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Running head: OPIOID EPIDEMIC CRISIS IN THE STATE OF FLORIDA 0

Evaluation of Providers’ Knowledge and Attitudes toward Using the Prescribing Drug Monitoring Program when Prescribing Opioid Medications

Sherna Constant

South University

Capstone in Applied Practice I

5/20/18

Evaluation of Providers’ Knowledge and Attitudes toward Using the Prescribing Drug Monitoring Program when Prescribing Opioid Medications

Introduction

The National Institute on Drug Abuse [NIDA] (2018) reported that the prescription drug abuse problem has spread to nearly every corner of society in Florida. In 2014, 2,062 Floridians died from prescription drug overdose which is a 7.6 percent increase from 2013. The same source has reported that some of the most commonly abused medications are prescription opioids, which provide necessary relief to people with chronic pain or to those who are recovering from a serious operation (NIDA, 2018). Some patients who are given prescriptions begin to abuse these medications by snorting, smoking, or injecting them in order to get an intense high feeling (NIDA, 2018). According to the Centers for Disease Control and Prevention [CDC] (2014), deaths from prescription drug overdose have drastically risen over the past decade and have become the leading cause of death among the different types of overdoses in the United States (Centers for Disease Control and Prevention [CDC], 2014). Broglio and Cole (2014) have reported that there are standards on undertreated pain provided by the Joint Commission; therefore, providers began to start prescribing pain medications to treat chronic pain. Many patients present to their doctors and ask for pain medications to treat their chronic pain because they have no teaching and training on how to manage their chronic pain; therefore, an increase in opioid pain medication being prescribed by primary care doctors and patients came to misuse their opioid pain medications (Broglio & Cole, 2014).

McHugh at al. (2014) have reported that opioids are the most commonly abused type of prescription drug and appear to be the largest contributor to the opioid epidemic crisis. Opioid pain medications are controlled substances that are subject to special regulatory requirements under the federal Food and Drug Administration Controlled Substances Act of 1970 (Phillips et al, 2017). Opioid medications such as oxycodone, hydrocodone, morphine, and many others bind to opioid receptor in the nervous system specifically in the central nervous system; therefore, these drugs are considered to be scheduled controlled substances and they are all fall under the Food and Drug Administration (FDA) regulatory requirements for prescribing them (Phillips et al, 2017). Over 100 million Americans are living with chronic pain, and pain is the most common reason why patients seek medical attention (Tompkins, Hobelmann, & Compton, 2017). Opioid misuse is a big concern in the state of Florida; therefore, the state of Florida has utilized the Prescription Drug Monitoring Programs to address the issue of prescription drug misuse (CDC, 2018). PDMPs improve patient safety by allowing clinicians to: Identify patients who are obtaining opioids from multiple providers, calculate the total amount of opioids prescribed per day, and identify patients who are being prescribed other substances that may increase risk of opioids misuse (CDC, 2018).

Although the use of the PDMPs have been shown to be useful among clinicians, in the past, utilization of the PDMPs have been less than optimal, South Florida has received both local and national media attention for being a questionable area for diverted prescription medications. PDMPs are funded so they are real-time and incorporated into the electronic health records to identify patients who are doctor shopping and recognize potential prescription drug abusers (Young et al, 2017). Preventing misuse of prescription drugs by properly prescribing opioid pain medications for patients with a diagnosis of chronic pain and/or opioid use disorders may lead to improved health outcomes. Patient-centered care and effective outcome-based care are essential for combatting this growing opioid epidemic crisis; therefore, the PDMP use will be essential for maintaining safety and healthy behaviors in patients with chronic pain and opioid use disorders that are seen at an outpatient clinic.

Purpose

The purpose of this project is to educate providers about the importance of accessing the prescription drug monitoring programs (PDMPs) and utilizing evidence-based guidelines to minimize opioid medication misuse among patients with chronic pain or opioid use disorders at an outpatient clinic. The outcomes of the project, when achieved, will increase providers’ knowledge about accessibility of PDMPs use and evidence-based guidelines when prescribing opioid medications to patients at an outpatient clinic and to help combat opioid misuse.

Background and Significance

Opioid misuse: The National Institute on Drug Abuse [NIDA] (2018) reported that substance abuse is currently an epidemic in the United States, drug overdoses are the leading cause of death for adult Americans mostly under 50 years of age, and deaths are rising faster than ever primarily because of opioids. NIDA (2018) estimated that approximately 95% of active substance abusers are in denial or unaware of their problem. Of those who recognize their problem, 273,000 have made an unsuccessful effort to obtain treatment. NIDA (2018) has indicated that the Healthy People 2020 stressed the necessity of improving access to treatment to reduce substance abuse to protect the health, safety, and quality of life for all. In 2013, Florida providers wrote 69.6 opioid prescriptions for every 100 persons (approximately 13.6 million prescriptions), compared to the average U.S. rate of 79.3 (NIDA, 2018). Annual Oxycontin prescriptions increased from 76 million to 207 million between 1991 and 2013, which correlates with a doubling of the number of opioid-related emergency department visits between 2004 and 2011 (NIDA, 2018). Morbidity associated with prescription drug abuse has increased and rates of prescription drug abuse related emergency department visits and treatment admissions have risen significantly in recent years. In adults, the percentage of emergency department (ED) visits during which an opioid was prescribed increased from 20.8% to 31.0% between 2001 and 2010, while prescribing of non-opioid analgesics were unchanged (CDC, 2015).

Overdose and death due to opioid pain medication prescription: In 2016, there were 2,798 opioid-related overdose deaths in Florida with a rate of 14.4 deaths per 100,000 persons compared to the national rate of 13.3 deaths per 100,000 persons (NIDA, 2018). Gomes et al. (2017) have reported that prescription opioid use is highly associated with risk of opioid-related death, with 1 of every 550 chronic opioid users dying within approximately 2.5 years of their first opioid prescription. From 1999 to 2016, more than 200,000 people died in the U.S. from overdoses related to prescription opioids. Overdose deaths involving prescription opioids were five times higher in 2016 than 1999 (CDC, 2017). According to the CDC, deaths from prescription drug overdose have surpassed traffic-related deaths in 2009 as the leading cause of death in the United States (CDC, 2014). The age range of highest death rates for prescription drug misuse in the United States lie between 45 and 49 years of age and occur among American Indians/Alaska Native, followed by whites then blacks (CDC, 2014).

Benefit of the Project to Nursing Practice

Benefits of this project are to improve evidence-based prescribing practices among providers and minimize opioid pain medication misuse among patients with chronic pain and opioid use disorders at an outpatient clinic.

Research is important and relevant in the continued progression of evidence-based practice (EBP), which ultimately assists in developing new treatments and procedures used throughout medical practice. EBP involves using the best evidence found by way of research in making patient care decisions; therefore, EBP is the current driving force behind current treatment within the medical field (Polit & Beck, 2017). Patient-centered care and treatment relies heavily on EBP due to the constant evolution and changes present in the nursing field. Polit and Beck (2017) have reported that it is important to develop and expand knowledge so that practice may stay consistent with current findings in research.

PICOT Question

In patients 19 to 65 years of age diagnosed with chronic pain and opioid use disorders, who present to their providers requesting prescriptions for opioid pain medications, at an outpatient clinic, in Florida, (P), how would providing education designed to increase provider’s knowledge about the use of PDMP and evidence-based guidelines when prescribing opioid pain medications (I) compare before and after this intervention (C) increase their knowledge about the use of PDMPs at an outpatient clinic (O) over a 5-week period (T)?

Scope of the Project

The goal of this project is to increase provider’s knowledge about the use of PDMP and evidence-based guidelines when prescribing opioid pain medications to patients diagnosed with chronic pain and opioid use disorders. An initial survey of clinicians, a focus group, pre- and posttests for an educational session will be provided to providers regarding the PDMPs use and evidence-based guidelines when prescribing opioid pain medication. These interventions will enhance prescriber’s education about safe and effective prescribing practices to ensure that patients with chronic pain and opioid use disorder receive the care they need and avoid opioid misuse. There will be a teaching tutorial about how to appropriately use the PDMP.

References

Broglio, K., & Cole, B. E. (2014). Prescribing opioid in primary care: Avoiding perils and pitfalls. The Nurse Practitioner, 39(6), 30-37.

Carpenter, C. R. (2017). Opioid epidemic, debatable emergency medicine culpability, and proactive problem-solving: Missouri college of emergency physicians. Retrieved from https://mocep.org/2017/01/opioid-epidemic-debatable-emergency-medicine-culpability-proactive-problem-solving/

Centers for Disease Control and Prevention. (2014). Drug overdose in the United States: Fact sheet. Retrieved fromhttp://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html

Centers for Disease Control and Prevention. (2018). Checking the PDMP: An important step to improving opioid prescribing practices. Retrieved from https://www.cdc.gov/drugoverdose/pdf/pdmp_factsheet-a.pdf

Centers for Disease Control and Prevention. (2017). Prescription opioid overdose data. Retrieved from https://www.cdc.gov/drugoverdose/data/overdose.html

Centers for Disease Control and Prevention. (2015). Today’s heroin epidemic. Retrieved from http://www.cdc.gov/vitalsigns/heroin/

Gomes, T., Juurlink, D. N., Antoniou, T., Mamdani, M. M., Paterson, J. M., & van den Brink, W. (2017). Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case–control study. PLoS Medicine, 14(10), e1002396. http://doi.org/10.1371/journal.pmed.1002396

Echevarria, L., & Walker, S. (2014). To make your case, start with a PICOT question. Nursing, 44, 18-19. https://doi.org/Doi: 10.1097/01.NURSE.0000442594.00242.f9

McHugh, R. K., Nielsen, S., & Weiss, R. D. (2015). Prescription drug abuse: From epidemiology to public policy. Journal of Substance Abuse Treatment, 48(1), 1–7. http://doi.org/10.1016/j.jsat.2014.08.004

National Institute on Drug Abuse. (2018). Florida opioid summary: Opioid-related overdose deaths. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/florida-opioid-summary

Phillips, J. K., Bonnie, R. J., & Ford, M. A. (2017). Opioid approval and monitoring by the U.S. food and drug administration: Pain management and the opioid epidemic - NCBI Bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK458654/\

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for

nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

Tompkins, D. A., Hobelmann, J. G., & Compton, P. (2017). Providing chronic pain management in the “fifth vital sign” era: Historical and treatment perspectives on a modern-day medical dilemma. Drug and Alcohol Dependence, 173, S11-S21. doi:10.1016/j.drugalcdep.2016.12.002

Young, H. W., Tyndall, J. A., & Cottler, L. B. (2017). The current utilization and perceptions of prescription drug monitoring programs among emergency medicine providers in Florida. International Journal of Emergency Medicine, 10, 16. http://doi.org/10.1186/s12245-017-0140-0