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/CE 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 ABIM 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 currently available for iOS and Android smartphones and tablets; Android phones may access NEJM Knowledge+ through our mobile-optimized browser version. Please note that on September 29, 2022, NEJM Knowledge+ will be migrating to a new platform and are retiring both the iOS and Android apps. The new platform will work on all mobile and desktop systems via your web browser whenever you have an internet connection.

  • 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, NEJM Group
David Sampson

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
Anna Lembke, MD
Eric Roeland, MD

Martha E. Billings, MD
Megan J. Bray, MD
Melissa Cavaghan, MD
Vincent W. Chiang, MD
Mihir M. Kamdar, MD
Amy Keim, MS PA-C
Patricia A. Kritek, MD, EdM
Dan L. Longo, MD
Michael Craig Miller, MD
Mark T. Nadeau, MD, MBA, FAAFP
Karen A. O’Brien, MD
Mark D. Price, MD, PhD
Shannon E. Scott-Vernaglia, MD
Katherine A. Sparger, MD
Derrick J. Todd, MD, PhD
David M. Vernick, MD

Soraya Azari, MD
Erica J. Bial, MD, MS
Allan S. Brett, MD
Ethan G. Brown, MD
Jeffrey Bruckel, MD
Patrick K. Cronin, MD
Robert R. Edwards, PhD
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
Danna Muir, MBA
Michelle Haché
Catherine Tomeo Ryan
Kathleen Bellisle

MMS Disclosure Policy

The Massachusetts Medical Society (MMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) and must ensure independence, balance, and scientific rigor in its accredited continuing education activities.

All individuals in control of the content for an MMS accredited continuing education activity must disclose all financial relationships with ineligible companies.

Disclosure Statement

The following individuals disclosed relevant financial relationships with ineligible companies within the past 24-months:

Ethan Brown, MD

2022Rune Labs, consultant
2023Nothing disclosed


Mihir M. Kamdar, MD

2022Nothing disclosed
2023Elevate, cofounder and chief medical officer

Fern Health, medical advisor

Note: Dr. Kamdar stepped down as Section Editor on May 15, 2023


Eric Roeland, MD

2023Napo Pharmaceuticals, scientific advisory board

Actimed Therapeutics, scientific advisory board, ended March 2022

Meter Health, scientific advisory board, endned May 2022

Veloxis Pharmaceuticals, consultant

Aileron Therapeutics, consultant, ended October 2021

BYOMass, consultant, ended December 2021

Takeda, advisory board, ended April 2022

Enzychem Lifesciences Pharmaceutical Company, data safety monitoring board, ended 2022

2024Actimed Therapeutics, scientific advisory board

Takeda, scientific advisory board, discontinued Apr 2022

Napo Pharmaceuticals, scientific advisory board

Meter Health, scientific advisory board, discontinued May 2022

Pfizer, speaker, discontinued Sep 2023

Dexcel Pharma, consultant, discontinued Sep 2023


Joji Suzuki, MD

2023Indivior, research support, ended Aug 2023

All relevant financial relationships have been mitigated prior to the beginning of this activity in accordance with ACCME and MMS policies. All other individuals in control of the content have reported no relevant financial relationships with ineligible companies for this activity.

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 10.25 Enduring Materials, Self-Study AAFP Prescribed credits. Term of Approval is from 04/15/2024 to 04/15/2025. 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

American Academy of Physician Assistants (AAPA)

AAPA Category 1 Self-Assessment CMEThis activity has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 10.25 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation. Approval is valid from 4/15/2024 to 4/14/2025. AAPA reference number: CME-2011305.

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 23036011. This activity was planned in accordance with AANP Accreditation Standards and Policies

ACPE Credits

ACPE LogoThe University of Rhode Island College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This is an application-based educational activity. Pharmacists will receive 8.0 contact hours (0.8 CEUS) for the educational activity. No partial credit is available.

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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