Pharmacology

In response to the opioid epidemic, individual states have developed and adopted voluntary guidelines or recommendations for the treatment of acute and chronic non-cancer pain. Based on research done on the state where you will practice clinically, include the following:
Provide the name of your practicing state’s organization, group or task force that created guidelines or recommendations for pain management therapies and education.
Briefly describe an overview of its development and include a web address where this information can be found. If your state does not have guidelines, discuss a federal guideline. (Note: you may need to contact your state’s board of nursing, pharmacy, or medicine if you cannot locate it on your own).
Some states have multiple organizations or initiatives (ex: Ohio) in place to combat the opioid epidemic and advocate for safer opioid prescribing. Explore whether your state has other resources, groups or organizations where prescribers can reference best practices for pain management treatment. If applicable, provide a brief overview of the group’s recommendations or initiatives. If your state does not have another state-specific resource, discuss the guidelines published by the American Pain Society OR Centers for Disease Control and Prevention.
Discuss when the use of opioids is appropriate and for what duration should they be prescribed? Provide a reference for your response. (This question is worth 13 points. 5 points for when opioids are appropriate, 5 points for a safe duration of use, and 3 points for a current edition APA formatted reference.)
State specific laws on controlled substance prescribing for the nurse practitioner:
Research your state laws on advanced practice nurses’ authority to prescribe controlled substances. Based on research done on the state where you will practice clinically, include the following:
Identify the law, rule, code, or statute that describes the advanced practice nurse’s authority to prescribe controlled substances in your state.
Discuss the provisions of the law, rule, code, or statute with regard to the following:
Conditions or limits on prescribing schedule I-V controlled substances.
Requirements (if any) in documentation for treating acute and chronic pain.
Are there specific requirements for advanced practice nurses to reference the state’s prescription drug monitoring database before prescribing a controlled substance? If so, what are they?
State Prescription Drug Monitoring Program (PDMP):
Research your state’s PDMP* and provide the following information:
Name of the state’s program.
Website for the state PMDP.
Discuss the registration requirements and process.
Discuss the standards and procedures for the access and review of database information.
State specific laws on medical devices prescribing for the nurse practitioner:
Research your state laws on advanced practice nurses’ authority to prescribe medical devices. These are also called Durable Medical Equipment (DME). Based on research done on the state where you will practice clinically, include the following:
Identify the law, rule, code, or statute that describes the advanced practice nurse’s authority to prescribe medical devices or DME in your state.
Discuss the provisions of the law, rule, code, or statute regarding the following:
Conditions or limits on prescribing medical devices or DME.

Sample Solution

State-Specific Opioid Guidelines or Recommendations

State: California

Organization: California Medical Association (CMA)

Website: https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/SACB/CDPH%20Document%20Library/Prescription%20Drug%20Overdose%20Program/PrescribingGuidelines4.26.17Compliant.pdf

Development: The CMA Opioid Prescribing Guidelines were developed by a workgroup of experts in pain management, addiction medicine, and public health. The guidelines were based on a review of the latest scientific evidence and were informed by input from clinicians, patients, and other stakeholders. The guidelines were first published in 2016 and are updated regularly.

Overview: The CMA Opioid Prescribing Guidelines provide recommendations for the safe and effective use of opioids for the treatment of acute and chronic pain. The guidelines cover a wide range of topics, including when to initiate opioid therapy, how to choose the right opioid and dose, and how to monitor patients for adverse effects. The guidelines also include recommendations for discontinuing opioid therapy when it is no longer necessary.

Other State Resources

Organization: California Department of Public Health (CDPH)

Website: https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/SACB/Pages/Opioids.aspx

Overview: The CDPH is leading the state’s response to the opioid epidemic. The CDPH website provides a variety of resources for clinicians, patients, and the public, including:

  • Information on the opioid epidemic in California
  • Resources for preventing and treating opioid use disorder
  • Links to state and federal opioid prescribing guidelines

Use of Opioids for Pain Management

When is the use of opioids appropriate?

Opioids are appropriate for the treatment of:

  • Acute pain, such as pain from surgery or injury, for a short period of time (3-7 days)
  • Severe chronic pain that has not responded to other treatments

For what duration should opioids be prescribed?

Opioids should be prescribed for the shortest possible duration necessary to achieve pain relief. For acute pain, opioids should be prescribed for no more than 3-7 days. For chronic pain, opioids should be prescribed for the shortest possible duration that is effective, with regular re-evaluation of the need for continued use.

Reference:

  • Centers for Disease Control and Prevention. (2022). CDC guideline for prescribing opioids for chronic pain — United States, 2022. https://www.cdc.gov/drugoverdose/pdf/Guidelines_At-A-Glance-508.pdf

State-Specific Laws on Controlled Substance Prescribing for the Nurse Practitioner

Law: California Business and Professions Code, Division 2, Chapter 4.5, Article 2, Section 2836.5

Provisions of the law:

  • Advanced practice nurses (APNs) in California may prescribe all schedules of controlled substances, including opioids.
  • APNs must complete a course in pain management and pharmacology before prescribing controlled substances.
  • APNs must register with the California Prescription Drug Monitoring Program (PDMP) and check the PDMP before prescribing any controlled substance.
  • APNs must maintain documentation of their pain management assessments and treatment plans for all patients who are prescribed controlled substances.

State Prescription Drug Monitoring Program (PDMP)

Name of the state’s program: California Prescription Drug Monitoring Program (CURES)

Website: https://www.ojp.gov/ncjrs/virtual-library/abstracts/prescription-drug-monitoring-program-california-state-profile

Registration requirements and process:

  • All prescribers in California must register with CURES.
  • Registration is free and can be done online.
  • Once registered, prescribers will be given a user ID and password to access the CURES database.

Standards and procedures for the access and review of database information:

  • Prescribers must check CURES before prescribing any controlled substance to a new patient.
  • Prescribers must also check CURES for all patients who are prescribed controlled substances on a regular basis.
  • CURES data can be used to identify patients who are at risk for opioid misuse, overdose, and other adverse events.

State-Specific Laws on Medical Device Prescribing for the Nurse Practitioner

Law: California Business and Professions Code, Division 2, Chapter 6.5, Article 6, Section 3036

Provisions of the law:

  • APNs in California may prescribe all types of medical devices, including durable medical equipment (DME).
  • APNs must complete a course in pharmacology before prescribing DME.
  • APNs must maintain documentation of their medical device assessments and treatment plans for all patients who are prescribed DME.

Conditions or limits on prescribing medical devices or DME:

  • APNs may prescribe DME for any condition that is within their scope of practice.
  • APNs may not

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