Prescription Drug and Controlled Substance Abuse
Opioid Diversion and Best-Practice Prescribing

CONTACT HOURS: 3

Copyright © 2023 Wild Iris Medical Education, Inc. All Rights Reserved.

BY: 

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

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:

  • Identify components of responsible opioid prescribing practices and reasonable standards of care.
  • Discuss the CDC guidelines for safe prescribing of opioids.
  • Explain strategies designed to prevent prescription drug misuse and diversion.
  • Describe considerations for the use of the opioid antagonist naloxone.
  • Recognize chemical dependency and impairment in the workplace.
  • Discuss nonpharmacologic interventions for pain.

TABLE OF CONTENTS

  • Scope of the Problem
  • Responsible Opioid Prescribing and Standards of Care
  • Preventing Prescripton Drug Misuse and Diversion
  • Prescribing and Administering Opioid Antagonists (Naloxone)
  • Chemical Dependency and Impairment in the Workplace
  • Nonpharmacologic Interventions for Pain
  • Conclusion
  • Resources
  • References

SCOPE OF THE PROBLEM


Millions of Americans suffer from pain and are often prescribed opioids to treat their conditions. However, the dangers of prescription misuse, opioid use disorder, and overdose have been a growing problem throughout the United States.

Since the 1990s, when the amount of opioids prescribed to patients began to grow, the number of overdoses and deaths from prescription opioids has also increased. Even as the amount of opioids prescribed and sold for pain has increased, the amount of pain that Americans report has not similarly changed (CDC, 2022).

From 1999 to 2020, more than 263,000 people died in the United States from overdoses involving prescription opioids. Overdose deaths involving prescription opioids increased by nearly five times from 1999 to 2020. In 2020, an average of 44 people died each day from overdoses involving prescription opioids, totaling more than 16,000 deaths (CDC, 2021a). Prescription opioids were involved in nearly 24% of all opioid overdose deaths in 2020, a 16% increase in prescription opioid-involved deaths from 2019 to 2020. (In order to account for increases in illicitly manufactured fentanyl, CDC Injury Center separates synthetic opioids, other than methadone, from prescription opioid death calculations.)

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. 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

Controlled substance: A drug or other substance that is strictly regulated under the federal Controlled Substances Act and/or other state laws and categorized based on its potential for abuse, accepted medical use, and safety or dependence liability

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)