Posted: February 27th, 2023

week 6 discussion answers

please respond to each discussion post with apa references  Thank you!

Prescription drug abuse is a significant problem in today’s society. Fatal prescription overdoses went from 1.4/100,000 deaths in 1999 to 5.4/100,000 deaths in 2011 (Haffejee et al, 2015). Much has changed in practices in the last 15 years as a result of these problems with a goal of curbing addiction and overdose. Prescription drug monitoring programs have been developed in response to the alarming rate of incidences. Initially, rates of the program was low at around 35% of prescribers enrolled (Haffajee, 2015). However with a mandatory requirement of a query before prescribing, a reduction in prescription drug abuse was found (Haffajee, 2015).

Impacts for health are complicated as controlled medications are now limited which are easy temporary fixes but other avenues of treatment are now utilized such as therapy and and other non pharmacological means. Insurers benefit as they do not have to deal with the sequalae of cost for addiction treatment and overdoses. Prescribers are encouraged to think outside of the box and not rely so heavily on pharmacological means of treating pain/sleep issues and seek other causes/treatments to these problems.  

Haffajee RL, Jena AB, Weiner SG. Mandatory Use of Prescription Drug Monitoring Programs. JAMA. 2015;313(9):891–892. doi:10.1001/jama.2014.18514

Over the past several decades, there have dramatic changes in the use of narcotics, barbiturates, and sleep medications due to their high risk for abuse.  Narcotic prescriptions began to dramatically increase in the 1990’s with the release of OxyContin, which is thought to be a central cause to the opioid epidemic in later decades.   In contrast, barbiturate use has dramatically decreased and replaced by benzodiazepines because they have been found to be safer and more effective (Weaver, 2015).  However, in recent years benzodiazepines prescriptions have increased and following the exponential increase of anxiety during the COVID-19 pandemic, have the potential to become its own epidemic (Sarangi et al., 2021).  As a result, there have been new guidelines released to guide prescribers to make decisions that will decrease their patient’s risk of abuse.  The Centers for Disease Control in 2022 released their latest guidelines for prescribing opioids, that addresses the concerns of abuse and providing guidance to providers (Dowell et al., 2022).  The guideline is quite expansive and addresses many conditions that cause pain with additional guidelines.  In contrast, according to the Agency for Healthcare Research and Quality, there is no agreed upon guideline for the prescription of benzodiazepines and the department is working develop evidenced based practice guidelines that are widely accepted by the medical community (Agency for Healthcare Research and Quality, 2022).  The question remains is how these changes in guidelines will affect our patients, insurance, and prescribers.  Patients can expect fewer opioid prescriptions, use of nonopioids, and increase in adjunct methods to manage their pain when coming into their primary care for management of their pain (Dowell et al., 2022).  While insurance companies will likely over time change the medications that they choose to cover with specific conditions related to pain.  Prescribers in my opinion, will have the one of the hardest jobs, applying all these new evidenced based practice guidelines into their practice.  As a result, these prescribers must be knowledgeable about alternatives for opioids, which can be as simple as recommending over the counter ibuprofen to understanding how certain antidepressants can be used effectively as adjuncts.   As our knowledge base on alternative medications continues to grow, the hope is we will see a decrease in narcotic and benzodiazepine usage that will result in better, safer outcomes for patients. 

Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022, November 4). CDC clinical practice guideline for prescribing opioids for pain. Centers for Disease Control; Centers for Disease Control MMWR Office.

https://doi.org/10.15585/mmwr.rr7103a1

Links to an external site.

Sarangi, A., McMahon, T., & Gude, J. (2021). Benzodiazepine Misuse: An Epidemic Within a Pandemic. Cureus, 13(6), e15816.

https://doi.org/10.7759/cureus.15816

Links to an external site.

Weaver M. F. (2015). Prescription Sedative Misuse and Abuse. The Yale journal of biology and medicine, 88(3), 247–256.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553644/

Links to an external site.

Diabetes is a chronic condition affection millions of people worldwide and requires a multifaceted approach to control. Education of the patient is one of the strongest predictors of outcome (ElSayed et al, 2023). However, there is much learning to be had including the promotion of making healthy eating choices, increasing physical activity, compliance with blood glucose monitoring as well as medication compliance. Due to these various factors, health outcomes remains a significant challenge. Between 2013-2016, only 64% of diagnosed adults met their personal A1C targets and only 23% met their glycemic targets (ElSayed et al., 2023). Although American Indians, blacks, Hispanics and Asians all have higher numbers of diabetes than whites (American Diabetes Association, 2022), some of the largest barriers to better outcomes is access to healthcare, education, and food (ElSayed et al., 2023). The homeless is estimated to be around 8% with diabetes and have no safe storage for medications as well as access to refrigeration in addition to lacking access to healthy food choices, literacy and lack of health insurance (ElSayed et al., 2023). The migrant worker population is another population that has significant challenges with managing diabetes. They are often Latino which has a proportionally higher number of diabetics (American Diabetes Association, 2022) as well as many of the issues associated with poverty such as literacy and access to healthcare and healthy food options (ElSayed et al, 2023). In 2021, national health center data accounted for 91,124 visits related to diabetes which was roughly 10% of all their visits with the migrant worker population (ElSayed et al, 2023) and this shows that diabetes is in fact significant. 

American Diabetes Association (2022). Statistics about diabetes. American Diabetes Association.  https://diabetes.org/about-us/statistics/about-diabetes

ElSayed, N., Aleppo, G., Aroda, V., Bannuru, R., Brown, F., Bruemmer, D., Collins, B., Cusi, K., Das, S., Gibbons, C., Giurini, J., Hilliard, M., Isaacs, D., Johnson, E., Kahan, S., Khunti, S., Kosiborod, M., Leon, Jose., Lyons, S., Murdock, L., Perry, M., Prahalad, P., Pratley, R., Jeffrie Seley, J., Stanton, R., Sun, J., Woodward, C., Young-Hyman, D., Gabbay., R (2023) Introduction and Methodology: Standards of Care in Diabetes—2023. Diabetes Care.  46 (Supplement_1): S1–S4. 

https://doi.org/10.2337/dc23-Sint

Links to an external site.

The American Diabetes Association reports that diabetes is a very common metabolic endocrine condition. As of 2022 the American Diabetes Association (ADA) estimated that 34.2% of the U.S. population had diabetes mellitus, making the illness the seventh largest cause of death in the country. Neither the pancreas nor the body can create enough insulin, which leads to metabolic diseases caused by abnormal endocrine function. Diabetes type 2 is brought on by insulin resistance. Insulin and other medications for type 2 diabetes reduce glucose levels in a variety of ways. Drugs treat diabetes by enhancing insulin sensitivity in cells, decreasing glucose synthesis in the liver, reducing gastric emptying, and stimulating the pancreas to release more insulin (Mayo Clinic, 2018). Treatment plans may be adjusted to accommodate individual patients’ conditions. Metformin, Sulfonylureas, and Meglitinides are some of the drugs prescribed to individuals with type 2 diabetes. Metformin decreases the liver’s glucose synthesis and raises the body’s sensitivity to insulin, allowing the insulin the patient takes to have a greater impact. Sulfonylureas stimulate insulin production, which benefits the patients. Meglitinides like Prandin and Starlix have the same effect as sulfonylureas in that they cause the pancreas to release more insulin, but they do it more quickly and for a shorter period of time in the body. Asian Americans, Hispanics, and African Americans have higher rates of type 2 diabetes than Caucasians.

American Diabetes Association (ADA) (2022). Statistics about Diabetes. Retrieved from https://www.diabetes.org/resources/statistics/statistics-about-diabetes