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Health Medical Homework Help. AU Clinicians & the Importance of Prescribing Accurate Drug Doses Discussion

Reply: Clinicians must understand appropriate prescribing, assessment, the potential for abuse and addiction, and potential psychological problems. Inappropriate prescribing typically involves not prescribing, under prescribing, over-prescribing, or continuing to prescribe when they are no longer effective. Is essential that health care providers when prescribing controlled substance understand the Florida State laws accordingly. This outlines best practices for evaluating and managing patients within the rules and regulations and the role of the healthcare team avoiding misuse or diversion. Appropriate prescribing includes prescribing sufficient medication through regular assessment, treatment planning, and monitoring to provide effective control while avoiding addiction, abuse, overdose, diversion, and misuse (Dydyk, 2021).

The Barbara Lumpkin Prescribing Act allows registered nurse practitioners and physician assistants in Florida to prescribe controlled medications. According to Lumpkin, the reasons for this bill was that every time a patient has to go to another doctor, it costs money. In hospitals more and more nurse practitioners are doing discharge, and they need to be able to write prescriptions. There are many practices in rural areas where if a nurse practitioner can’t give prescription medications, the patient needs go to the ER or to see another physician. The bill authorizes physician assistants (PAs) and advanced registered nurse practitioners (ARNPs) to prescribe controlled substances under current supervisory standards for PAs and protocols for ARNPs beginning January 1, 2017 and creates additional statutory parameters for their controlled substance prescribing.

According to the CDC, approximately 70% of the nearly 5,000 reported drug overdose deaths in Florida involve opioids and deaths involving prescription opioids remain considerable. Fatalities from benzodiazepines are also significant, with alprazolam being the most common drug. Understanding of addiction is often confusing, inaccurate, and inconsistent due to the broad range of perspectives of those dealing with patients suffering from addiction and clinicians prescribing opioids face challenges that involve medical negligence in either failure to provide adequate pain control or risk of licensure or even criminal charges if it is perceived they are involved in drug diversion or misuse. On the other hand, patients often develop opioid tolerance, significant psychological, behavioral, and emotional problems, including anxiety and depression related to under or over-prescribing (O’Donnell, 2020). 

Under the bill, an ARNP’s and PA’s prescribing privileges for controlled substances listed in Schedule II are limited to a seven-day supply and do not include the prescribing of psychotropic medications for children under 18 years of age, unless prescribed by an ARNP who is a psychiatric nurse. Prescribing privileges may also be limited by the controlled substance formularies that impose additional limitations on PA or ARNP prescribing privileges for specific medications. An ARNP or PA may not prescribe controlled substances in a pain management clinic. The concerns are particularly prominent in patients with chronic pain and have resulted in patients suffering from inadequately treated pain while at the same time there has been a development of concomitant opioid abuse, addiction, diversion, and overdose. Sometimes knowledge gap is present among healthcare providers, it is equally prevalent in politicians writing laws and law enforcement attempting to enforce the laws they write. Payers are responsible for the expenses associated with the evaluation and treatment of addiction. Persistent lack of education and the use of obsolete terminology continue to contribute to a societal lack of understanding for effectively dealing with the challenges of addiction (Imtiaz, 2020). 

References

Dydyk AM, Sizemore DC, Fariba K, et al. Florida Controlled Substance Prescribing. [Updated 2021 Apr 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK566600/

O’Donnell J, Gladden RM, Mattson CL, Hunter CT, Davis NL. Vital Signs: Characteristics of Drug Overdose Deaths Involving Opioids and Stimulants – 24 States and the District of Columbia, January-June 2019. MMWR Morb Mortal Wkly Rep. 2020 Sep 04;69(35):1189-1197. 

Imtiaz S, Shield KD, Fischer B, Elton-Marshall T, Sornpaisarn B, Probst C, Rehm J. Recent changes in trends of opioid overdose deaths in North America. Subst Abuse Treat Prev Policy. 2020 Aug 31;15(1):66.

Haffajee RL, Mello MM. Drug Companies’ Liability for the Opioid Epidemic. N Engl J Med. 2017 Dec 14;377(24):2301-2305.

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