According to the CDC, 2014 was a record year for deaths from drug overdoses, with more than 60 percent of these deaths resulting from drugs classified as an opioid. Between 2000 and 2014, close to half a million Americans died from drug overdose—that is roughly equivalent to 78 deaths per day. The CDC estimates that at least half of these deaths involved a legally prescribed drug. In some cases, the patient for whom the drug was prescribed became physically dependent on the painkiller, resulting in his own death. But there are also many instances of drug diversion—in which patients hand over their legally obtained controlled substance to a friend, relative, or another person (either with or without the understanding that this practice is illegal).
Epidemiologists at the CDC say that rising rates of opioid prescriptions are a driving factor in the 15-year increase in opioid deaths. Since 1999, sales of prescription painkillers have nearly quadrupled, and overdose deaths have followed suit.
As a nurse, you already know that an opioid is any compound that binds to specific receptors in the human body and blocks pain signals to the nerves; and that these opioid compounds include natural substances like morphine as well as synthetic drugs like methadone. You also know that opioids can be useful tools in managing pain that results from surgery or conditions like advanced cancer—and that it’s your professional and ethical obligation to ensure freedom from suffering among your patients. So what is the role of nursing in this current epidemic of opioid dependence and overdose?
The ANA has formally recognized opioid addiction as a significant public health crisis and states that “As healthcare providers practicing on the front lines of the opioid epidemic, registered nurses are qualified and well positioned to play a leading role in assessing, diagnosing, and managing patients battling addiction.” Furthermore, the ANA is working to develop resources aimed at helping nurses to play a central role in addressing opioid dependence and overdose, through a comprehensive approach. And because of nursing’s patient advocacy role, the ANA states that “Issues surrounding abuse and misuse of prescription opioids must be balanced with the real and legitimate needs of those seeking treatment for pain.”
While national experts are working to define the role of nursing in the current opioid epidemic, here are some ways you may be able to help:
- Use the medication reconciliation process as an opportunity to educate your patients about issues like tolerance, physical dependence, opioid misuse, and drug diversion.
- Inform patients that sharing a prescription drug with another person is not only a federal crime according to the Controlled Substances Act, but could cause serious harm to a person who is using a medication without medical oversight. Don’t fall into the trap of believing everyone already knows this.
- Educate yourself and your patients about ways to store controlled substances to prevent diversion, and how to properly dispose of any leftover medications that are no longer needed. Please be aware that flushing pills down a toilet or garbage disposal is no longer considered to be an environmentally sound practice.
- If you are an advanced practice nurse who can legally prescribe opioids, consider taking a continuing education course that focuses on best prescribing and patient monitoring practices.
- Advocate for and support relevant policies at every level of government, from municipal to federal. Relevant policies might include those that relate to: expanded access to medication-assisted treatment (MAT) for addiction, interoperability between state-run electronic pharmaceutical databases, drug take-back programs, programs that address the psychosocial needs of those living with chronic pain, and policies regarding the responsible distribution of naloxone (a drug that can reverse opioid effects and prevent death from overdose).
True advocacy goes beyond advocating for the needs of the individual patients currently under your personal care. It means having the passion and the knowledge to identify opportunities to advocate for every healthcare consumer who relies on our current healthcare system. While nurses have an individual responsibility to advocate for individual patients, they also have the ethical responsibility to approach broader advocacy issues as a united group of nursing professionals.
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