As states pass regulations to curb opioid abuse, what are the consequences for legitimate pain management? Forty-nine states have adopted prescription drug monitoring programs (PDMP) to detect potentially inappropriate opioid prescribing and use. Several studies have estimated the impact of PDMPs in reducing abuse and deaths. However, no study addresses an equally important question -- do PDMPs generate negative or positive spillover effects for pain management in the millions of Americans suffering from pain? We use 2003-2013 home health agency-level panel data to assess the effect of PDMPs on pain improvements in home health patients. We hypothesize that implementation of a PDMP in the context of home health care may induce agencies to substitute away from opioids to other (potentially more effective) treatments, such as physical therapy. Using a fixed effects, two-stage least squares model, we estimate pain improvements as a result of whether a state has implemented a PDMP and control for endogeneity between state policies and pain management practices. We find that home health agencies in states with PDMPs are on average more successful at improving pain in their patients. However, the effect varies according to how the agencies are reimbursed for services. Our results suggest that home health agencies are adapting their models of care to state opioid policies, and the incentives embedded in reimbursement systems can either promote better or worse pain management.

Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

Prescription Drug Diversion and Pain provides an interdisciplinary overview of medications used to treat chronic pain, specifically the benefits and risks that are posed by long-term opioids use. These essential pain-relieving medications must be carefully managed to prevent serious side effects that may include physical dependence, addiction, and even death, which has led in recent years to increased attention on the development of alternative treatments for chronic pain. This book not only offers a single, comprehensive source for understanding the specialized field of the opioid crisis, but also addresses provocative topics including how pain drugs came to be regulated by the U.S. Government and the rarely-discussed aggressive marketing behind the spread of these drugs. Chapters are written by expert contributors from diverse backgrounds in medicine, psychiatry, pharmacy, nursing, health law, and ethics. Prescription Drug Diversion and Pain is a must-read for healthcare professionals, caregivers, policy makers, regulatory officials, law enforcement, and those in the pharmaceutical industry seeking to address the current and future opioid crisis.

Prescription Drug Diversion and Pain provides an interdisciplinary overview of medications used to treat chronic pain, specifically the benefits and risks that are posed by long-term opioids use. These essential pain-relieving medications must be carefully managed to prevent serious side effects that may include physical dependence, addiction, and even death, which has led in recent years to increased attention on the development of alternative treatments for chronic pain. This book not only offers a single, comprehensive source for understanding the specialized field of the opioid crisis, but also addresses provocative topics including how pain drugs came to be regulated by the U.S. Government and the rarely-discussed aggressive marketing behind the spread of these drugs. Chapters are written by expert contributors from diverse backgrounds in medicine, psychiatry, pharmacy, nursing, health law, and ethics. Prescription Drug Diversion and Pain is a must-read for healthcare professionals, caregivers, policy makers, regulatory officials, law enforcement, and those in the pharmaceutical industry seeking to address the current and future opioid crisis.

This paper seeks to understand the treatment effect of Prescription Drug Monitoring Programs (PDMPs) on opioid prescription rates. Using county-level panel data on all opioid prescriptions in the U.S. between 2006 and 2015, we investigate whether state interventions like PDMPs have heterogeneous treatment effects at the sub-state level, based on regional and temporal variations in policy design, extent of urbanization, race, and income. Our models comprehensively control for a set of county and time fixed effects, county-specific and time-varying demographic controls, potentially endogenous time-series trends in prescription rates, and other state-level opioid interventions such as Naloxone Access and Good Samaritan laws, Medicaid expansion, and the provision of Methadone Assistance Treatment. We find that PDMPs are only effective in reducing prescription rates if they obligate doctors to check for patients' history prior to filling out a prescription, but the frequency at which a state requires its PDMP to be updated is irrelevant to its effectiveness. Moreover, the significant treatment effects of PDMPs are almost exclusively driven by urban and predominantly white counties, with the relatively more affluent regions showing greater responsiveness than their less affluent counterparts.

"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/