Stakeholder Analysis
Health-Related Policy
In 2018, Governor Scott of Florida approved the comprehensive controlled substance Bill that increased tightened regulation on prescribers and dispensers. The law also expanded the use of PDMP (Prescription Drug Monitoring Program) (Scott, 2018). The policy addresses drug use by setting limits for acute pain, increasing the required continuation of education on controlled substances, and setting the limits for severe pain.
Description of the Policy
Florida’s governor signed the comprehensive Controlled Substance Bill CS/CS HB 21 into law on 19th March 2018. This policy increased regulation on the prescribers, dispenser, and expanded the application of PDMP. The policy was expected to control the use of drugs in Florida by limiting access and improving record-keeping of drugs. For instance, controlled substances used to treat acute pain are limited to a 3-day supply, and under special circumstances, the limit is seven days (Scott, 2018). Furthermore, under this law, the PDMP transitioned at least 25,000 active users to a new platform called PMP AWARxE™, which enables members to identify substance use earlier and use proprietary patient-matching algorithms to increase data accuracy (Scott, 2018). It is also possible to access the pharmacy management system and add reports. Comparatively, the other platform launched was the NarxCare™, a comprehensive platform that identifies and manages disorders related to substance abuse (Scott, 2018). Prescriber Report Solution Feature, which summarizes a patient’s history, was also launched in 2018. The government of Florida increased monitoring of controlled drugs to combat the opioid abuse crisis in his county.
Accordingly, several factors prompted the amendment of this policy. The first was the existing drug abuse crisis that adversely affected Florida. To illustrate, in 2017, there were 6,932 deaths related to consumption of more than one prescription drug of note is, the 2017 figure was a 4% increase from the previous year (“Patterns and Trends,” 2018). Secondly, opioid abuse had escalated in the state. In 2017, Florida was among the top six states that declared opioid abuse a public health emergency. In 2017, at least 4,279 deaths were caused by opioid consumption. This was a 9% increase since 2016, where the opioid-related death rate was 3,922. Over 40% of the opioid deaths in 2017 occurred because of consuming multiple opioids (“Patterns and Trends,” 2018). The health emergency departments saw a rising number of emergency, with a 22% increase in heroin intake. The escalating drug abuse problem, compounded with the worsening opioid crisis necessitated the formulation of tighter policies.
Equally, previous measures to curtail the opioid crisis had not been successful. The first measure was increasing access to naloxone. The Health Department conducted training on overdose recognition to people who were interested in the program. Equally, the state worked with non-profit organizations to distribute free naloxone kits to individuals susceptible to overdose. By 2017, over 3,100 individuals had been trained on overdose recognition, and the state had attained 1,800 cases of overdose reversal cases (“Patterns and Trends,” 2018). Despite the success of the program, the opioid crisis was still increasing, and tougher regulations were needed to reduce the impact even more.
Actors Involved in Making the Policy
There are various players involved in promoting and implementing the bill. Accordingly, at the national level, there are six main players. The first is the Health Quality Subcommittee (HQS) (“Bill Sponsors,” 2018). The heath quality subcommittee members were providing payments, healthcare, and health delivery systems. This committee supports the Governor’s plan to end the opioid crisis by toughening the existing regulations. Comparatively, the Appropriations Committee (AC) also sponsored the bill. The role of this stakeholder was to authorize the spending of public resources towards implementing the Bill by creating an annual budget. The Committee supports this bill as it will help combat the opioid pandemic in the county. The Health & Human Services Committee (HHSC) equally sponsored the bill (“Bill Sponsors,” 2018). The purpose of the Committee was to ensure the effectiveness and integrity of any legislature passed. Moreover, the Committee guarantees efficiency when implementing bills. The Florida PDMP Foundation (FF) is a stakeholder (“Bill Sponsor,” 2018). This non-profit organization was incorporated into the Florida Department of State and provides funds for government activities towards ending the epidemic.
Politicians also are essential because they passed the Bill. The same politicians are also capable of amending the Bill if it does not prove effective (Scott, 2018). Their input is also necessary with regards to how the implementation process will roll out. Their interest in sponsoring this bill was to reduce the opioid epidemic in the state. Additionally, as the opioid crisis is a sensitive issue, taking proactive measure improves their image and loyalty with the citizens.
The only external stakeholder are the various federal departments. These include the Department of Justice, Bureau of Justice Assistance, and Office of Justice Programs (Scott, 2018). The departments are interested in funding the law because by reducing the opioid crisis, it is likely that the rate of crimes associated with drug abuse would also decline.
Facility Level
At the facility level, various stakeholders are affected as they are the implementers of the policy. Firstly, Nurse practitioners (NP) and physician assistants (PA) as they are required to fulfil a mandatory three-hour course learning on substance control and identification (Cheng, Murimi, & Alexander, 2018). Again, as long as they are registered to the NPDP, they are required to follow the updated policies. RNs and PAs are also integral in reducing drug overdose problems as they can monitor patients and limit access to medication. Moreover, pharmacists (Ph) are impacted by the policy because they advise patients on taking medication and dispense the drugs. Pharmacists registered in the PDMP are affected in that, they must consult the PDMP system before dispensing any medication (Scott, 2018). Pharmacists are at the frontline of combating the overdose problem. The physicians (P) are also crucial in implementing this bill. For one, they have access to the health records of patients and make prescriptions. These individuals are interested in reducing overdose and over-prescription of opioid medication.
Other than individuals, healthcare facilities are affected. The PDMP was integrated into the electronic health records. Further, the program NarxCare™ was expected to increase the efficiency of prescriber reports as well as advanced analytics (Scott, 2018). Having such technologies improves the operation of facilities. Moreover, it is a form of complying with the state directive.
Stakeholder Table (Schmeer, 2000)
| No. | Name | Org | Internal/external | Knowledge | Position | Interests | Alliances | resources | Power (1,2,3) | Leader (Y/N) | ||
| Level 1,2,3 | Definition | Adv/disadv | Quality | Mobilize | ||||||||
| 1 | HQS | Senate | I | 3 | 3 | S | Lower opioid crisis | 3 | 3 | 3 | Y | |
| 2 | AC | Senate | I | 3 | 3 | N | Lower opioid crisis | 3 | 3 | 3 | Y | |
| 3 | HHSC | senate | I | 3 | 3 | S | Lower opioid crisis | 3 | 3 | 3 | Y | |
| 4 | FF | Department of state | I | 3 | 3 | S | Reduce opioid crisis | 2 | 3 | 3 | Y | |
| 5 | FD | Fed govt. | E | 3 | 3 | S | Reduce crime related to opioids, lower crisis | 3 | 3 | 3 | Y | |
| 6 | Politicians | Senate | I | 3 | 3 | S | Decrease crisis, public approval | 3 | 3 | 3 | Y | |
| 7 | NP | Facility | I | 2 | 2 | N | Follow directive, improve healthcare | 1 | 1 | 1 | N | |
| 8 | PA | Facility | I | 2 | 2 | S | Improve healthcare | 1 | 1 | 1 | N | |
| 9 | P | Facility | I | 2 | 2 | S | Improve health follow rules | 2 | 3 | 2 | Y | |
| 10 | Ph. | Pharmacy | I | 2 | 2 | S | Follow rules, reduce opioid crisis | 1 | 1 | 1 | N | |
| 11 | Facilities | Healthcare dept. | I | 3 | 3 | S | Benefit from systems, follow directives | 3 | 3 | 3 | Y | |
Implementation
The implementation was a success. For one, the number of enrollees into PDMP increased to 64, 029, with 667 individuals authorized to conduct investigations on opioid subscriptions (Scott, 2018). Additionally, there has been a 4% decline in supply days for controlled substances. The prescription of Morphine reduced by 1.7%. Moreover, the opioid prescriptions reduced by 10.1%, translating to 3,770 prescriptions by the end of 2018 (Scott, 2018). The figure is a change from the 35,614 prescribers in early January to June of 2018. Implementing the policy helped to reduce prescriptions of the opioid medications, which also diminishes the complications of these drugs.
At the same time, patient behavior improved significantly. The reduction was at 76.1%, with fewer people having opioid drug overdose cases. Moreover, the likelihood of multiple provider episodes has minimized, resulting in fewer prescriptions for patients (Scott, 2018). This is because the patients cannot use fraudulent means like forging prescriptions to acquire more medicine. The opioid pandemic has gradually reduced since tighter laws were implemented. Patient behavior has changed positively as access to opioids has become tougher.
References
Bill Sponsors. (2018). House Of Representatives Staff Analysis. https://trackbill.com/s3/bills/FL/2018/HB/21/analyses/bill-analysis-appropriations-committee-post-meeting.pdf
Cheng, H., Murimi, I., Alexander, C. (2018). Impact of Florida’s prescription drug monitoring program and pill mill law on high-risk patients: A comparative interrupted time series analysis. Pharmacoepidemiol Drug Saf, 28 (4), pp. 422-429.
Patterns and Trends of the Opioid Epidemic in Florida. (2018). Florida Department of Families and Children. Florida.
Schmeer, K. (2000). Stakeholder analysis guidelines. Policy toolkit for strengthening health sector reform. Partnerships for Health Reforms.
Scott, R. (2018). 2017-18 prescription drug monitoring program annual report. E-Forcse. Tallahassee: Florida.