Critical Analysis Paper- Opioid Crisis

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Arkansas State University, Main Campus *

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6303

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Medicine

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Dec 6, 2023

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docx

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Opioid Crisis in America “In 2017 there were 70,237 drug overdose deaths in the United States, 47,600 of which were attributable to opioids” (Mauri et al., 2020). “Policy efforts have focused on enhancing access to mediations for Opioid Use Disorder (OUD) treatment, which can substantially reduce overdose and mortality rates” (Saunders & Panchal, 2023). I chose to do research over this topic because the more states that allow Advanced Nurse Practitioners (APRNs) to have full practice authority, APRNs will start to be more involved in this crisis as a prescriber. This is a topic that should be taken very seriously because statistics show that this problem is still on the rise and efforts need to be taken to help prevent opioid misuse. Article 1 The first article I chose discuses opioid misuse prevention policies, policymakers interested in reducing the number of opioids prescribed and dispensed by programs to monitor the drugs, and it talks about further research needing to focus on consequences of opioid misuse prevention policies that include different populations, interventions, and patient-related outcomes (Mauri et al., 2020). The article talks about certain states have policies in place to show prevention at different levels such as, primary prevention of the first exposure to opioids, secondary prevention to avoid high-risk opioid exposure, and tertiary prevention to treat patients with opioid use disorder (Mauri et al., 2020). An example of primary prevention provided was, “laws regulated to pain management clinics which could be policies that target inappropriate prescribing from health care facilities that primarily manage and treat chronic pain” (Mauri et al., 2020). An example of secondary prevention provided was, “prescription drug monitoring programs like an electronic database that collects, monitors, and analyzes controlled substances prescribing and dispensing. Laws vary widely but can include which providers and state officials have access to the PDMP; mandatory prescriber and dispenser querying; interstate data sharing; update frequency; schedule of controlled substance monitored; and operating agency (Mauri et al., 2020). Lastly a tertiary prevention example provided was, “naloxone access laws that would include policies that increase lay access to naloxone. Laws could include third-party prescriptions; pharmacist dispensing without a prescription; and standing-order provisions (Mauri et al., 2020). I believe if any of these examples were implemented through health care, we would start to see progress made towards opioid misuse prevention. The results for the primary prevention example provided noted “it is unclear whether laws related to pain management clinics exert a direct, combined, or null effect on opioid prescribing” (Mauri et al., 2020). It is also to note only one study was done over this topic, so it was a limited study. For the secondary prevention example provided, the results showed mixed reviews across the outcomes and specifically mandatory access provisions showed more promise in reducing opioids prescribed. Of the studies they provided, a lot of what was seen, is the programs may have decreased some of the schedule drugs like II and III, but then had no change on other schedule drugs like IV or V (Mauri et al., 2020). For the tertiary example I provided in regard to naloxone, it is noted the results showed evidence from two evaluations from Gertner et al. (2018) and Xu et al. (2018), “suggest that naloxone access laws increase prescription naloxone dispensing overall. Xu et al. (2018) “found that naloxone access laws are associated with a 79% increase in naloxone prescriptions dispensed per state-quarter” (Mauri et al, 2020). Rees et al. “suggests that naloxone access laws reduced overall opioid-related mortality by 9% (Mauri et al., 2020). Overall, after the study was concluded, it is recommended that “future research examine policies

that have received insufficient attention, investigate unintended consequences and differential effects across socioeconomic groups and focus on patient health outcomes (Mauri et al., 2020). Article 2 The second article I chose to review was to specifically look further into Arkansas and the opioid exposure among individuals here. The objective of this article was to “assess the concordance between and benefit of adding prescription drug monitoring program (PDMP) data to all-payer claims database data for identifying and classifying opioid exposure among insured individuals” (Mahashabde et al., 2023). The article further defines PDMPs are a “secondary data resource used to inform state-level initiatives in combatting the opioid epidemic. PDMPs are statewide electronic databases that collect records for all Schedule II-V controlled substance prescriptions dispensed from all pharmacies” (Mahashabde et al., 2023). It defines All-Payer Claims Databases (APCDs) as something that was “created to improve quality and mitigate costs within health care systems. APCDs capture health insurance claims from nearly all health care payers in each state” that ranges from all types of insurance providers (Mahashabde et al., 2023). The purpose of this study was to review how accurate claims data reflects the individual’s exposure to opioid therapy and to quantify the extent to which adding PDMP prescription records changed the opioid exposure (Mahashabde et al., 2023). After analysis of the study, it showed “exposure to opioids in Arkansas APCD compared to Arkansas PDMP, and the concordance between the two datasets showed the Arkansas PDMP being considered the “gold standard” data source” (Mahashabde et al., 2023). The findings were limited to only insured population with a one-year continuous pharmacy benefits in Arkansas. It also stated that for Arkansas, “pharmacies are mandated to submit all controlled substances to the PDMP within one business day, but administrative errors are possible (Mahashabde et al., 2023). It was also noted they “only investigated the medical characteristics of enrollees with opioid prescriptions in the APCD, but not in PDMP which can be studied in future research” (Mahashabde et al., 2023). Overall, the conclusion is “APCD has high sensitivity and specificity in classifying opioid exposure when compared to PDMP-derived records and APCD alone is fairly accurate in classifying enrollees according to the level or risk of opioid therapy as compared to APCD merged with PDMP (Mahashabde et al., 2023). Analysis Specifically looking at the first article reviewed, this relates to APRNs because we are going to start seeing APRNs in the provider role of prescribing medications and having full practice authority. Being aware of the opioid misuse will help guide APRNs to watch for warning signs of opioid abuse in individuals and what steps to take when this is encountered. When looking at the tertiary example from article one where it discusses allowing naloxone to be available to the lay person without a prescription, this would be something an APRN should be aware of to educate individuals. On the other hand, looking at article two that I reviewed, this is also an important topic to look at because it reviews the difference between PDMP programs and APCD in Arkansas. It is important for APRNs to be aware of insurance claims and in Arkansas there are PDMP in place to record data for all Schedule II-V controlled substances. The APCD is in place to improve quality and costs in health care. Both topics have room for further research and even a bigger study would help show more accurate results. I don’t think we have found the solution for the opioid crisis yet, but it is on the radar for America and providers are aware of the crisis.

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