Smith, T. J., & Hillner, B. E. (2019). The cost of pain. JAMA Network Open, 2 (4), e191532. https://doi.org/10.1001/jamanetworkopen.2019.1532 Stahl, S. (2020). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th Ed.). Cambridge Press. Stanford College of Medicine. (2022). Opioid equianalgesic table. https://palliative.stanford. edu/opioid- conversion/equivalency-table/ Stokes, M., & Abdijadid, S. (2022). Disulfiram. StatPearls. https://www.ncbi.nlm.nih.gov/ books/NBK459340/#_NBK459340_pubdet_ Substance Abuse and Mental Health Services Administration (SAMHSA). (2022a). Medication-assisted treatment (MAT). https://www.samhsa.gov/medication-assisted- treatment Substance Abuse and Mental Health Services Administration (SAMHSA). (2022b). Statutes, regulations, and guidelines. https://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). Highlights for the 2021 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/ default/files/2022- 12/2021NSDUHFFRHighlights092722.pdf SureScripts. (2022a). Electronic prescribing for controlled substances: 20 years of persistence and progress. https://surescripts.com/news-center/intelligence-in-action/ opioids/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 Swann, W. L., Kim, S., Kim, S. Y., & Schreiber, T. L. (2021). Urban-rural disparities in opioid use disorder prevention and response activities: A cross-sectional analysis. The Journal of Rural Health, 37 , 16-22. https://doi- org.wilkes.idm.oclc.org/10.1111/jrh.12491 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. https://doi.org/10.1001/jamanetworkopen.2020.2361 The University of Michigan. (2022). Michigan open. https://opioidprescribing.info/ U.S. Department of Health and Human Services (HHS). (2016). 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. https://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. https://www.hhs.gov/opioids/about-the-epidemic/ U.S. Department of Justice (DOJ). (2018). Justice Department issues memo on marijuana enforcement. https://www.justice.gov/opa/pr/justice-department-issues-memo-marijuana- enforcement U.S. Drug Enforcement Agency (DEA). (2010a). Electronic prescriptions for controlled substances (EPCS). https://www.deadiversion.usdoj.gov/ecomm/e_rx/index.html U.S. Drug Enforcement Agency (DEA). (2010b). Role of authorized agents in communicating controlled substance prescriptions to pharmacies. https://www. deadiversion.usdoj.gov/fed_regs/rules/2010/fr1006.htm
U.S. Drug Enforcement Agency (DEA) (2018a). The Controlled Substances Act. https://www. dea.gov/drug- information/csa U.S. Drug Enforcement Agency (DEA) (2018b). Drug scheduling. https://www.dea.gov/ drug-information/drug- scheduling U.S. Drug Enforcement Agency (DEA). (2018c). Drug policy. https://www.dea.gov/drug- information/drug-policy U.S. Drug Enforcement Agency (DEA). (2020a). Drugs of abuse: A DEA resource guide. https://www.dea.gov/sites/default/files/2020-04/Drugs%20of%20Abuse%202020-Web%20 Version-508%20compliant-4-24-20_0.pdf U.S. Drug Enforcement Agency (DEA). (2020b). Pharmacist’s Manual: An informational outline of the Controlled Substances Act. https://www.deadiversion.usdoj.gov/GDP/ (DEA-DC-046)(EO-DEA154)_Pharmacist_Manual.pdf U.S. Drug Enforcement Agency (DEA). (2022). Mid-level practitioners’ authorization by state. https://www.deadiversion.usdoj.gov/drugreg/practioners/index.html U.S. Food and Drug Administration (FDA). (2018). FDA education blueprint for health care providers involved in treating and monitoring patients with pain. https://www.fda.gov/ media/99496/download U.S. Food and Drug Administration (FDA). (2020). FDA and cannabis: Research and drug approval process. https://www.fda.gov/news-events/public-health-focus/fda-and-cannabis- research-and-drug-approval-process U.S. Food and Drug Administration (FDA). (2021). Approved risk evaluation and mitigation strategies (REMS). https://www.accessdata.fda.gov/scripts/cder/rems/index. cfm?event=RemsDetails.page&REMS=17 U.S. Food and Drug Administration (FDA). (2022a). FDA warns about several safety issues with opioid pain medicines; requires label changes. https://www.fda.gov/drugs/fda-drug- safety-podcasts/fda-drug-safety-podcast-fda- warns-about-several-safety-issues-opioid-pain- medicines-requires-label U.S. Food and Drug Administration (FDA). (2022b). FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. https://www.fda.gov/drugs/fda-drug- safety-podcasts/fda-drug-safety- podcast-fda-warns-about-serious-risks-and-death-when-combining-opioid-pain-or- cough U.S. Food and Drug Administration (FDA). (2022c). FDA restricts prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women. https://www.fda.gov/drugs/fda-drug-safety-podcasts/fda-drug- safety-podcast-fda-restricts-use-prescription-codeine- pain-and-cough-medicines-and- tramadol U.S. Food and Drug Administration (FDA). (2022d). FDA urges caution about withholding opioid addiction medications from patients taking benzodiazepines or CNS depressants: Careful medication management can reduce risks. https://www.fda.gov/drugs/fda-drug- safety-podcasts/fda-drug-safety-podcast-fda-urges-caution-about- withholding-opioid- addiction-medications-patients U.S. Food and Drug Administration (FDA). (2022e). Medication guides. https://www.fda.gov/ drugs/drug-safety-and- availability/medication-guides Werner, A, Koumans, E., Chatham-Stephens, K., Salvatore, P., Armatas, C., Byers, P., Clark, C., Ghinai, I., Holzbauer, S., Navarette, K., Danielson, M., Ellington, S., Moritz, E., Petersen, E., Kiernan, E., Baldwin, G., Briss, P., Jones, C., King, B., … Regan-Steiner, S. (2020). Hospitalizations and deaths associated with EVALI. New England Journal of Medicine. https://doi.org/10.1056/NEJ/Moa1915314 https://www.nejm.org/doi/full/10.1056/ NEJMoa1915314 World Health Organization. (2022). Tobacco: E-cigarettes. https://www.who.int/news-room/ questions-and- answers/item/tobacco-e-cigarettes
PRESCRIBING CONTROLLED SUBSTANCES SAFELY: A DEA REQUIREMENT Self-Assessment Answers and Rationales
1. The correct answer is A. Rationale: Poison Control (1-800-222-1222) is available 24 hours a day to patients and clinicians to answer any questions concern- ing accidental ingestion or contact with known or unknown sub- stances. 2. The correct answer is D. Rationale: Clinicians who are agents or employees of a hospi- tal or other institution (e.g., interns, residents, staff physicians, advanced practice providers) may, in the normal course of their duties, administer, dispense, or prescribe controlled substances under the registration of the hospital or other institution in which they are employed, provided that the dispensing, administering, or prescribing is in the normal course of practice; practitioners are authorized to do so by the state in which they practice; the hospital or institution has verified the practitioner is permitted to dispense, administer, or prescribe controlled substances within the state; the practitioner only acts within the scope of employ- ment in the hospital or institution, and the hospital or institution authorizes the practitioner to dispense or prescribe under its reg- istration and assigns a specific internal code for each practitioner so authorized.
3. The correct answer is D. Rationale: If the prescriber institutes long-term opioid therapy, a written informed consent and treatment agreement is recom- mended. The informed consent may address several issues, such as evidence that the benefit of opioids or other medications in managing chronic pain is limited (except for cancer); potential risks and benefits of opioid therapy; potential short- and long- term side effects of opioid therapy; likelihood that tolerance to and physical dependence on the medication will develop; risk of drug interactions and oversedation; risk of impaired motor skills; risk of substance abuse disorder, overdose, and death; the clini - cian's prescribing policies (e.g., number and frequency of refills, early refills, exceptions); reasons the drug may be changed or dis - continued, and that the treatment may be discontinued without agreement from the patient, such as with violations of the treat - ment agreement. Educate the patient that complete elimination Rationale: Integrative medicine and integrative nursing are the same. In the past, these therapies were called complementary. 5. The correct answer is A. Rationale: (Remediation) Any tapering schedule must be patient- specific to minimize withdrawal symptoms while maintaining ad - equate pain management. A general recommendation is to begin with a 10% decrease of the initial dose per week. of pain should not be expected. 4. The correct answer is A.
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