Assessment of family history of substance abuse for preventive interventions with patients experiencing chronic pain: A quality improvement project

Exploratory descriptive analysis of opioid prescribing prevalence of nurse practitioners and the specialties associated with the top prescribers

BACKGROUND

Opioid prescription drug abuse is increasingly becoming a concern beyond the United States. Little is known regarding nurse practitioners' opioid prescribing patterns or settings.

AIM

To examine nurse practitioners' opioid prescription patterns.

METHODS

We conducted a retrospective cross-sectional descriptive study of the 2016 Medicare Part D Prescriber Public Use File and analysed the association between the number of nurse practitioners and the number of opioid prescriptions. We conducted Web searches on the top 1% of prescribers to obtain the specialty areas in which nurse practitioners worked.

RESULTS

There was no significant correlation between the prevalence of nurse practitioners and the opioid prescription rates among the states in the United States. Most nurse practitioners do not prescribe opioids. Opioid prescription is highly concentrated among nurse practitioners, as 1% of nurse practitioners account for one third of opioids prescribed by nurse practitioners. Most of the top 1% opioid prescribers practice in specialty care with board-certified pain medicine physicians.

CONCLUSIONS

The prevalence of nurse practitioners is not likely a significant contributing factor to the opioid epidemic. Rather than increased scrutiny of opioid prescribing, a better approach to curb the opioid crisis might be to facilitate collaboration among physicians, nurse practitioners and patients.

Family history of substance use disorder and chronic pain management

The use of family history of substance use disorder information as part of a comprehensive assessment of chronic pain can provide important data for treatment. This case example illustrates assessment, patient education, and brief motivational interviewing with referral to appropriate resources.

Impact of Family History of Substance Abuse on Admission Opioid Dose, Depressive Symptoms, and Pain Catastrophizing in Patients with Chronic Pain

The objectives of this study were to examine association between a family history of substance abuse and admission morphine equivalent dose, depression and pain catastrophizing screening scores, as well as reported personal history of substance use. The retrospective research was completed in an interdisciplinary three-week pain rehabilitation center. The subject cohort included admissions from January through December 2014 with 351 datasets for family history of substance abuse and oral morphine equivalency and 341 for depression, pain catastrophizing and use of substances. Outcome measures included admission self-reported data on family history of substance abuse and past and current substance use, admission morphine equivalency dose, and scores on the Center for Epidemiologic Studies-Depression Scale and the Pain Catastrophizing Scale. One hundred forty-seven patients were using opioid medications on admission and those with a positive family history of substance abuse had an oral morphine equivalency (M = 92.12, SD = 95.32) compared to a negative history (M = 80.34, SD = 64.86); the difference was not statistically significant, t (120.01) =.87, p = .39. Patients with a positive family history reported higher levels of both depression, t (327.40) = 3.15, p = .002 and pain catastrophizing, t (338) = 2.76, p = .01. Those with a positive family history endorsed greater frequency of past alcohol use χ² (1, N = 326) = 6.67, p = 0.1 and marijuana use χ² (1, N = 341) = 4.23, p = .04 and past χ² (1, N = 329) = 9.90, p = .002 and current tobacco use χ² (1, N = 327) = 8.81, p = .003. Use of family history of substance abuse information may help provide data for multimodal treatments of chronic non-cancer-pain. The findings from this study can be used to guide future research.