Module 1: Professional Accountability and Prescribing
Types of credible research and the uniqueness of substance use and misuse evidence
NPs moving into prescribing controlled drugs and substances will find that much of the evidence to inform clinical practice comes from the specialized area of substance use and misuse (SUM) literature.
This specialized area uses multiple terminologies, conditions and approaches. Therefore finding research for clinical practice is challenging for multiple reasons (Einstein, 2015):
- It is not exclusively medically focused (one cannot rely only on medical or clinically-specific databases to find evidence)
- It spans epidemiological, social science, psychology and rehabilitative research realms (each of these may include exploring separate or unique databases)
- Research in the SUM area has focused heavily on addiction and very ill clients and often investigates illicit drugs only. Findings from such research cannot be directly applied to the ever-expanding age range of clients being prescribed controlled drugs and substances who have healthy lifestyles but are experiencing prescription drug use challenges or clients with multiple behavioral needs and complex medical conditions.
- Many interventions previously studied for addicted clients lack an assessment of the contextual effects of culture treatment costs, health care delivery processes, and societal values.
- The need for research results in the area of SUM now spans proactive prevention and awareness, acute management, strategic individualized interventions, and a wide range of rehabilitative and supportive interventions and ongoing pharmacologic and non-pharmacologic treatment options
- There is a need for more qualitative evidence as patient perspectives are increasingly recognized as important as is a collaborative approach to determine the most appropriate therapies to prescribe.
In light of these, it is important to follow a step-wise process for evidence-informed practice that starts with a clearly defined clinical question to narrow the search and target the specific type of data needed.
- Einstein, S. S. (2015). Substance use and misuse fifty years later: Ongoing flaws and unfinished business. Substance Use and Misuse, 50, 917-938.