Nursing Regulatory Boards Efforts to Provide Guidance to Nurses About Mitigating Prescription Medication Abuse/Diversion

Transcription

1 Nursing Regulatory Boards Efforts to Provide Guidance to Nurses About Mitigating Prescription Medication Abuse/Diversion Cathy Carlson, PhD, APN, FNP-BC Aaron Gilson, MS, MSSW, PhD Authors Conflicts of Interest: C. Carlson, No Conflict of Interest A. Gilson, No Conflict of Interest Participants should: Understand the current epidemiological evidence about the non-medical use of prescription opioid medications in the U.S., as well as important considerations when interpreting this information, including the role of diversion Understand the methodology used to evaluate all states nursing board websites to identify content related to prescription opioid medication abuse and diversion Identify the variety of ways that state nursing board websites are used to inform licensees about mitigating prescription opioid medication abuse and diversion Identify the different content available through state nursing board websites about reducing prescription opioid medication abuse and diversion Define quality indicators of state nursing boards efforts to reduce prescription opioid medication abuse and diversion Recognize additional approaches that state nursing boards could use to encourage licensees to incorporate in their practice to reduce prescription opioid medication abuse and diversion 1

2 Deaths involving prescription opioid analgesics outnumber deaths from heroin and cocaine combined 20,000 Overdose Deaths Involving Opioid Analgesics, Cocaine, & Heroin: U. S ,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2, Opioid Analgesics** Cocaine Heroin National Institute on Drug Abuse. (December, 2015). Overdose death rates. Retrieved from Sources of drugs for non-medical users, Percent % Friend or relative for free Friend or relative for cost Friend or relative wo knowledge Drug dealer or stranger Other illicit sources Prescription Substance Abuse and Mental Health Services Administration. (September, 2014). Summary of National Findings. Retrieved from Prescription medication Prescribed medication Essential to determine whether valid prescription was involved 2

3 Senate Testimony: Over the past several years hundreds of millions of dosage units of controlled substanceswere diverted into the illicit marketplace across the United States. (July, 2012, p. 5) Factors to Consider Diversion (i.e., no prescription found) Doctor-shopping (i.e., diversion) Motivations?? Non-medical routes of administration Co-morbidities (e.g., substance use history) Poly-pharmacy Previous overdose episodes Little clinical information Not a linear effect Not causal Legitimate Patients? Methadone Analgesics with No Abuse Potential Practitioner Education Treatment Benefit/Risk Evaluations ED Guidelines Safeguarding Prescription Pads Drug Formularies 3

4 2-week evaluation period (June 1- June 14) CC & AG separately reviewed each state s website Content created on or after January 1, 2013 Reviewed websites for territories lack of websites or information excluded them from final analysis Excluded content: Policy/laws Nurse impairment/nurse abuse & diversion Met on June 14 to coordinate findings AG created categories for content and methods to relay information Inter-rater reliability = (Fair agreement) CUMULATIVELY identified at least most of the recent information No content = 15 states (29%) Some websites had older content, and were not tallied Some resources not directly accessible via nursing board website CT, MI 4

5 Availability of Information Single page CO, MN, NH, OR, RI, TX, WY Resources only available through APN section Some under Pain Management Most states had information strewn throughout site Mechanisms for Relaying Information DC Slide Show (3 states) No Slide Show (48 states) 5

6 Video (3 states) No Video (48 states) 6

7 News (11 states) No News (40 states) Practice Notices (14 states) No Practice Notices (37 states) 7

8 DC Newsletter (16 states) No Newsletter (35 states) 8

9 DC Links (20 states) No Links (31 states) Topics Offered PDMP information (20 states) PDMP registration (2 states) PDMP information and registration (5 states) No content (24 states) 9

10 DC Substance Abuse (3 states) Controlled Substances Prescribing (1 state) PDMP (1 state) REMS (1 state) Substance Abuse & CS Rx (1 state) Substance Abuse & REMS (2 states) No content (42 states) DC Diversion (4 states) Aberrant Behaviors/Drug Seeking (3 states) Drug Disposal/Wasting (3 states) Take Back (2 states) Prescription Fraud Reporting (1 state) Securing Medications (1 state) No content (37 states) Drug Misuse & Abuse/Prescription Safety (14 states) No Content (37 states) 10

11 DC Preventing Adverse Events/Harm Reduction/Overdose (9 states) No Content (42 states) Naloxone Content (7 states) No Content (44 states) DC Any Content (36 states) No Content (15 states) 11

12 Quality Indicators for State Boards of Nursing Websites Definitions: An inherent or distinguishing characteristic; a property or attribute A personal trait, especially a character trait Essential character; nature Superiority of kind Degree or grade of excellence ISO 9000: Degree to which a set of inherent characteristics fulfills requirements A perceptual, conditional, and somewhat subjective attribute understood differently by different people Verifiable measures stated in either quantitative or qualitative terms that: Capture performance in terms of how something is being done relative to a standard or target Allow and encourage comparison Support the goals and objectives of the organization Performance metrics (i.e., Indicators) often represent how far a metric is above or below a specified target 12

13 The link to the (PDMP) in each state needs to be readily accessible by nurses and especially advanced practice registered nurses (APRNs) E-newsletters should be an option for nursing professionals from their SBN Requiring course regarding opioid prescribing, abuse and/or diversion Facebook posts provides licensees with useful information 13

14 Separate page/link for APRNs Separate page/link for pain management Separate page/link for public/professional Header Navigation Links Local Navigation Links Main Content Page Right Column Footer Exemplars 14

15 All websites should have content for licensees related to addressing prescription medication abuse/diversion Links to external resources NCSBN could encourage such content Content should be easily searchable (e.g., 1 page) Other topics could be addressed Prescription form security/tamper-resistant forms Prescription series E-prescribing Coordinated care/integrative care PCSS-Ois a collaborative effort led by American Academy of Addiction Psychiatry (AAAP) in partnership with: Addiction Technology Transfer Center (ATTC), American Academy of Neurology (AAN), American Academy of Pain Medicine (AAPM), American Academy of Pediatrics (AAP), American College of Physicians (ACP), American Dental Association (ADA), American Medical Association (AMA), American Osteopathic Academy of Addiction Medicine (AOAAM), American Psychiatric Association (APA), American Society for Pain Management Nursing (ASPMN), International Nurses Society on Addictions (IntNSA), and Southeast Consortium for Substance Abuse Training (SECSAT). For more information visit: For questions pcss-o@aaap.org Funding for this initiative was made possible (in part) by Providers Clinical Twitter: System for Opioid Therapies (grant no. 5H79TI025595) from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. 15