Intent to change practice Some critical elements can be used to change practice and enhance recognition, intervention, and return-to-work issues. Everyone must take an active role in changing practice outcomes. Some elements of intent to change practice include the following: ● Encourage the delivery of and participation in SUD education. ● Review/establish specific policies and procedures that guide SUD recognition, reporting, consequences of not reporting, and support and treatment options for the person dealing with SUD. ● Encourage the development of programs that educate specific staff members as interventionists when confrontation is necessary. Conclusion Healthcare providers who prescribe controlled substances ensure that these potentially dangerous medications are used as safely and effectively as possible. Providers can use many tools to help them prescribe controlled substances, including thorough history-taking, professional documentation, patient–provider agreements, and informed consent. Keeping up to date with American Academy of Family Physicians (AAFP). (2021). AAFP chronic pain toolkit. http s:// www.aafp.org/dam/AAFP/documents/patient_care/pain_management/cpm- toolkit.pdf • American Association of Nurse Practitioners (AANP). (2022). State practice environment. http s://www.aanp.org/advocacy/state/state-practice- environment • American Medical Association (AMA). (2021). Report shows decreases in opioid prescribing and increases in overdoses. https://www.ama-assn.org/press-center/press- releases/report- shows-decreases-opioid-prescribing-increase-overdoses • American Psychological Association [APA], (2013) Diagnostic and statistical manual of mental disorders. (5th Ed.) • Anheyer, D., Haller, H., Lauche, R., Dobos, G., & Cramer, H. (2022). Yoga for treating low back pain: A systematic review and meta-analysis, Pain, 163 (4), e504-e517: doi: 10.1097/j. pain.0000000000002416 • Boland, R., & Verduin, M. (2022). Substance use and addictive disorders. In Kaplan & Saddock’s synopsis of psychiatry (12th ed.). Wolter’s Kluwer. • Brown, K., & Capili, B. (2020). Opioid Use Disorder: Pathophysiology, Assessment, and Effective Interventions. The American journal of nursing , 120 (6), 38–46. https://doi. org/10.1097/01.NAJ.0000668736.80609.4e • Centers for Disease Control and Prevention (CDC). (2021). Understanding the epidemic. http s://www.cdc.gov/drugoverdose/epidemic/index.html • Centers for Disease Control and Prevention. (2022a). Pocket guide: Tapering opioids for chronic pain. http s://www.cdc.gov/drugoverdose/prescribing/clinical-tools.html • References • Centers for Disease Control and Prevention (CDC. (2022b). About CDC’s opioid prescribing guideline. http s://www.cdc.gov/opioids/providers/prescribing/guideline.html Centers for Disease Control and Prevention (CDC). (2022c). Calculating total daily dose of opioids for safer dosage. http s://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf • Centers for Disease Control and Prevention (CDC). (2022d). Provisional drug overdose death count s. https://www.cdc.gov/media/releases/2022/s0210-prescribing-opioids.html • Clark M, Galati S. Guide to Chronic Pain Assessment Tools. Practical Pain Management (12)1. 2012;12(1). • Cohen, S. P., Vase, L., & Hooten, W. M. (2021). Chronic pain: An update on the burden, best practices, and new advances. The Lancet, 397 (10289), P2082-2097. doi.org /10.1016/S0140- 6736(21)00393-7 • DeBar, L., Mayhew, M., Benes, L., Bonifay, A., Deyo, R. A., Elder, C. R., Keefe, F. J., Leo, M. C., McMullen, C., Owen-Smith, A., Smith, D. H., Trinacty, C. M., & Vollmer, W. M. (2022). A primary care–based cognitive behavioral therapy intervention for long-term opioid users with chronic pain: A randomized pragmatic trial. Annals of Internal Medicine . https://doi. org/10.7326/M21-1436 • Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022). CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports , 71 (3), 1–95. https://doi.org/10.15585/mmwr.rr7103a1 • Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain: United States. MMWR Recommendations and Reports , 65 (RR-1), 1-49. http:// dx.doi.org/10.15585/mmwr.rr6501e1 • Drug abuse. Com (2019). Facts about Substance Use https://drugabuse.com/statistics- data/ get-the-facts-substance-abuse/ • Goldstick, J. E., Guy, G. P., Losby, J. L., Baldwin, G., Myers, M., & Bohnert, A. S. B. (2021). Changes in initial opioid prescribing practices after the 2016 release of the CDC Guideline for Prescribing Opioids for Chronic Pain. JAMA Network Open, 4 (7), e2116860. doi: 10.1001/jamanetworkopen.2021.16860 • Hadland, S. E., Rivera-Aguirre, A., L., Marshall, B. D., & Cerdá, M. (2019). Association of Pharmaceutical Industry marketing of opioid products with mortality from opioid-related overdoses. JAMA Network Open , 2 (1). http s://doi.org/10.1001/ jamanetworkopen.2018.6007 • Halpape, K., Jorgenson, D., Ahmed, A., Kizlyk, K., Landry, E., Marwah, R., Raiche, T., & Wiebe, A. (2022). Pharmacist-led strategy to address the opioid crisis: The Medication Assessment Centre Interprofessional Opioid Pain Service (MAC iOPS). Canadian Pharmacists Journal/Revue Des Pharmaciens Du Canada, 155 (1), 21-25. http s://doi. org/10.1177/17151635211045950 • Hayden, J. A., Ellis, J., Ogilvie, R., Malmivaara, A., & van Tulder, M. W. (2021). Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews, 9 (CD009790). doi 10.1002/14651858.CD009790.pub2 • House Bill 6095. (2021). Scheduling of drug products containing cannabidiol. Florida Senate. http s://www.flsenate.gov/Session/Bill/2021/6095/Analyses/h6095z1.PPH.PDF • Kene, M., Bhopale, S., Eaton, A., Awsare, S. V., & Reed, M. E. (2022). Opioid safety initiative associated with decreased emergency department opioid prescribing. The American Journal of Managed Care, 28 (6), e203-e211. doi: 10.37765/ajmc.2022.89158 • Kiang, M. V., Humphreys, K., Cullen, M. R., & Basu, S. (2019). Opioid prescribing patterns among medical providers in the United States, 2003–17: Retrospective, observational study. The BMJ , 368 . http s://doi.org/10.1136/bmj.l6968 • Kreitzer, M., & Koithan, M. (2019). Integrative nursing (2nd ed.). In Kreitzer, M. & Koithan, M, (Eds). Oxford Press. • Kroenke, K., Alford, D. P., Argoff, C., Canlas, B., Covington, E., Frank, J. W., Haake, K. J., Hanling, S., Hooten, W. M., Kertesz, S. G., Kravitz, R. L., Krebs, E. E., Stanos, S. P., & Sullivan, M. (2019). Challenges with implementing the Centers for Disease Control and
● Examine one’s attitudes toward people with SUD and how they influence intervention. ● Volunteer to serve on committees, task forces, and so on to improve the safety culture of the organization, as a culture of safety must be maintained. The current emphasis is on helping nurses with substance use disorder recover and continue with their careers, not lengthy punishment and disciplinary action. However, to benefit from this treatment emphasis, nurses have to engage in an approved alternative treatment program and adhere to all of its mandates, as well as to the mandates of state law and rules of their respective state board of nursing. Additionally, all nurses are obligated to complete continuing education courses on substance use disorder, act in their patients’ best interests, and facilitate the treatment and recovery of their colleagues. current guidelines and regulatory information will help nurse practitioners stay informed on the ever-changing controlled substance recommendations. In addition, preventing substance use disorders from developing by appropriately prescribing controlled substances following state and federal regulations can help slow the trends of drug abuse nationwide. Prevention opioid guideline: A Consensus Panel report. Pain Medicine, 20 (4), 724-735. http s://doi.org/10.1093/pm/pny307 • LaBruyere, R. M. (2022). Attorney General Garland reconfirms the DOJ’s hands-off approach toward federal marijuana prosecution. The National Law Review . http s://www.natlawreview. com/article/attorney-general-garland-reconfirms-doj-s-hands- approach-toward-federal- marijuana • National Conference of State Legislatures (NCSL). (2019). Prescribing policies: States confront opioid overdose epidemic. https://www.ncsl.org/research/health/prescribing- policies-states-confront-opioid-overdose-epidemic.aspx • National Council State Boards of Nursing (2018). Discipline https://www.ncsbn.org/nursing- regulation/discipline.page • National Institute on Drug Abuse (2020). • Opioid Response Network (ORN). (2021). Opioid regulations: State by state guide. http s:// www.acep.org/globalassets/sites/acep/media/by-medical-focus/opioids/opioid-guide-state- by-state.pdf • Pak, D. J., Yong, R. J., Kaye, A. D., & Urman, R. D. (2018). Chronification of pain: Mechanisms, current understanding, and clinical implications . Current Pain and Headache Reports, 22 (2), 9. doi: 10.1007/s11916-018-0666-8; PMID: 29404791 • Pino, C. A., & Wakeman, S. E. (2022). Prescription of opioids for acute pain in opioid naïve patients. UpToDate . https://www.uptodate.com/contents/prescription-of-opioids-for- acute- pain-in-opioid-naive-patients • Raihan, N., & Cogburn, M. (2023). Stages of Change Theory. In StatPearls . StatPearls Publishing. • Riva, J. J., Noor, S. T., Wang, L., Ashoorion, V., Foroutan, F., Sadeghirad, B., Couban, R., & Busse, J. W. (2020). Predictors of prolonged opioid use after initial prescription for acute musculoskeletal injuries in adults: A systematic review and meta-analysis of observational studies. Annals of Internal Medicine . http s://doi.org/10.7326/M19-3600 • Robinson, A., Wilson, M. N., Hayden, J. A., Rhodes, E., Campbell, S., MacDougall, P., & Asbridge, M. (2021). Health care provider utilization of prescription monitoring programs: A systematic review and meta-analysis. Pain Med, 22 (7), 1570-1582. doi: 10.1093/pm/ pnaa412 • Senate Bill 63. (2021). Missouri Senate modifies provisions relating to the monitoring of certain controlled substances. http s://www.senate.mo.gov/21info/BTS_Web/Bill.aspx? SessionTy pe=R&BillID=54228843 • Smith, T. J., & Hillner, B. E. (2019). The cost of pain. JAMA Network Open, 2 (4), e191532. doi: 10.1001/jamanetworkopen.2019.1532 • Stanford College of Medicine. (2022). Opioid equianalgesic table. http s://palliative. stanford.edu/opioid-conversion/equivalency- table/ • Substance Abuse and Mental Health Services Administration (SAMHSA). (2022a). Medication-assisted treatment (MAT). http s://www.samhsa.gov/medication-assisted- treatment • Substance Abuse and Mental Health Services Administration (SAMHSA). (2022b). Statutes, regulations, and guidelines. http s://www.samhsa.gov/medication-assisted- treatment/ statutes-regulations-guidelines • Substance Abuse and Mental Health Services Administration (SAMHSA). (2022c). Become a buprenorphine waivered practitioner. https://www.samhsa.gov/medication- assisted- treatment/become-buprenorphine-waivered-practitioner • Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). Removal of DATA Waiver (X-Waiver) Requirement. https://www.samhsa.gov/medications- substance- use-disorders/removal-data-waiver-requirement • SureScripts. (2022a). Electronic prescribing for controlled substances: 20 years of persistence and progress. http s://surescripts.com/news-center/intelligence-in- action/ op ioids/electronic-prescribing-for-controlled-substances-20-years-of-persistence-and- progress • SureScripts. (2022b). Scripts Network Alliance: 2021 national progress report. https:// surescripts.com/docs/default-source/national-progress-reports/2021-national-progress-report. pdf?sfvrsn=71fcbe15_14 • Swift A (2015) Pain management 3: The assessment of pain in adults. Nursing Times; 111: 41, 12-17. • Tori, M. E., Larochelle, M. R., & Naimi, T.S. (2020). Alcohol or benzodiazepine co- involvement with opioid overdose deaths in the United States. JAMA Network Open, 3 (4), e202361. doi: 10.1001/jamanetworkopen.2020.2361 • University of Michigan. (2022). Michigan open. http s://opioidprescribing.info/ • U.S. Department of Health and Human Services (HHS). (2016). Office of the Surgeon General: Facing addiction in America. The surgeon general’s report on alcohol, drugs, and health. https://store.samhsa.gov/sites/default/files/d7/priv/surgeon-generals-report.pdf • U.S. Department of Health and Human Services (HHS). (2019a). Indian Health Services: Pain management. https://www.ihs.gov/painmanagement/treatmentplanning/informedconsent/ • U.S. Department of Health and Human Services (HHS). (2019b). Pain Management Best Practices Inter-Agency Task Force Report: Updates, gaps, inconsistencies, and recommendations. http s://www.hhs.gov/opioids/prevention/pain-management- options/ index.html • U.S. Department of Health and Human Services (HHS). (2021). About the U.S. opioid epidemic. http s://www.hhs.gov/opioids/about-the-epidemic/
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