Opioid Resources

The misuse of opioids, a therapeutic class of narcotic medications for pain, presents a significant risk to patient life and safety. According to the Centers for Disease Control and Prevention, more than 33,000 Americans died in 2015 - about 91 people per day - from prescription and illicit opioid overdoses. The 27 national organizations of NCC MERP have the common goal of combatting prescription opioid misuse, abuse, diversion, and overdose. Each member organization has been tackling the opioid crisis from its own perspective. This webpage provides an access point to toolkits, policy statements, educational materials, and other resources for organizations, practitioners, and patients that may aid in the lessening of opioid misuse and abuse.

The resources contained on this page represent the collective work of the Council. In this briskly changing environment, the page will be updated periodically. The format is set to provide resources to

• Organizations
• Practitioners
• Patients.

Organizations

• Beware of Basal Opioid Infusions with PCA Therapy: Safe practice recommendations for standardizing the PCA dosing process and revising the standard PCA order form. 
• FDA Advise-ERR: FDA approves HYDROmorphone labeling revisions to reduce medication errors: FDA approved revisions to the Prescribing Information, container labels, and carton labeling for Dilaudid and Dilaudid-HP may reduce confusion and medication errors.
• National Action Plan for ADE Prevention: The National Action Plan for Adverse Drug Prevention (ADE Action Plan) was established to address two key objectives: (1) identify common, preventable, and measurable adverse drug events (ADEs) that may result in significant patient harm; and (2) align the efforts of Federal health agencies to reduce patient harms from these specific ADEs nationally.
• Policy Statements: American Nurses Association and stakeholder policy statements on the opioid epidemic.
• High Alert Medication Feature Reducing Patient Harm From Opiates: ISMP suggested safeguards for reducing patient harm from opiates.
• Recent PCA by proxy event suggest reassessment of practices that may have fallen by the wayside: Safety strategies to prevent PCA by proxy.
• FentaNYL Patch Fatalities Linked to "Bystander Apathy” We ALL Have a Role in Prevention!: Focused education for the proper use, storage, and disposal of Fentanyl patches.
• Fatal PCA Adverse Events Continue To Happen…  Better Patient Monitoring Is Essential To Prevent Patient Harm: Case report and safety recommendations to prevent PCA dosing errors.
• Ongoing, Preventable Fatal Events With Fentanyl Transdermal Patches Are Alarming!: Safe practice recommendations for proper prescribing of fentanyl patches.
• Organization  Assessment of Safe Opioid Practices: Sample tool to assess the safety of facility opioid practices and identify opportunities for improvement.
• Results of the Opioid Knowledge Assessment from the  PA Hospital Engagement Network Adverse Drug Event Collaboration: The results of the knowledge assessment supported the Authority’s perception that Pennsylvania hospitals may have underestimated or were unaware of the degree of opioid knowledge deficit among practitioners.
• Results of the 2013-2014 Opioid Knowledge Assessment : Progress Seen, but Room for Improvement: The report indicates a need for a mix of high-leverage strategies to improve and sustain the safe and appropriate use of opioids.
• Results of the PA-HEN Organization Assessment if Safe Practices for a Class of High Alert Medications: This article provides a descriptive analysis of the key findings from the assessment, with a focus on areas where significant improvements in opioid medication safety are needed.
• Analysis of the Multiple Risks Involving the Use of IV Fentanyl: Analysis of medication errors and adverse drug reactions (ADRs) involving intravenous (IV) fentaNYL that were reported to the Pennsylvania Patient Safety Authority.
• Adverse Drug Events with Hydromorphone:  How Preventable are They?: Analysis of medication errors and adverse drug reactions (ADR) involving Hydromorphone that were reported to the Pennsylvania Patient Safety Authority.
• Inadvertent Mix-up of Morphine and Hydromorphone:  A Potent Error: Case report and safety recommendations to reduce patient harm in inadvertent mix-ups of morphine and hydromorphone.

Practitioners

• Pathways to Safer Opioid Use is an immersive, interactive training tool that was designed using the opioid-related recommendations outlined in the National Action Plan for Adverse Drug Event Prevention (ADE Action Plan).
• CDC developed and published the CDC Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings.
• Reducing Opioid Abuse & Misuse: Explore current resources from the AMA Opioid Task Force to help reverse the nation's opioid epidemic.
• Randall Steven Hudspeth (2016) Standards of Care for Opioid Prescribing: What Every APRN Prescriber and Investigator Need to Know. Journal of Nursing Regulation. Volume 7, Issue 1, Pages 15–20. April 2016: This article outlines the current standards of care for pain management and safe opioid prescribing that are necessary for APRNs and other providers prescribing opioids
• White House Event, AACN Announces Commitments by Nursing Schools to Combat Opioid Use Disorder. April 29, 2016: At White House Event, AACN Announces Commitments by Nursing Schools to Combat Opioid Use Disorder.
• AANP and Nursing Organizations Launch Initiative to Combat Opioid Abuse and Promote Safe Prescribing. April 29, 2016: The American Association of Nurse Practitioners (AANP) and other leading nursing organizations announced a new educational series to combat opioid abuse, encourage safe prescribing practices, and ensure patients with pain still maintain access to necessary pain relief.
• Randall Hudspeth 2016. Remediation for APRN Over-prescribing. 2016 Discipline Case Management Conference, NCSBN: This presentation discusses issues to be considered in practice remediation following a discipline decision being made; and reviews currently available methodologies and resources for over‐prescribing remediation.
• 2015 APRN Roundtable, April, 2015. State-based Challenges and Solutions, Prescription Drug Monitoring Programs in the U.S: This site contains a collection of presentations and materials from the NCSBN APRN Roundtable: State-based Challenges and Solutions.
• Tri-regulator Symposium, 2012, Plenary Session: Combatting Opioid Abuse: Presentations available from a plenary session on Combating Opioid Prescription Abuse at a symposium  jointly hosted by NCSBN, Federation of State Medical Boards (FSMB) and the National Association of Boards of Pharmacy (NABP).
• VA Pain Management: Recognizing the clinical challenges to successfully managing pain and prescribing safely for our Veterans, the VA/DoD Opioid Safety Initiative (OSI) contains information about clinical guidelines, toolkits, and research resources.
• Pathways to Prevention: The Role of Opioids in the Treatment of Chronic Pain: Find the final reports, video casts, and background research from the 2014 NIH Pathways to Prevention workshop on The Role of Opioids in the Treatment of Chronic Pain.
• National Pain Strategy: NIH developed  the National Pain Strategy aim to decrease the prevalence of pain across its continuum from acute to high-impact chronic pain and its associated morbidity and disability across the lifespan. The intent is to reduce the burden of pain for individuals, their families, and society as a whole.
• Opioid Use, Abuse and Misuse Resource Center: APhA created a clearinghouse of information to enable pharmacists to play an important role in patient access to opioids, but also opioid drug abuse prevention, education, and assistance.
• NAPB PMP InterConnect: NABP PMP InterConnect facilitates the transfer of prescription monitoring program (PMP) data across state lines. It allows participating state PMPs across the United States to be linked, providing a more effective means of combating drug diversion and drug abuse nationwide.
• Opioid Knowledge Assessment: Healthcare facilities can use this sample assessment for practitioners who prescribe, dispense, and/or administer opioid products. This assessment addresses selection, dosing, and patient monitoring when using opioid products.
• 2016 Surgeon General's Letter and Pledge: An initiative of the Surgeon General to end the Opioids Crisis.

For Patients

• Opioid Medications: FDA has developed a comprehensive action plan to take concrete steps toward reducing the impact of opioid misuse and abuse. The latest information on FDA actions related to opioid medications are highlighted here.
• Fentanyl patch: Fentanyl is a high alert medicine. Access important safety information here. High-alert medicines have been proven to be safe and effective, but these medicines can cause serious injury if a mistake happens while taking them. 
• Fentanyl patch (Spanish version): El fentanilo es un medicamento de alerta. Acceda a la información de seguridad importante aquí. Se ha comprobado que los medicamentos de alerta alta son seguros y eficaces, pero estos medicamentos pueden causar lesiones graves si ocurre un error al tomarlos.
• Hydrocodone/Acetaminophen: Hydrocodone with Acetaminophen is a high alert medicine. Access important safety information here.  High-alert medicines have been proven to be safe and effective, but these medicines can cause serious injury if a mistake happens while taking them.
• Hydrocodone/Acetaminophen (Spanish Version): Hydrocodone con Acetaminophen es un medicamento de alerta alta. Acceda a la información de seguridad importante aquí. Se ha comprobado que los medicamentos de alerta alta son seguros y eficaces, pero estos medicamentos pueden causar lesiones graves si ocurre un error al tomarlos.
• Oxycodone/Acetaminophen: Oxycodone with Acetaminophen is a high alert medicine. Access important safety information here. High-alert medicines have been proven to be safe and effective, but these medicines can cause serious injury if a mistake happens while taking them.
• Oxycodone/Acetaminophen (Spanish Version): Oxycodone con Acetaminophen es un medicamento de alerta alta. Acceda a la información de seguridad importante aquí. Se ha comprobado que los medicamentos de alerta alta son seguros y eficaces, pero estos medicamentos pueden causar lesiones graves si ocurre un error al tomarlos.
• Safe Use Of Opioids: National Association of Boards of Pharmacy created a resource center to help patient ensure they are taking medications safely.
• Safe Disposal Of Opioids: National Association of Boards of Pharmacy created a resource center to help patient ensure they are storing and disposing of medications safely.
• Legal But Deadly: A growing number of people 50+ are abusing prescription painkillers, sometimes with fatal consequences.
• DoD Makes Prescription Drug Disposal Easy For Beneficiaries: DoD has a new Drug Take Back program that allows for Defense Department health care beneficiaries to safely and easily dispose of expired and unused medications by bringing them to a military treatment facility.
• Stopping Opioid Abuse: An article from PhRMA calling for and supporting national policies and action to address opioid abuse.