605: Evaluating the Effectiveness of an Online Opioid Self-Assessment Program

Topic: Education, Societal Impact, and Others
Subtopic: Education of pain care

Background and Aims: In North America, opioid-related harms remain a leading cause of drug-related mortality due to the direct relationship with opioid prescriptions. Despite the availability of national guidelines, considerable variability and non-adherence persist in opioid prescribing practices. Educational interventions are crucial to improve the knowledge gaps, low clinical confidence, and inconsistent guideline adherence among opioid prescribers. While multi-modal continuing medical education (CME) has shown promise, few studies have rigorously evaluated the impact of scalable digital-provided CME. This study evaluates the effectiveness of the Online Opioid Self-Assessment Program, a self-guided, accredited digital CME module designed to improve knowledge of the Canadian Opioid Guideline.

Methods: We conducted a national single-arm pre-post evaluation of the SAP, a bilingual, CME-accredited, self-paced online course. The program integrated interactive cases with reference-based educational materials, self-assessment quizzes, and curated resources across six opioid-related domains. Participants included Canadian physicians, dentists, nurse practitioners, and healthcare trainees. Participants completed demographic questions, a 10-item pre-test, the 3-hour module, and a 10-item post-test from a validated question bank. Participant characteristics were described, and secondary analyses examined learning domain-level performance and qualitative feedback from the participants. Quantitative data were analyzed using descriptive statistics and t-tests; qualitative feedback was thematically coded.

Results: 1,599 individuals registered: medical students (40%), residents (12%), and family physicians (9%). The majority (75%) were located in Ontario. The mean knowledge scores increased from 45.8 ± 4.9% to 87.3 ± 2.1% (p ≤ 0.05). Improvements were observed across all domains, notably Tapering (Δ = 39 - 42%) and Prevention of Opioid Use Disorder (Δ = 37 -39%). Seventy percent of both learners and prescribers reported intent to change clinical practice. Feedback highlighted strengthened opioid knowledge confidence, improved communication skills, and the value of tailored, interactive digital learning. Participants affirmed that learning objectives were met and the program addressed relevant practice challenges.

Conclusions: The Online Opioid SAP produced measurable improvements in knowledge and high user endorsement of practice-relevant content areas such as tapering and communication. Given the strong alignment between learning outcomes and feedback domains, this digital CME model shows promise in enhancing clinician competence in opioid stewardship. To confirm impact at the patient level, further studies must connect CME participation with objective prescribing outcomes and safety metrics.

References: Busse, Jason W., Samantha Craigie, David N. Juurlink, D. Norman Buckley, Li Wang, Rachel J. Couban, Thomas Agoritsas, Elie A. Akl, Alonso Carrasco-Labra, Lynn Cooper, Chris Cull, Bruno R. da Costa, Joseph W. Frank, Gus Grant, Alfonso Iorio, Navindra Persaud, Sol Stern, Peter Tugwell, Per Olav Vandvik, and Gordon H. Guyatt. 2017. “Guideline for Opioid Therapy and Chronic Noncancer Pain.” CMAJ: Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne 189(18):E659–66. doi:10.1503/cmaj.170363.

Busse, Jason W., Li Wang, Mostafa Kamaleldin, Samantha Craigie, John J. Riva, Luis Montoya, Sohail M. Mulla, Luciane C. Lopes, Nicole Vogel, Eric Chen, Karin Kirmayr, Kyle De Oliveira, Lori Olivieri, Alka Kaushal, Luis E. Chaparro, Inna Oyberman, Arnav Agarwal, Rachel Couban, Ludwig Tsoi, Tommy Lam, Per Olav Vandvik, Sandy Hsu, Malgorzata M. Bala, Stefan Schandelmaier, Anne Scheidecker, Shanil Ebrahim, Vahid Ashoorion, Yasir Rehman, Patrick J. Hong, Stephanie Ross, Bradley C. Johnston, Regina Kunz, Xin Sun, Norman Buckley, Daniel I. Sessler, and Gordon H. Guyatt. 2018. “Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-Analysis.” JAMA 320(23):2448–60. doi:10.1001/jama.2018.18472.

Campbell, Gabrielle, Suzanne Nielsen, Briony Larance, Raimondo Bruno, Richard Mattick, Wayne Hall, Nicholas Lintzeris, Milton Cohen, Kimberley Smith, and Louisa Degenhardt. 2015. “Pharmaceutical Opioid Use and Dependence among People Living with Chronic Pain: Associations Observed within the Pain and Opioids in Treatment (POINT) Cohort.” Pain Medicine 16(9):1745–58. doi:10.1111/pme.12773.

Canada, Health. 2021. “Canadian Pain Task Force Report: March 2021.” https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2021.html.

CDC. 2011. “Vital Signs: Overdoses of Prescription Opioid Pain Relievers --- United States, 1999--2008.” https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm.

Davis, Corey S., and Derek Carr. 2016. “Physician Continuing Education to Reduce Opioid Misuse, Abuse, and Overdose: Many Opportunities, Few Requirements.” Drug and Alcohol Dependence 163:100–107. doi:10.1016/j.drugalcdep.2016.04.002.

Davis, D. A., M. A. Thomson, A. D. Oxman, and R. B. Haynes. 1992. “Evidence for the Effectiveness of CME. A Review of 50 Randomized Controlled Trials.” JAMA 268(9):1111–17.

Dhalla, Irfan A., Muhammad M. Mamdani, Tara Gomes, and David N. Juurlink. 2011. “Clustering of Opioid Prescribing and Opioid-Related Mortality among Family Physicians in Ontario.” Canadian Family Physician 57(3):e92–96.

Furlan, Andrea D., Jane Zhao, Jennifer Voth, Samah Hassan, Ruth Dubin, Jennifer N. Stinson, Susan Jaglal, Ralph Fabico, Andrew J. Smith, Paul Taenzer, and John F. Flannery. 2019. “Evaluation of an Innovative Tele-Education Intervention in Chronic Pain Management for Primary Care Clinicians Practicing in Underserved Areas.” Journal of Telemedicine and Telecare 25(8):484–92. doi:10.1177/1357633X18782090.

Hartung, Daniel M., Jennifer A. Lucas, Nathalie Huguet, Steffani R. Bailey, Jean O’Malley, Robert W. Voss, Irina Chamine, and John Muench. 2023. “Sedative-Hypnotic Co-Prescribing with Opioids in a Large Network of Community Health Centers.” Journal of Primary Care & Community Health 14:21501319221147378. doi:10.1177/21501319221147378.

Henry, Stephen G., Debora A. Paterniti, Bo Feng, Ana-Maria Iosif, Richard L. Kravitz, Gary Weinberg, Penney Cowan, and Susan Verba. 2019. “Patients’ Experience with Opioid Tapering: A Conceptual Model with Recommendations for Clinicians.” The Journal of Pain : Official Journal of the American Pain Society 20(2):181–91. doi:10.1016/j.jpain.2018.09.001.

Jones, Christopher M., Karin A. Mack, and Leonard J. Paulozzi. 2013. “Pharmaceutical Overdose Deaths, United States, 2010.” JAMA 309(7):657–59. doi:10.1001/jama.2013.272.

Juurlink, David N., and Irfan A. Dhalla. 2012. “Dependence and Addiction during Chronic Opioid Therapy.” Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology 8(4):393–99. doi:10.1007/s13181-012-0269-4.

Kennedy, Laura C., Ingrid A. Binswanger, Shane R. Mueller, Cari Levy, Daniel D. Matlock, Susan L. Calcaterra, Stephen Koester, and Joseph W. Frank. 2018. “‘Those Conversations in My Experience Don’t Go Well’: A Qualitative Study of Primary Care Provider Experiences Tapering Long-Term Opioid Medications.” Pain Medicine: The Official Journal of the American Academy of Pain Medicine 19(11):2201–11. doi:10.1093/pm/pnx276.

Ledlie, Shaleesa, David N. Juurlink, Mina Tadrous, Muhammad Mamdani, J. Michael Paterson, and Tara Gomes. 2024. “Opioid-Related Deaths between 2019 and 2021 across 9 Canadian Provinces and Territories.” CMAJ : Canadian Medical Association Journal 196(14):E469–76. doi:10.1503/cmaj.231339.

Leece, Pamela, Yalnee Shantharam, Samah Hassam, Daniel Z. Buchman, Michael Hamilton, Navindra Persaud, Meldon Kahan, Sheryl Spithoff, Anita Srivastava, Beth A. Sproule, Leslie Carlin, and Andrea D. Furlan. 2020. “Improving Opioid Guideline Adherence: Evaluation of a Multifaceted, Theory-Informed Pilot Intervention for Family Physicians.” BMJ Open 10(1):e032167. doi:10.1136/bmjopen-2019-032167.

Leung, Janni, Thomas Santo Jr, Samantha Colledge-Frisby, Tesfa Mekonen, Kate Thomson, Louisa Degenhardt, Jason P. Connor, Wayne Hall, and Daniel Stjepanović. 2022. “Mood and Anxiety Symptoms in Persons Taking Prescription Opioids: A Systematic Review with Meta-Analyses of Longitudinal Studies.” Pain Medicine 23(8):1442–56. doi:10.1093/pm/pnac029.

Levy, Benjamin, Leonard Paulozzi, Karin A. Mack, and Christopher M. Jones. 2015. “Trends in Opioid Analgesic–Prescribing Rates by Specialty, U.S., 2007–2012.” American Journal of Preventive Medicine 49(3):409–13. doi:10.1016/j.amepre.2015.02.020.

Madadi, Parvaz, Doris Hildebrandt, Albert E. Lauwers, and Gideon Koren. 2013. “Characteristics of Opioid-Users Whose Death Was Related to Opioid-Toxicity: A Population-Based Study in Ontario, Canada.” PLOS ONE 8(4):e60600. doi:10.1371/journal.pone.0060600.

Mazer-Amirshahi, Maryann, Peter M. Mullins, Irit Rasooly, John van den Anker, and Jesse M. Pines. 2014. “Rising Opioid Prescribing in Adult U.S. Emergency Department Visits: 2001-2010.” Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine 21(3):236–43. doi:10.1111/acem.12328.

Naimer, Michelle S., Jessica Munro, Suzanne Singh, and Joanne A. Permaul. 2019. “Improving Family Medicine Residents’ Opioid Prescribing: A Nurse Practitioner-Led Model.” The Journal for Nurse Practitioners 15(9):661–65. doi:10.1016/j.nurpra.2019.07.002.

Pytell, Jarratt D., Komal J. Narwaney, Anh P. Nguyen, Jason M. Glanz, and Ingrid A. Binswanger. 2025. “New Alcohol-Related Condition Diagnoses Are Associated With Opioid Tapers Among Patients Receiving Long-Term Opioid Therapy.” Journal of Addiction Medicine 19(3):290–97. doi:10.1097/ADM.0000000000001412.

Spithoff, Sheryl, Stephanie Mathieson, Frank Sullivan, Qi Guan, Abhimanyu Sud, Susan Hum, and Mary Ann O’Brien. 2020. “Clinical Decision Support Systems for Opioid Prescribing for Chronic Non-Cancer Pain in Primary Care: A Scoping Review.” The Journal of the American Board of Family Medicine 33(4):529–40. doi:10.3122/jabfm.2020.04.190199.

Starrels, Joanna L., William C. Becker, Mark G. Weiner, Xuan Li, Moonseong Heo, and Barbara J. Turner. 2011. “Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain.” Journal of General Internal Medicine 26(9):958–64. doi:10.1007/s11606-011-1648-2.

Venugopal, Jeyasakthi, Amanda VanSteelandt, Lindsey Yessick, Keltie Hamilton, and Jean-Franois Leroux. 2024. “Chronic Pain and Accidental Acute Toxicity Deaths in Canada, 2016–2017.” Health Promotion and Chronic Disease Prevention in Canada : Research, Policy and Practice 44(7–8):306–18. doi:10.24095/hpcdp.44.7/8.02.

Webster, Fiona, Kathleen Rice, Joel Katz, Onil Bhattacharyya, Craig Dale, and Ross Upshur. 2019. “An Ethnography of Chronic Pain Management in Primary Care: The Social Organization of Physicians’ Work in the Midst of the Opioid Crisis.” PLOS ONE 14(5):e0215148. doi:10.1371/journal.pone.0215148.

Zin, C. S., L. C. Chen, and R. D. Knaggs. 2014. “Changes in Trends and Pattern of Strong Opioid Prescribing in Primary Care.” European Journal of Pain (London, England) 18(9):1343–51. doi:10.1002/j.1532-2149.2014.496.x.

Presenting Author: Andrea D. Furlan
Submitting Author: Andrea Furlan

Senior Author: Andrea D. Furlan

IASP 2026 Global Year theme of Neuropathic Pain: No

• Nagina Parmar: PhD - University Health Network
• Sena Gok: MD - University Health Network