Transitioning Florida NPs to opioid prescribing

Abstract

Prior to statutory changes in prescriptive authority for controlled substances, this study examined the knowledge gaps and prescribing limitations of Florida advanced registered nurse practitioners regarding opioids. Study results revealed statistically significant knowledge gaps in the areas of federal and state guidelines; opioid classes and proper doses; risk assessment skills; monitoring of treatment; and confidence in dealing with challenges of opioid prescribing.

Identifying barriers and facilitators for nurse practitioners' opioid management of chronic pain

“…Six of nine articles identified professional education as either a barrier or a facilitator for NPs' management of chronic pain (Craig-Rodriguez et al, 2017; Franklin et al, 2013; Mazurenko et al, 2020; Nikpour et al, 2021; Spitz et al, 2011; St Marie, 2016). As barriers to opioid prescription for older adults, 77% of NPs and physicians in one study identified fear of causing harm from adverse effects, and 35% identified insufficient pain management education (Spitz et al, 2011).…”

“…Four of nine articles reported that NPs' restricted prescriptive authority was a barrier to managing opioid issues (Craig-Rodriguez et al, 2017; Mack, 2018; Nikpour et al, 2021; Spitz et al, 2011). Restricted authority in Florida was initially a barrier for APRNs.…”

“…Restricted authority in Florida was initially a barrier for APRNs. Legislation to schedule II-IV prescriptive authority did not lead to adoption of schedule II-IV because 50% of state APRNS did not possess Schedule II-IV Drug Enforcement Administration registration 2 years after the legislation's passage (Craig-Rodriguez et al, 2017). In restricted prescription authority states, the Food and Drug Administration upscheduling of hydrocodone combination medication created great barriers to pain management for APRNs and led them to make more referrals (Mack, 2018).…”

“…As barriers to opioid prescription for older adults, 77% of NPs and physicians in one study identified fear of causing harm from adverse effects, and 35% identified insufficient pain management education (Spitz et al, 2011). Florida APRNs lacking previous training in opioid prescription or Drug Enforcement Administration registration showed significant gaps in knowledge in the areas of federal and state guidelines (Craig-Rodriguez et al, 2017). Web-based continuing educational training was identified as a facilitator for opioid prescription by 90% of 856 primary care providers, including 425 APRNs (Franklin et al, 2013).…”

APRNs' controlled substance prescribing and readiness following Florida legislative changes

“…4 At the time, Florida was still trying to repair its reputation as the "epicenter of prescription drug diversion" in the US. 5,6 Just 6 years earlier, the DEA had reported that Florida physicians were dispensing fi ve times more oxycodone than the national average, resulting in a massive increase in deaths from opioid misuse. 5,6 Subsequent increased regulation of pain clinics and standardization of physician prescribing guidelines and monitoring dramatically decreased overdose deaths in the state.…”