. Weimer, DO
–    Advisory role with Alkermes

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

Conflict of Interest Resolution

The Massachusetts Medical Society has established procedures to identify and resolve any potential conflicts of interest (COI) prior to this educational activity. To ensure content objectivity, independence, fair balance and the alignment of the content with the interests of the public, any potential COI issues were resolved through content review.

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

This Enduring Material activity, NEJM Knowledge+ Pain Management and Opioids, has been reviewed and is acceptable for up to 10.00 Prescribed credit(s) by the American Academy of Family Physicians. AAFP certification begins 04/03/2019. Term of approval is for one year from this date. 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

NCCPA Accreditation Statement

PAs may claim a maximum of 10 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.

Credit Information for Nurse Practitioners

For the purposes of recertification, the American Academy of Nurse Practitioners Certification Board (AANPCB) accepts AMA PRA Category 1 Credit(s)™ issued by organizations accredited by ACCME as the number of hours of participation. Documentation of participation to non-physicians specifying the number of hours of participation is provided upon successful completion.

Please note: 1 CME Credit = 60 minutes or 1 contact hour, all of which are pharmacology credit-worthy.

Accreditation Term

Original Release Date: April 3, 2019
Review dates: N/A
Termination Date: April 3, 2022

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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