CPSUD Exam Content Outline

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Certified Pharmacist in Substance Use Disorders (CPSUD)

Official Examination Content Outline

This document provides the official content outline for the Certified Pharmacist in Substance Use Disorders (CPSUD) examination. The exam certifies that a pharmacist possesses the specialized clinical knowledge and skills to provide comprehensive, evidence-based care to patients with substance use disorders, including patient assessment, pharmacotherapy management, and harm reduction strategies.

Examination Specifications

Name of Credential Certified Pharmacist in Substance Use Disorders (CPSUD)
Certification-Issuing Body The Council on Pharmacy Standards (CPS)
Designation Awarded CPSUD
Target Population Clinical pharmacists in addiction medicine, pain management, primary care, and community settings.
Examination Length 120 multiple-choice items
Administration Time 3.0 hours

Examination Content Outline

The CPSUD examination is weighted according to the six domains listed below, which cover the full spectrum of care for patients with substance use disorders, from foundational science to advanced practice management.

Domain 1: Foundational Principles and Patient Assessment 20%
Domain 2: Pharmacotherapy and Withdrawal Management 20%
Domain 3: Harm Reduction and Overdose Prevention 15%
Domain 4: Co-Occurring Disorders and Special Populations 20%
Domain 5: Healthcare Systems, Law, and Policy 15%
Domain 6: Quality, Safety, and Innovation in SUD Care 10%

Domain 1: Foundational Principles and Patient Assessment (20%)

Task 1: Apply knowledge of the neurobiology of addiction.
  • Describe the key neural pathways involved in reward and reinforcement.
  • Explain the neuroadaptive changes that occur with chronic substance use.
  • Define concepts such as tolerance, dependence, withdrawal, and craving.
  • Explain how medications for addiction treatment (MAT) work to normalize brain chemistry.
Task 2: Evaluate a patient's social and cultural context.
  • Assess for social determinants of health (SDOH) that impact care.
  • Apply trauma-informed and culturally responsive approaches to SUD assessment and care planning.
  • Use person-first, non-stigmatizing language to build a therapeutic alliance.
  • Implement strategies to provide culturally humble and equitable care.
Task 3: Implement patient screening and assessment using validated tools.
  • Utilize validated screening tools (e.g., AUDIT-C, DAST-10, ASSIST) in various practice settings.
  • Employ a universal screening approach (Screening, Brief Intervention, and Referral to Treatment - SBIRT).
  • Assess the severity of an SUD (mild, moderate, severe) based on DSM-5 criteria.
  • Assess the patient's readiness to change using models like the Transtheoretical Model.
Task 4: Assess withdrawal syndromes.
  • Assess the severity of opioid withdrawal using a validated scale (e.g., COWS).
  • Assess the severity of alcohol withdrawal using a validated scale (e.g., CIWA-Ar).
  • Recognize the signs and symptoms of benzodiazepine and stimulant withdrawal.
  • Differentiate between managing withdrawal in an inpatient versus an outpatient setting.
Task 5: Interpret toxicology and laboratory test results.
  • Differentiate between various types of toxicology tests and their windows of detection.
  • Interpret qualitative and quantitative toxicology screen results, including common false positives.
  • Use toxicology testing to monitor for adherence and abstinence.
  • Interpret lab values relevant to substance use, such as liver function tests.
Task 6: Conduct a comprehensive substance use history.
  • Obtain a detailed history of all substances used, including routes of administration and patterns of use.
  • Assess the quantity and frequency of use for each substance.
  • Elicit a history of past treatment attempts, including medications and psychosocial interventions.
  • Assess for a history of high-risk behaviors, such as injection drug use.

Domain 2: Pharmacotherapy and Withdrawal Management (20%)

Task 1: Manage pharmacotherapy for Opioid Use Disorder (OUD).
  • Compare and contrast the pharmacology of buprenorphine, methadone, and naltrexone.
  • Initiate, titrate, and maintain patients on all formulations of buprenorphine and naltrexone, including long-acting injectables.
  • Manage the transition from illicit opioids to buprenorphine, including conducting a proper induction.
  • Manage common clinical challenges, such as precipitated withdrawal and managing pain in patients on MOUD.
Task 2: Manage pharmacotherapy for Alcohol Use Disorder (AUD).
  • Compare and contrast the mechanisms and efficacy of naltrexone, acamprosate, and disulfiram.
  • Select the most appropriate medication for AUD based on patient goals and comorbidities.
  • Evaluate the evidence for and clinical use of second-line agents like topiramate and gabapentin.
  • Develop a patient-centered treatment plan that combines pharmacotherapy with psychosocial support.
Task 3: Manage pharmacotherapy for Tobacco Use Disorder (TUD).
  • Compare and contrast the efficacy and mechanisms of nicotine replacement therapy (NRT), varenicline, and bupropion.
  • Design a patient-specific treatment plan, including selection of medication and behavioral counseling.
  • Develop combination therapy regimens for highly dependent smokers.
  • Understand the role of e-cigarettes and other harm reduction strategies in TUD.
Task 4: Manage withdrawal syndromes.
  • Develop a symptom-triggered protocol for managing opioid withdrawal with agents like clonidine.
  • Develop a symptom-triggered or fixed-dose protocol for managing acute alcohol withdrawal with benzodiazepines.
  • Develop a safe and effective tapering plan for patients with Benzodiazepine Use Disorder.
  • Ensure appropriate supportive care during withdrawal, including administration of thiamine.
Task 5: Manage poly-substance use.
  • Assess for the use of multiple substances and prioritize treatment based on risk.
  • Manage the treatment of co-occurring opioid and stimulant use disorders.
  • Manage the treatment of co-occurring opioid and benzodiazepine use disorders.
  • Understand the increased risk of overdose and other complications associated with poly-substance use.
Task 6: Evaluate emerging pharmacotherapies.
  • Critically appraise the emerging evidence for psychedelic-assisted therapies (e.g., psilocybin, MDMA).
  • Evaluate the role of ketamine in the management of AUD and other SUDs.
  • Assess the evidence for cannabinoids as both a risk factor for and potential treatment of SUDs.
  • Stay current with the evolving landscape of novel treatments for addiction.

Domain 3: Harm Reduction and Overdose Prevention (15%)

Task 1: Implement naloxone education and dispensing.
  • Identify patients, family members, and community members who should be offered naloxone.
  • Provide clear, step-by-step instructions on how to recognize an overdose and administer naloxone.
  • Understand and apply state-specific laws, such as standing orders and Good Samaritan laws.
  • Develop a workflow to proactively offer and dispense naloxone in a pharmacy or clinic setting.
Task 2: Implement safer use and managed use strategies.
  • Provide non-judgmental counseling to people who use drugs on safer use practices to prevent infection and overdose.
  • Educate patients on the risks of mixing substances, particularly opioids with other sedatives.
  • Advise patients to "start low and go slow" when using drugs from an unknown source.
  • Encourage patients to never use drugs alone and to have naloxone present.
Task 3: Implement services for people who inject drugs.
  • Describe the core services provided by a syringe service program (SSP) and their role in public health.
  • Collaborate with local SSPs to provide referrals and integrated services.
  • Counsel on safer injection techniques to prevent skin and soft tissue infections.
  • Manage the prevention and treatment of infectious diseases, such as HIV and viral hepatitis.
Task 4: Implement drug checking and adulterant screening.
  • Explain the purpose and proper use of fentanyl test strips to detect the presence of fentanyl in other drugs.
  • Provide counseling on how to respond to a positive fentanyl test strip result.
  • Describe the risks associated with xylazine as an adulterant in the illicit drug supply.
  • Integrate drug checking education into broader harm reduction counseling.
Task 5: Manage post-overdose follow-up and linkage to care.
  • Understand the importance of initiating MOUD in the emergency department after an overdose.
  • Develop workflows to facilitate a warm handoff from the hospital to an outpatient treatment provider.
  • Collaborate with peer support specialists to engage patients after an overdose event.
  • Provide intensive patient and family education on overdose prevention after a non-fatal overdose.
Task 6: Evaluate digital and innovative harm reduction tools.
  • Assess the role of mobile apps and text messaging services in overdose prevention and response.
  • Evaluate virtual platforms for providing harm reduction counseling and support.
  • Understand the concept of safe consumption sites and their role in overdose prevention.
  • Stay current with emerging technologies and strategies in the field of harm reduction.

Domain 4: Co-Occurring Disorders and Special Populations (20%)

Task 1: Manage co-occurring mental health disorders.
  • Recognize the high prevalence of co-occurring psychiatric disorders in patients with SUDs.
  • Screen patients for common mental health conditions like depression, anxiety, and PTSD.
  • Collaborate with mental health providers to develop an integrated treatment plan.
  • Manage complex drug interactions between SUD medications and psychiatric medications.
Task 2: Manage substance use disorders in patients with chronic pain.
  • Differentiate between physical dependence, tolerance, and opioid use disorder in patients on chronic opioid therapy.
  • Develop strategies to treat OUD in patients with co-occurring chronic pain.
  • Utilize multimodal approaches to pain management to reduce reliance on opioids.
  • Manage acute pain in patients who are on MOUD.
Task 3: Manage substance use in pregnant and postpartum individuals.
  • Develop safe and effective treatment plans for pregnant and postpartum patients with SUDs.
  • Manage neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS).
  • Counsel on contraception and reproductive health for patients with SUDs.
  • Collaborate with obstetric and pediatric providers to ensure coordinated care.
Task 4: Manage substance use in adolescents and young adults.
  • Address the unique neurodevelopmental needs of adolescents and young adults.
  • Involve family and caregivers in the treatment process when appropriate.
  • Adapt communication and engagement strategies for a younger population.
  • Select pharmacotherapy with consideration for the developing brain.
Task 5: Manage substance use in geriatric populations.
  • Adapt treatment plans considering age-related pharmacokinetic changes and comorbidities.
  • Screen for and manage SUDs in older adults, who may present with atypical symptoms.
  • Address the risks of polypharmacy and drug interactions in this population.
  • Collaborate with geriatric specialists to provide comprehensive care.
Task 6: Manage care for justice-involved and LGBTQ+ populations.
  • Address the specific needs of patients who are incarcerated or re-entering the community.
  • Implement strategies to ensure continuity of MOUD during transitions in the justice system.
  • Provide care for LGBTQ+ individuals in a gender-affirming and inclusive manner.
  • Recognize and address the unique access barriers and health disparities faced by these populations.

Domain 5: Healthcare Systems, Law, and Policy (15%)

Task 1: Evaluate federal and state regulations for MOUD.
  • Understand the history of the DATA 2000 waiver and the current DEA rules for prescribing buprenorphine.
  • Describe the specific regulations for methadone dispensed through an Opioid Treatment Program (OTP).
  • Adhere to all state-specific laws and regulations regarding the prescribing and dispensing of MAT.
  • Understand state-level naloxone standing orders and collaborative practice agreements.
Task 2: Manage billing, reimbursement, and credentialing for SUD services.
  • Identify and apply appropriate billing codes for pharmacist-led SUD services.
  • Navigate the reimbursement landscape for SUD treatment across different payers (e.g., Medicaid, Medicare, commercial).
  • Understand the process for pharmacist credentialing with health plans.
  • Develop a sustainable business model for pharmacist-led SUD services.
Task 3: Implement interprofessional collaboration.
  • Serve as the medication expert on a multidisciplinary addiction treatment team.
  • Communicate effectively with physicians, nurses, counselors, and social workers.
  • Participate in case conferences and team meetings to develop patient care plans.
  • Advocate for the integration of pharmacy services into addiction treatment settings.
Task 4: Advocate for policy change.
  • Analyze how laws and policies can create barriers to or facilitate access to care.
  • Advocate for policies that reduce the criminalization of substance use and promote a public health approach.
  • Engage with professional organizations and policymakers to advance the role of pharmacists in addiction care.
  • Promote policies that support harm reduction and equitable access to treatment.
Task 5: Implement patient-centered counseling and behavioral techniques.
  • Utilize motivational interviewing to enhance patient engagement and readiness to change.
  • Apply principles of trauma-informed care to create a safe and supportive environment.
  • Use shared decision-making to develop treatment plans that align with patient goals.
  • Refer patients to evidence-based psychosocial treatments, such as Cognitive Behavioral Therapy (CBT).
Task 6: Manage transitions of care.
  • Develop protocols to ensure continuity of care as patients move between settings.
  • Facilitate warm handoffs from inpatient settings to outpatient treatment providers.
  • Coordinate with community-based organizations and recovery support services.
  • Implement strategies to prevent relapse during high-risk transition periods.

Domain 6: Quality, Safety, and Innovation in SUD Care (10%)

Task 1: Apply quality improvement principles to SUD care.
  • Develop and track key performance indicators for an SUD service (e.g., treatment initiation and retention rates).
  • Use a structured QI methodology (e.g., PDSA) to test and implement improvements to the care delivery process.
  • Benchmark program performance against national standards where available.
  • Foster a culture of continuous quality improvement.
Task 2: Leverage health information technology (IT).
  • Utilize the EHR to document care, track outcomes, and facilitate communication.
  • Use patient registries and data analytics to manage a population of patients with SUDs.
  • Integrate Prescription Drug Monitoring Program (PDMP) data into the clinical workflow.
  • Ensure all use of health IT is compliant with privacy and security regulations (e.g., HIPAA, 42 CFR Part 2).
Task 3: Evaluate and integrate digital therapeutics for SUDs.
  • Critically appraise the evidence for FDA-cleared digital therapeutics (e.g., reSET, reSET-O).
  • Integrate digital therapeutics into a comprehensive treatment plan.
  • Counsel patients on the use of mobile apps and other digital tools that support recovery.
  • Understand the reimbursement and access pathways for prescription digital therapeutics.
Task 4: Incorporate patient-reported outcomes (PROs) into practice.
  • Utilize validated PRO tools to assess a patient's progress and quality of life.
  • Incorporate PRO data into shared decision-making and care plan adjustments.
  • Use aggregate PRO data to evaluate the effectiveness of a program or intervention.
  • Empower patients by demonstrating that their self-reported experiences are a valued part of their care.
Task 5: Implement medication safety strategies for SUD medications.
  • Develop protocols to ensure the safe initiation of MOUD, such as buprenorphine induction.
  • Manage the risks of drug interactions with medications used to treat SUDs.
  • Implement strategies to prevent the diversion of MOUD.
  • Educate patients on the safe storage and handling of their medications.
Task 6: Manage telehealth and collaborative practice agreements (CPAs).
  • Utilize telehealth platforms to provide remote SUD care in a compliant manner.
  • Understand the specific regulations governing the telehealth prescribing of controlled substances.
  • Develop and practice under a CPA to expand the pharmacist's role in SUD management.
  • Establish clear communication and referral protocols within a CPA.

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