Randomized clinical trial of the effects of screening and brief intervention for illicit drug use: the Life Shift/Shift Gears study.

BackgroundAlthough screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals.MethodsA total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite.ResultsOf 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12).ConclusionsIn this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome.Trial registrationClinicalTrials.gov NCT01683227

Chronic Pain Management With Opioids: An Assessment of Alaska Nurse Practitioner Practices

Presented to the Faculty of the University of Alaska Anchorage in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCEThe purpose of this project was to determine chronic opioid pain management practices of Alaskan Nurse Practitioners (NPs) in primary care, compare them to best practices, and describe perceived barriers to evidence-based guideline use. Participants included NPs in Alaska who work in primary care and currently have an active Alaska NP license and Alaska mailing address. This project answered the questions of to what extent primary care NP practices are consistent with current Federation of State Medical Boards (2013) guidelines when managing chronic non-cancer pain with opioid therapy as well as identified the perceived barriers to guideline use. A cross sectional, descriptive design was used. The principal investigator mailed a paper survey to a convenience sample of NPs in Alaska. Nurse practitioners in Alaska follow guidelines when initiating opioid therapy most of the time, with all but three guidelines being followed ‘very frequently’ by at least 50% of respondents. Respondents follow guidelines less often when managing opioid therapy with only one guidelines being followed ‘very frequently’ by at least 50% of respondents. Two major barriers to guideline use include resource and knowledge barriers. The findings of this project were used to make clinical recommendations for improved practice.Signature Page / Title Page / Abstract / Table of Contents / List of Figures / List of Tables / List of Appendices / Introduction / Significance to Alaska Advance Nursing Practice / Purpose / Literature Review / Research Question / Methods / Results / Discussion / Implications / Dissemination / References / Appendice

Policy Analysis: Appropriate Opioid Prescribing Practices for Post-Surgical Patients

The pervasiveness of legally prescribed opioids in the United States has led to increased post-surgical patients succumbing to opioid dependence. There is a vast disparity in pain management practices across clinical settings. The lack of well-defined policies specifying opioid prescribing practices for post-surgical patients has created inconsistency among providers. This situation creates a risk for misuse and long-term opioid dependence for patients. This policy analysis aims to implement an evidence-based opioid prescribing policy for post-surgical patients to improve current opioid prescribing practices and implement a best practice culture to reduce excessive opioid practices. Collins (2005) health policy analysis adapted from Bardachs eightfold path to more effective problem solving (2000) guided the assembly and comparison of three evidence-based policies to reduce adverse effects of overprescribing practices with opioids. Three policy options assessed prescribing guidelines, patient risk assessment tools, and multimodal analgesia therapy with the intent to implement one or more. Keywords: dependence, opioids, policy analysis, post-surgical patients, opioid prescribing guidelines, risk assessment, pain management

Early Intervention: Addressing Opioid Use Disorder with Emergency Department Initiated Buprenorphine Therapy

The subsequent review evaluates opioid use disorder (OUD) as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria, including the use of buprenorphine in the process of induction, its efficacy for the management of OUD, and barriers to its initiation. The outcomes of the initiation of office-based buprenorphine treatment are compared to emergency department-initiated buprenorphine treatment for the management of OUD. This project is a review of current meta-analysis, systematic reviews, cross-sectional, longitudinal, and survey methodologies were analyzed. The medical research databases PubMed, Embase, Cochrane Review, CINAHL Complete, and PsychINFO, have been utilized in obtaining peer-reviewed literature resources. The sources eliminated include those published before 2007, lacked a formal research format, or did not provide valid statistical information. A total of 20 sources were selected for this literature review. The research revealed that buprenorphine is effective in treating OUD when appropriate induction and maintenance doses are implemented. However, there continue to be barriers in prescribing buprenorphine resulting in limited access to the medication. Office-based buprenorphine treatment of OUD shows decreased engagement in treatment within the first 30 days. Emergency department-initiated buprenorphine treatment reveals increased participation in treatment within the first 30 and 60 days, a decrease in opioid use, and a decrease in adverse opioid-related events. The treatment outcome engagement data reveals that at the 6- and 12-month time frames, retention in buprenorphine therapy is essentially the same when comparing both treatment modalities

Nasal Spray Can Save Lives: Engaging Emergency Department Nurses in the Provision of Naloxone Nasal Spray to High Risk Patients

The opioid overdose epidemic continues to escalate in the United States. Some of the morbidity and mortality associated with opioid overdose can be prevented with the timely administration of naloxone, an opioid reversal agent. The literature emphasized that the emergency department (ED) venue and registered nurses are well positioned to screen and identify high risk individuals whether they present as a result of an overdose or for other medical reasons. The literature also pointed to the importance of providing naloxone to high risk individuals and those who would be most likely to be at the scene of an overdose. This is critical because most overdoses occur at home. Additionally, negative attitudes and stigmatization towards individuals with substance use disorders (SUD) can result in provision of suboptimal patient care for this population. The literature demonstrated that education can improve knowledge gaps and negative attitudes towards patients with SUD. The purpose of this evidence-based practice improvement project (EBPI) was to address the knowledge gaps and attitudes of Emergency Department Registered Nurses (EDRNs) about the scope of the opioid overdose epidemic, SUDs as a disease, pathways from prescription opioids to heroin, treatment, recovery, harm reduction education, and nasal naloxone spray. The goal of the EBPI was to use evidence to increase the EDRNs’ knowledge and improve attitudes to facilitate delivery of evidence-based care

Secondary Traumatic Stress in Teachers and School Communities Impacted by the Opioid Epidemic

People who support others who have experienced trauma, like nurses, doctors, social workers, or first responders can sometimes be affected by a type of stress called secondary traumatic stress (STS). Although the effect of STS has been studied in helpers like social workers and medical professionals, the prevalence and characteristics of STS in teachers have not been studied extensively and are less understood. Schools in our communities impacted by the opioid epidemic also report additional stressors from issues like addiction, overdose, crime, neglect, rise in foster care, increased medical care, and death. This dissertation investigates STS in K-12 public school teachers in the United States, in areas of varying opioid impact. Specifically, K-12 teachers (n = 450), in 26 states and Washington, D. C., were surveyed utilizing a validated instrument for secondary traumatic stress (Secondary Traumatic Stress Scale; Bride, Robinson, Yegidis, & Figley, 2004), along with demographic questions and open-ended questions. Teachers were also asked about adverse childhood experiences of their students, using the PHL-ACE categories (Health Federation of Philadelphia and Philadelphia ACE Research and Data Committee, 2012). The prevalence and extent of teacher STS were explored in communities of low-, medium-, and high-opioid impact levels as defined by the National Institute of Health epidemiology parameters. I used descriptive statistics and correlations (Spearman’s Rho) to determine the prevalence of STS in the sample of teachers and to determine if this prevalence had any relationship to the opioid mortality rate in communities. Over half of the teachers in the VII study (59.56%) experienced STS at a moderate or higher level. Teachers in high opioid zones reported the highest mean STSS scores (M = 43.78, SD = 16.00), with 62.67% scoring at 38 or higher. Over 85% of teachers endorsed intrusion symptoms at a diagnostic level. Between 91-93% of all teachers surveyed endorsed adverse events experienced by their students. Using Spearman’s Rho correlation, I did not find a relationship between the environment of the opioid zone or the demographic characteristics of the teachers. Additional findings and implications are discussed and support the need to continue teacher STS research in all communities

The Impact of Simulation Learning on Community Opioid Overdose Prevention in Nursing Education

Drug overdose, especially from opioids, is a global problem which has stretched across all racial, generational, and socio-economical groups. Millions of people have been affected on a personal or professional basis by the emotional, physical, and financial impacts of this crisis. There is a critical need to provide support for public health awareness and education on opioid overdose prevention. Worldwide, federal, state and grassroot initiatives have been implemented to help reduce harm from opioid use. The goal of this scholarly project was to prepare Associate Degree nursing students with the requisite knowledge, skills, and attitudes to manage opioid overdose within community settings and provide education on opioid overdose prevention to members of the community. The educational intervention consisted of classroom lecture and two low-fidelity simulations. A convenience sample of 34 senior nursing students participated in a pretest posttest design to evaluate the efficacy of the educational intervention. Study results indicated the use of classroom lecture and low-fidelity simulations were an effective educational intervention for preparing nursing students to manage opioid overdose within community settings and providing education on opioid overdose prevention to community members

New York State Emergency Department Assessment Treatment and Referral of Individuals Presenting to the Emergency Department with Opioid Use Disorder

Opioid dependence and addiction are classified as severe medical conditions that cause adverse effects on the individual, their family, and society as a whole. The increasing number of opioid overdose cases and deaths has posed a significant challenge for emergency departments (EDs) as they play a crucial role in providing immediate medical attention to patients with opioid use disorder (OUD). The consequences of OUD are alarming, with high morbidity and mortality rates. The purpose of this study was to examine the policies, practices, and barriers to adherence to nationally recognized clinical best practices for treating patients with OUD in New York State (NYS) EDs. Adherence to established guidelines for treating OUD is critical in saving lives by preventing relapses and overdose deaths as well as promoting long-term recovery. However, provider practices often do not align with nationally recognized guidelines, and healthcare organizations face several barriers, such as a need for more resources and administrative nonprioritization of the issue in adhering to these guidelines. This descriptive study was conducted using a survey and the PRECEDE-PROCEED model framework that offers a structural approach for organizational planning, intervention, and implementation of policies and procedures for standardizing OUD best practices in ED settings. The study aimed to assess NYS ED provider practices, policies, barriers, and facilitators in adherence to nationally recognized clinical best practices for treating individuals with OUD. The study findings indicated that only 23% of the respondents reported being aligned, with around 80% of nationally recognized as clinical best practices for treating individuals with OUD and a mere 14% being aligned with all best practices. These results suggested that there is high variability in provider practices and a lack of adherence to established best practices by providers and institutions. Implementing best practices can be achieved through standardization of practices across NYS EDs, ensuring that all patients in NYS receive the same level of care, regardless of the healthcare organizatio

Early Treatment for Neonatal Abstinence Syndrome: A Palliative Approach.

Objective To describe medical, safety, and health care utilization outcomes associated with an early treatment model for neonatal opioid withdrawal. Study Design This is a retrospective review of 117 opioid-exposed infants born in a large regional hospital and treated in the level I nursery with methadone initiated within 48 hours of birth. Results For this cohort, mean length of stay was 8.3 days. Hospital safety events were infrequent; there were no medication errors or deaths. Within 30 days of discharge, 14% of infants visited the emergency department; 7% were readmitted. Per birth, mean hospital charges were $10,946.96; mean costs were$5,908.93. Conclusion This study is the first to describe an early treatment model in a low-acuity nursery to prevent severe neonatal opioid withdrawal. The described model may be safe, effective, low-cost, and feasible for replication

Opioid Overdose Response Teaching to Staff in a Homeless Shelter

Background/Purpose: Opioid overdose can occur in anyone who uses illicit drugs, but relationship correlation exists between homelessness and illicit drug use. Between March 2019 and March 2020, 92 deaths were attributed to opioids in the DNP Project state. Methods: Naloxone education was given to a single population of homeless shelter staff. An Opioid Overdose Attitude Scale (OOAS) and Opioid Overdose Knowledge Scale (OOKS) were administered to the sample prior to education, immediately after education, and 3 months after education.Results: OOAS and OOKS changes between surveys as a whole were not statistically significant (p=0.14; p=0.25). Individual components of the surveys did show statistical significance. OOKS pre-education and immediate post education risk and naloxone questions were statistically significant (p=0.03, p=0.02). OOAS competency for preeducation to immediate post-education (p=0.00075) and pre-education to 3-month post (p=0.017) was statistically significant.Discussion: This specific statewide naloxone program showed an increase in baseline knowledge and a sustained increase in survey scores over time. This indicates that the teaching method is effective in certain areas but requires tailoring to the specific audience to improve efficacy of the education. Implications for Practice: This DNP Project has the potential to equip high-risk environments with lifesaving treatment