○ Nurse practitioners prescribing controlled substances: requirements. ○ Integrative Therapies. Controlled substance prescribing practices. ○ Prescription drug monitoring programs (PDMPs). ○ Electronic prescribing of controlled substances (EPCS). ○ Facsimile and oral prescriptions for Schedule II controlled substances. Course overview Nurse Practitioners (NPs), Physician Assistants (PAs), Pharmacists, and Dentists care for patients with disorders in many healthcare settings. Individuals may seek care for an acute illness or worsening of a chronic condition. Often, pain is the leading reason for seeking medical care. Appropriate prescribing practices are critical for all medications, but controlled substances require special attention. The Drug Enforcement Agency (DEA), the Food and Drug Administration (FDA), and the U.S. Department of Health and Human Services (HHS) all have a role in controlled medication schedules. Prescribers must Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing Substance use disorders are a significant public health problem with a wide range of negative effects on individuals' mental, physical, and social well-being. Mental health problems co- occurring with substance use disorders include depressive, anxiety, and psychotic disorders, as well as organic brain syndromes (American Psychiatric Association [APA], 2013). Substance use disorders share many of the same features but differ in pharmacology and associated behaviors that account for the unique effects of each substance (Boland & Verduin, 2022).
○ Schedules III-V controlled substance prescribing considerations. ○ FDA warning for codeine- and hydrocodone-containing cough and cold products. ○ Special considerations for nurse practitioners prescribing controlled substances.
understand federal and state requirements for all controlled substances. This course will provide a general review of federal and state-controlled substance regulations and the prescribing practices for controlled substances. Additionally, substance use disorders are complex phenomena affecting many lives. This course also reviews common substance use disorders, including alcohol, anxiolytics, stimulants, hallucinogens, and tobacco/ vaping. However, the focus is on clinical safety considerations when prescribing non-cancer-related opioid medications for acute/chronic pain in adults. implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
INTRODUCTION
Alcohol, opioids, central nervous stimulants, cannabinoids, and tobacco describe the phenomenon associated with substance disorders. The hallmark of substance use disorders includes cognitive, behavioral, and physiological symptoms of intoxication, withdrawal, and dependence (APA, 2013). Diagnosis is based on pathological patterns of substance use. All substances activate the same brain reward pathway via dopaminergic neurotransmission (Paxos & Teter, 2019).
NEUROBIOLOGY OF SUBSTANCE USE DISORDERS
Substance use disorders (SUDs) are complicated physiologic and psychologic disorders with multiple intersecting factors, such as drug use behaviors and poor judgment influenced by the pharmacodynamics and pharmacokinetic actions of the drug (Boland & Verduin, 2022). The central element of drug dependence is drug-using behavior. Drug use initiates a cascade of rewarding or aversive physical, psychological, and social consequences that determine the likelihood of subsequent use (Boland & Verduin, 2022). The development and persistence of SUDs are primarily based on key components within the basal ganglia, amygdala (extended), and prefrontal cortex (U.S. Department of Health and Human Services [HHS], 2016). The basal ganglia and its subnetworks are responsible for reward, pleasure, and the formation of habitual substance use (HHS, 2016). The amygdala is responsible for uneasy feelings, anxiety, and withdrawal irritability. The prefrontal cortex is involved in executive function and exerts control over the individual’s cognitive inability to reject substance use based on neurocircuitry, namely impulsivity and compulsivity (Stahl, 2020). These endophenotypes are found trans-diagnostically present across many psychopathologies.
Impulsivity causes the individual to act without forethought and with lack of reflection on previous behavior. Compulsivity is characterized by inappropriate actions which persist regardless of the situation (Stahl, 2020). Over time, impulsive substance use becomes compulsive addiction as this dysregulation becomes a dependent conditioned response. The impulses in the ventral loop of reward and motivation migrate dorsally because of neuroplasticity and engage in a habit system, creating the conditioned response of addiction (Stahl, 2020). Impulsive drug use produces a high , which, if experienced too often, cause the migration to compulsive use (addiction) to reduce the unpleasant effects of withdrawal. The mesolimbic pathway is hypothesized to be the final common pathway of reward and reinforcement in the brain, where all addictive drugs increase dopamine, especially with habitual use (Stahl, 2020; Wise & Jordan, 2021). Arising in the ventral tegmental area (VTA), it projects into the nucleus accumbens (NA) and prefrontal cortex (PFC). The psychology of substance use disorders reflects psychodynamic theories dating back 100 years (Boland & Verduin, 2022). Disturbed ego functions, self-medication, and alexithymia (inability to describe feelings) are common among substance users. Aside from pharmacologic effects, positive reinforcement is gained from paraphernalia and associated
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Book Code: DFL3024
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