Use of risk mitigation practices by family nurse practitioners prescribing opioids for the management of chronic nonmalignant pain

ABSTRACT

Background: Ongoing opioid analgesic use in patients suffering from chronic nonmalignant pain (CNMP) has been associated with the development of opioid misuse, abuse, addiction, and overdose. To prevent these adverse outcomes, it is important that family nurse practitioners (FNPs) implement recommended risk mitigation practices (RMPs) when treating CNMP patients with opioids. Methods: A national sample of 856 FNPs was invited to answer an online survey about their utilization of opioids and RMPs in treating CNMP. Results: One hundred sixty-eight FNPs responded (20% response rate), of whom 51.2% affirmed that they prescribe opioids for CNMP. Of the 86 FNPs who prescribe opioids, 66.7% said that less than 25% of their patients were receiving ongoing opioid therapy. The most frequently prescribed opioids were hydrocodone (77.9%) and oxycodone (58.1%). With respect to RMPs, 50 of the 86 opioid-prescribing FNPs (58.8%) reported using treatment contracts with their CNMP patients. Far fewer (20.9%) used formal screening tools to gauge the risk of opioid abuse and misuse. Most respondents (54.94%) reported using prescription monitoring programs, whereas only 33.0% reported using urine toxicology to monitor opioid use. Of the prescribing FNPs, 15.1% reported using abuse-deterrent opioid formulations. Age was found to be a correlate for prescribing opioids for CNMP, with those under 40 years of age less likely to use urine toxicology than those over 41 (45.2% vs. 4.2%; χ²(6) = 11.90, P = .06). Additionally, respondents who did not use treatment contracts reported significantly fewer years in practice (10.5 years, SD = 6.1) than those who did (13.6 years, SD = 1.54, df = 2.82, P = .02). Conclusions: Although RMPs are recommended for use in all CNMP patients receiving ongoing opioid therapy, FNPs do not consistently implement them. In the midst of the current opioid epidemic, FNPs must be vigilant about using appropriate opioid prescription practices.

KEYWORDS:

• Advanced nurse practitioners
• chronic noncancer pain
• chronic nonmalignant pain
• family nurse practitioners
• risk mitigation practices
• risk mitigation strategies
• opioids
• opioid therapy

Acknowledgments

The authors thank Sarah Kinney, BA, for her assistance with the survey's administration. The authors declare that they have no conflicts of interest.

Funding

This work was supported in part by a Georgetown University Medical Center Intramural Incentive Award to Dr. Compton, The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author contributions

Dr. Compton conceptualized and designed the study. Mr. Chaudhary conducted all data collection and data entry. Data analysis was jointly conducted. Mr. Chaudhary wrote the original draft of the manuscript, with both authors working on subsequent revisions. Dr. Compton was responsible for the manuscript in its final submitted version.