Case Study: Millenium Health Meeting

Opioid use in the US has increased over the years, and this has led to an increase in substance abuse. Substance abuse is not only associated with use of illicit drugs but also prescription drugs. In 2015, of the 20.5 million reported cases of substance abuse, 2 million had an abuse disorder related to prescription pain relievers and 591,000 associated with heroin.1 The increase in substance abuse disorder has led to an increase in opioid related death. In 2015 drug overdose was the leading cause of accidental death in the US with 52, 404 lethal drug overdoses.2

Statistically, Arkansas has been ranked first in non-medical use of prescription pain relievers. Daily, 2,500 children (ages 12-17) experiment with prescription pain medications, and Arkansas averages a death per day from prescription drug abuse. These statistics are embarrassing to our state and need to be trimmed down to help protect our youth. In an effort to help curtail this problem, the Arkansas Prescription Monitoring Program (PMP) was implemented in 2013 by the Arkansas Department of Health pursuant to the enactment of An Act to Establish a Prescription Drug Monitoring Program (Act 304) by the Arkansas State Legislature. The program is currently funded through federal grants. The initial goals of the PMP are:

There are three predominate forms of Medication Assisted Treatment (MAT) that have proven effective in combating opioid use disorder. Methadone, buprenorphine, and naltrexone have all shown to be effective in the treatment of substance use. When prescribed and monitored properly, MAT has been shown to reduce illicit drug use and reduce the rate of accidental overdose. However, while as many as 2.5 million people are suffering from substance use disorder, less than 40% have access to MAT

Doctors and clinical prescribers have discovered their role in curtailing the increased opioid prescriptions in America. It is without a doubt that they play a role in facilitating the opioid misuse endemic in the past by being enablers of the situations. When patients ask for pain medications, they do not take time to analyze the pain complaints or suggest alternative medications other than opioids. Even in instances when one doctor declines to offer a patient an opioid prescription for their pain needs, the patient is likely to find another who will give the prescription. However, there has been wide recognition of the opioid misuse endemic such that clinical prescribers are practicing more vigilant prescribing and are advocating opioid-free

Roughly 100 million Americans suffer from chronic pain with an annual cost of $600 billion dollars in health care and a limited number of pain specialist physicians (Harle, et al., 2015). The conditions require the daily use of opioid medications which are being prescribed by primary care providers and providers in the ED. Along with multiple prescribers of opioid medications, the number of prescriptions for these medications has quadrupled from 1999-2013 in correlation with an increase in deaths related to opioid use (Greenwood-Ericksen, Poon, Nelson, Weiner, & Schuur, 2016). The significant increase of opioid related deaths and complications is commonly being referred to as the prescription opioid epidemic and to blame for the most unintentional deaths in the US (Smith, et al., 2015). Though responsible for administering and prescribing opioids to provide pain management, nurse practitioners in the ED have limited patient history and are placed under time constraints. Improved education regarding pain management, clinical practice guidelines and the use of resource tools like the Prescription Drug Monitoring Programs (PDMP) have been proven effective for reducing opioid related complications (Greenwood-Ericksen et al.,

According to the Department of Health and Human services, over 650,000 opioid prescriptions are dispensed in one day. This translates to around 230 million prescriptions each year. This amount just barely falls short of being high enough to give every adult in the United States their own bottle of opioid pills. The loose prescribing habits of medical professionals are to blame for these absurdly high numbers. Current doctors will prescribe an opiate-based painkiller for anything from a backache, toothache, to even headaches. To give patients “highly addictive” drugs for low scale chronic pain over the three-days recommended max incurs high risk for tolerance, dependence, and potential addiction to opioids. Some would argue that doctors are simply doing their job by solving their patient’s pain problem and that people should not intrude upon a medical professional’s expertise. However, while doctors should be unbiased pillars of medical advice and treatment, they should also take into account the risks involved with their treatment for their patient’s sake. Particularly for opioid prescriptions, doctors should have to abide by dosing criteria, receive guidance on when to seek consultation, and know how to use their state’s prescription drug monitoring program (Alexander et al., 2015). According to Alexander et al., (2015) Prescription Drug Monitoring Programs (PDMPs) are underutilized by 81% of all prescribers.

Jamison RN, Serraillier J, Michna E. Assessment and treatment of abuse risk in Opioid prescribing for chronic pain. Pain Res Cl. 2011;2011:1-12. doi:10.1155/2011/941808.

Prescription drug abuse is an increasingly rampant public health issue. The Centers for Disease Control and Prevention (CDC) has affirmed that the United States is in the midst of an epidemic of prescription drug overdose deaths (2010a). Drug overdose, especially related to the non-sanctioned consumption of prescription opioid analgesic (painkiller) drugs, is the second leading cause of deaths from unintentional injuries in the United States, surpassed only by motor vehicle mortalities (Girion, Glover, & Smith, 2011). In 2005, President Bush signed the National All Schedule Prescription Electronic Reporting Act (NASPER), which amends section 390O of the Public Health

Statistics for the growing prescription opioid abuse problem are alarming. Prescription analgesics are the second highest dispensed drug in the healthcare system. (Younger, et al., 2011). In 1991, approximately 76 million prescriptions were written for opioids. By 2011, that number had grown to 219 million (Jamison & Mao, 2015). Around 63 million people in the U.S. have used nonmedical prescription

One thing contributing to the high usage of opiates is their ability to have strong pain relieving effects. The availability of prescription medications containing opium contributed to the misuse and abuse of the substance as well (Chen, Humphreys, & Shah, 2013, p. 60). Since opiates were easy to possess from medical personnel, it became clear that it was contributing to issues related to the misuse and abuse of opiates (Chen, Humphreys, & Shah, 2013, p. 60). Therefore, over the past few years, prescription drugs which possessed addictive qualities such as opioids, has been closely monitored to avoid nonmedical usage (Chen, Humphreys, & Shah, 2013, p. 60). Nonmedical prescription drug use and disorders are pervasive in the U.S. population, it also tends to be highly comorbid with other psychiatric disorders (Huang, et al., 2006, p.

The program is an online database about patients’ controlled prescription drug history. This information helps doctors detect, and potentially prevent, abuse and facilitates identification of patients who are misusing or diverting controlled substances. The CDC states that “PDMPs continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.” PDMPs are necessary tools for state authorized officials to collect, monitor and analyze prescription and dispensing data submitted by pharmacies or medical practitioners. Since medical records are difficult to examine due to necessary laws protecting one’s health information, PDMPs provide critical information for doctors prescribing dangerous, habit forming drugs. While this program may not be drastic or swift enough to put an end to the opioid epidemic anytime soon, it is currently one of our best

To help combat the opioid crisis, there are some existing policies that have been set in place by the government and various agencies. For instance, the U.S. Centers for Disease Control and Prevention (CDC) have implemented the use of Prescription Drug Monitoring Programs (PDMPs). These state-run programs are electronic databases that track down the prescriptions of controlled substances, including opioids. Physicians and other medical personnel can utilize this database to look at specific information such as the type of drug prescribed, the quantity, and so on. In addition, they can look at a patient’s history with controlled substances, which in turn helps them to avoid the prescription of controlled substances to a person with possible

The Opioid Risk Tool (ORT) specifically identifies whether or not an individual has a family history of substance use, personal history of substance use or a psychological disorder. A second assessment is The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), this tool is typically self administered and consists of 24 questions. The SOAPP-R was designed to identify aberrant medication-related behaviors (Lakha, Louffat, Nicholson, Deshpande & Mailis-Gagnon, 2014). Finally, The Current Opioid Misuse Measure (COMM), a 17 question inventory, was also designed to measure the likelihood that the patient will misuse their prescribed medication. The SOAPP-R and the COMM were both designed to take an individual's pain scale into consideration during the assessment (Jamison, Serrailler & Michna,

Prescription drug abuse and overdose-related deaths have reached an epidemic level in the United States and are an urgent public health concern. To combat this opioid crisis, in 2016 Comprehensive Addiction and Recovery Act (CARA) was signed into law. CARA authorizes grants to increase access to treatment services and opioid reversal drugs such as Naloxone, strengthen the Prescription Drug Monitoring Program (PDMP), expand prevention and educational efforts. In spite of the extensive range of activities authorized by CARA to control this epidemic, the US has experienced an increase in the number of the opioid overdose-related emergency visit from 2016 to September 2017. Therefore, after considering the policy options to reform this act, the most apropos solution would be the universal mandate of PDMP use. Mandating PDMPs can reduce prescription overdose and misuse of opioids. In order to ensure the impact of this program, PDMPs will have to be implemented on a Federal level. This will essentially make sure that all states taking part in the program are responsible for keeping track of registered physicians and dispensers under the Prescription

Chronic pain is an important public health problem that negatively impacts the quality of life of affected individuals and exacts a tremendous cost in both healthcare costs and lost productivity. The Institute of Medicine (IOM) in its landmark report on relieving pain in American estimated that 100 million individuals suffer from chronic pain at a socio-economic cost of between $560 and $635 billion annually [IOM, 2011]. Opioids have been increasingly prescribed for the management of chronic pain, and along with this increase in use has come an increase in opioid misuse and abuse. Of the opioids that are abused, 60% are obtained directly or indirectly through a physician’s prescription.