CDC Clinical Practice Guidelines for Prescribing Opioids for Pain Recommendation 10: When prescribing opioids for subacute or chronic pain, clinicians should consider the benefits and risks of toxicology testing to assess for prescribed medications as well as other prescribed and nonprescribed controlled substances. Recommendation 11: Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently and consider whether the benefits outweigh the risks of concurrent prescribing of opioids and other central nervous system (CNS) depressants. Recommendation 12: Clinicians should offer or arrange treatment with evidence-based medications to treat patients with opioid use disorder. Detoxification alone, without medications for opioid use disorder, is not recommended to address opioid use disorder because of increased risks of resuming drug use, overdose, and overdose death.
Note . Dowell et al., 2022.
Healthcare Consideration: State boards of nursing are an excellent source of information for NPs on how state laws and regulations impact practice. NPs must know all the details about advanced practice in their state—from signature authority to the number of CE hours required for licensure. Prescription drug monitoring program (PDMP) All states maintain a prescription drug monitoring program (PDMP) for controlled substances to address overprescribing opioids and other controlled substances. Missouri was the last state to create a statewide prescription drug monitoring program with Senate Bill 63 (SB63, 2021). Prescription drug monitoring programs involve a statewide electronic database that tracks all controlled substance prescriptions. State requirements for using PDMPs while prescribing controlled substances vary substantially; however, the White House Office of National Drug Control Policy and the CDC recommend creating and utilizing these programs when prescribing controlled substances, especially opioids. In addition, the CDC’s National Center for Injury Prevention and Control is updating the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain (CDC, 2022a; Dowell et al., 2016). PDMPs collect controlled substance prescription data from retail pharmacies (in-state, mail order, Internet), hospitals dispensing to emergency department patients (dispensing >48-hour supply), clinicians dispensing controlled substances from an office, and Department of Veterans Affairs pharmacies. Prescription data collected include patient information (e.g., name, date of birth, gender, Social Security number, driver’s license number), prescriber’s name and DEA registration number, and prescription information (dates prescriptions were written and filled, quantity, days supplied, National Drug Code (NDC) [provides drug name and strength], and source of payment). PDMPs do not track methadone dispensed at federally regulated clinics; controlled substances dispensed for administration to patients in hospitals, long-term care facilities, jails, or correctional facilities; pseudoephedrine sold over the counter Electronic prescribing of controlled substances (EPCS) In June 2010, the DEA published an interim final rule allowing electronic prescription of controlled substances (EPCS) in all states. States must meet specific requirements, including certification of the electronic prescribing and pharmacy applications to sign, transmit, and process the controlled substance prescriptions; audits and certification reports for these applications; and two-factor authentication for prescribers (DEA, 2010a). However, implementation of EPCS has been slow. In 2015, only 2.2% of prescribers and fewer than 50% of pharmacies were enabled for EPCS, while over 70% of prescribers and 95% of pharmacies could e-prescribe or accept other prescriptions (American Academy of Family Physicians [AAFP], 2021). Delays included necessary updates to electronic health records and pharmacy systems, as well as changes to state legislation to allow for EPCS.
(often tracked separately); military pharmacy dispensing; or Schedule I substances. Most states share PDMP information with prescribers in other states through a nationwide network. As a result, authorized users can access prescription data such as medications dispensed and doses. PDMPs are tools (1) to promote safe prescribing and dispensing practices for Schedules II–V controlled substances to reduce the number of opioids and other controlled substances available for abuse; (2) that help law enforcement reduce drug diversion and illegal prescribing and dispensing; (3) for the health professions’ licensure boards to support licensee reviews and investigations; and (4) for analysis of data that can help identify problematic trends with specific drugs, geographic regions, and patient demographics. The purpose of PDMPs is to (1) improve medication safety for opioids and other controlled substances by allowing clinicians to identify patients who are obtaining controlled substances from multiple prescribers (e.g., doctor shopping); (2) determine the total amount of opioids prescribed per day; and (3) identify patients who are being prescribed other substances that may increase the risk of opioids, such as benzodiazepines (Dowell et al., 2016). However, the effect of PDMPs is uncertain, as studies have reported conflicting results. Suggested improvements to prescription drug monitoring programs include improved clinician training in using PDMPs, prescriber dashboards for higher-risk patients, proactive alerts, mandatory registration, mandatory querying for specific prescriptions, improved interfaces, and integration into electronic medical records (Robinson et al., 2021). As the opioid crisis has worsened, the importance of the implementation of ECPS as a tool for increased security against diverted controlled substance prescriptions has been recognized (SureScripts, 2022a). E-prescribing has continued to raise the bar for safe, precise prescriptions with better data quality and more efficient communication between pharmacists and prescribers. A Centers for Medicare & Medicaid Services (CMS) rule requiring that Part D providers use EPCS took effect on January 1, 2021 (according to the requirements of the SUPPORT for Patients and Communities Act), and state legislation continued moving forward throughout the year (SureScripts, 2022b). With a growing number of U.S. adults using telemedicine every month in 2021, it is no surprise that e-prescribing use increased throughout the year. EPCS brings extra safety and security to controlled substance prescriptions, which is critical amid an
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