Best-Practice Prescribing and Drug Diversion Training for West Virginia Nurses (3 Hours)

CONTACT HOURS: 3

BY: 

Loretta Ann Bostic, DNP, MBA, APRN, CRNA; Dennis Crean, BA, Staff Writer; Cherie R. Rebar, PhD, MBA, RN, COI

LEARNING OUTCOME AND OBJECTIVES:  Upon completion of this continuing education course, you will be prepared to help prevent prescription drug misuse and diversion. Specific learning objectives to address potential knowledge gaps include:

  • Discuss the scope of prescription drug misuse and diversion.
  • Identify components of responsible prescribing practices for opioid medications.
  • Summarize the CDC Guideline for Prescribing Opioids for Chronic Pain.
  • Describe the West Virginia Safe and Effective Management of Pain (SEMP) Guidelines.
  • Explain various strategies designed to prevent prescription drug misuse and diversion.
  • Discuss considerations for the use of the opioid antagonist naloxone.

TABLE OF CONTENTS

  • Scope of the Problem
  • Responsible Opioid Prescribing
  • Preventing Prescription Drug Misuse and Diversion
  • Prescribing and Administering Opioid Antagonists (Naloxone)
  • Conclusion
  • Resources
  • References

SCOPE OF THE PROBLEM


The United States has been profoundly affected by the substance use epidemic that began in the 1990s. “Underprescribing” was a predominant issue at the time because of the physiologic and psychological effects caused by unrelieved pain. Concerns about undertreatment of pain despite the availability of effective drugs led to a movement toward more aggressive pain management, which then became a driving force behind more liberal opioid prescribing. Over time, this prescribing trend contributed to the drug epidemic the United States continues to face three decades later (U.S. DHHS, 2021).

The serious and deadly consequences of this epidemic prompted the medical community to reevaluate chronic pain treatment and prescribing practices, resulting in the CDC’s release of new evidence-based guidelines for prescribing opioids for chronic pain in 2016. Since that time, the prescription opioid-involved death rate has decreased, with figures showing a 7% drop from 2018 to 2019.

However, the crisis is far from resolved. Disturbing evidence points to a growing number of individuals beginning to misuse prescription drugs. The National Survey on Drug Use and Health estimates that in 2019:

  • 9.7 million people ages 12 and older misused prescription pain relievers.
  • 4.9 million misused prescription stimulants.
  • 5.9 million misused prescription tranquilizers or sedatives.
  • Each day, 2,600 new people ages 26 and older began to misuse a prescription pain reliever.
    (SAMHSA, 2020)

Opioid addiction remains the driving force behind the prescription drug crisis in America. Alarmingly, a person is more likely to die today from an accidental opioid overdose than from a motor vehicle crash (NSDUH, 2020; NSC, 2019).

Substance use disorder has specifically impacted the health, well-being, and economy of West Virginia. In 2019, West Virginia had the highest age-adjusted drug overdose death rate in the nation (CDC, 2021a). And from March 2020 to March 2021, West Virginia experienced a 62.1% increase in counts of drug overdose-related deaths (CDC, 2021c).

One of the biggest challenges in healthcare practice is providing safe and appropriate pain care without contributing to this epidemic of prescription drug misuse, drug diversion, and drug overdose deaths. In West Virginia, SB 437 mandates that all healthcare providers who prescribe, dispense, or administer controlled substances receive specific education to help combat the problem of prescription drug abuse and diversion.

Nurses in particular are in a unique position to address this problem since they care for more patients than any other health profession. Nurses who understand the risks associated with prescription drug abuse will be better prepared to identify and intervene with patients and colleagues who may be at risk.

FENTANYL AND OVERDOSE DEATHS

Drug overdose deaths accelerated during the COVID-19 pandemic, outpacing overdose death rates from any previous year. Illicitly manufactured fentanyl, which is increasingly found in counterfeit prescription medications, was the main driver of the near 30% increase in overdose deaths from 2020 to 2021 (CDC, 2021d).

(See also “Counterfeit Pills” later in this course.)

DEFINITION OF TERMS

Addiction: A treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences

Chronic pain: Pain that persists for weeks, months, or years

CNS depressants: Drugs that include sedatives, tranquilizers, and hypnotics that slow brain activity

Dependence: A state in which the body adapts to a drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal)

Illicit drug use: Nonmedical use of a variety of drugs that are prohibited by law (can be illegally obtained drugs or misuse of prescription drugs)

Opioids: Drugs that act on opioid receptors in the spinal cord and brain to reduce the intensity of pain-signal perception intensity

Pain: An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage

Prescription drug misuse (or nonmedical use of prescription drugs): Taking a medication in a manner or dose other than prescribed, taking someone else’s prescription, or taking a medication to feel euphoria

Prescription drug diversion: Prescription medicines that are obtained or used illegally

Psychotherapeutic drugs: Drugs that have an effect on the function of the brain and that often are used to treat psychiatric/neurologic disorders; includes opioids, sedatives, tranquilizers, and stimulants

Stimulants: Drugs that speed up the body’s system

Substance abuse: A term that is no longer used in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5); see instead substance use disorder below

Substance use disorder (SUD): A complex condition in which there is uncontrolled use of a substance despite harmful consequence; occurs when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home

(ASAM, 2021; NINDS, 2021; NIDA, 2020; CDC, 2021b, 2019; Nicholas et al., 2019; SAMHSA, 2021a; U.S. DEA, 2020b; APA, 2021)