How can nurses help slow opioid abuse?
Friday, April 01, 2016
Most nurses today would quickly agree there is an epidemic of overuse and abuse of prescription pain medication. The public is also beginning to see the effects of liberal prescriptive practices and abuse of prescription medications.
Clearly, there's a problem when a Super Bowl ad is geared toward "opioid-induced constipation." The controversial ad and medication demonstrates the widespread problem rippling through the United States, with little end in sight by the big pharm companies that are profiting on their use and abuse. With more than 28,000 deaths in 2014 linked to opioid overdoses, care and treatment of known side effects by another pharmaceutical agent is not the answer for this grave public health concern.
Gone are the beliefs that these medications are "safe" simply because there are prescribed. Although there has been a decline in the use of "illegal" drugs, such as cocaine, the rise in prescription drug abuse has been steadily increasing.
In 2011, prescription drug abuse was noted to the second-most abused drug after marijuana. From 2007 to 2012, opioid prescriptions increased 7.3 percent with more than 259 million prescriptions written in 2012. That equates to enough pain medication for every adult in the United States having a bottle of pills that year.
The magnitude of the problem is clear. However, most nurses and healthcare providers often feel helpless, as if they can make little impact. With a rising consciousness of this public health concern, this problem can no longer be ignored or brushed aside.
In March, the CDC released strong guidelines for the use of opioids for chronic pain — basically stating opioids should not be used as first-line agents when treating transient pain or discomfort that is not for active cancer treatment, palliative care or end-of-life care. This call to action to prescribing parties places ownership to those helping to put these medications into the general population and ultimately placing lives at risk.
St. Joseph's Regional Medical Center in Patterson, New Jersey, is taking matters into their own hands by reducing the use of opioid medication use in their emergency department. In January, the emergency room initiated a plan to reduce the use of opioid medications as first-line agents. Since the inception, opioids have been used to treat pain in only 1 out of 4 pain patients.
Instead of covering up the pain with medications, they are being proactive in addressing the cause of the pain. This conscious decision demonstrates that with action, changes can be made and communities can be impacted.
The opioid epidemic is a not just a prescriber problem — this is a concern for every healthcare worker who cares for people, especially those suffering from pain. Nurses, especially those working in acute care facilities, are especially on the front line as they are typically the healthcare worker who will actually be providing or administering the medications.
What can nurses do?
Educate themselves — Nurses need to be educated on pain management strategies, the risk of addiction and the recognition of persons who may be addicted. Little training is centered on alternative pain management strategies, addiction and the strategies to help avoid it and treat it.
Nurses need to be proactive in their knowledge and be open to alternative treatments that may not be the easiest route. They need to educate themselves on recognizing patients who may be suffering from an opioid addiction and how they can best be cared for.
Choose wisely — Nurses are typically the decision makers when it comes to administering medications in the acute care setting. Often, they are presented with multiple options for treating pain, however, they need to be exceptionally mindful of the choices made for their patients.
Prior to going straight to an opioid mediation, nurses should consider nonopioid pharmacological agents, accompanied with nonpharmacological interventions. Not only does this prevent the risk of addiction, it incorporates the patients in taking control of their comfort as well as increasing their alertness, which enables them to recover quicker.
Educate their patients and families — Nurses are natural patient educators, so this comes easily to them. However, when discussing taboo topics such as addiction, many will often retreat. But, if we want to help in fixing this problem, we have to speak up.
Make sure patients and families understand the risks of starting an opioid medication without attempting another strategy. Ensure they understand the need to only use them for short term and how to dispose of them properly. Know available resources your patients and families can use or access if they need to seek assistance with addiction.
If nurses and other healthcare providers do not start facing this problem head on, it will continue to grow. There is no question this is a complex issue, but there are solutions and actions that can be taken by everyone. This will not be an easy, quick fix, but with prompt mindful decisions, it can be contained and lives saved.
Remember, a journey of a thousand miles always starts with the first step — let that first step be you.
For more information on substance abuse or where to get treatments, please contact Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-HELP.
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