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Fighting the Opioid Epidemic: What’s Nursing’s Role?

Created Jul 19 2016, 08:00 PM by Lippincott Solutions
  • OD
  • pain medications
  • overdose
  • opioids
  • prescription opioids
  • addiction

Wednesday, July 20, 2016

Every day, we hear about more accidental deaths as the result of inadvertent opioid overdoses.  The deaths of renowned celebrities such as Prince, Michael Jackson and Heath Ledger has brought even more attention to this growing epidemic.  While many deaths may be caused by misuse of illegal substances, these drugs may not always be illicit; they may be prescription opioid pain medications, such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others…and an overdose may not always be intentional.

Deadly cocktail

Drug overdoses can result from mixing prescription medications with other drugs (legal or illegal), alcohol, over-the-counter preparations, and herbal supplements. Drug-drug interactions may also cause drug-related deaths. For example mixing central nervous system depressants, such as opioid pain medications, sedatives, hypnotics, and alcohol can cause respiratory depression and subsequent unintentional overdose. The misuse of these drugs can produce an unpredictable, fatal response; and many of these deaths are preventable.

Epidemic proportions

So, how serious is the opioid epidemic? According to the Centers for Disease Control and Prevention (CDC), 21.5 million Americans ages 12 and older had a substance use disorder in 2014, 1.9 million of those individuals had a substance use disorder involving prescription pain medications; while 586,000 had a substance use disorder involving heroin.  Drug overdose, the leading cause of accidental death in the United States, was responsible for 47,055 deaths in 2014. Opioid addiction is leading this epidemic, with 18,893 overdose deaths related to prescription opioids, and 10,574 overdose deaths related to heroin.

According to the CDC, for every death associated with prescription pain medications, there are 10 substance abuse treatment admissions, 32 emergency department visits for abuse or misuse, 130 individuals who abuse or are addicted, and 825 nonmedical users. Staggering figures!

Drug suppliers

How are individuals getting these prescription opioids? Opioids are commonly diverted from a friend or family member who has a legitimate prescription; they’re either given freely (54.2%) or sold or stolen (16.6%).

Ending the epidemic

Nurses are uniquely positioned to help reduce the incidence, and potentially deadly consequences of prescription opioid diversion. The medication reconciliation process is a great time to track use and teach patients about opioid diversion and misuse. As nurses, here’s what we can do to battle this epidemic:

  • Track patients’ opioid medication use for acute and chronic conditions. Monitor pain diaries, pill counts, and if permitted by your state law, your state’s prescription drug monitoring program.
  • Teach patients about the risks associated with nonmedical opioid use.
  • Educate patients about the risks associated with opioid diversion. Inform them that the majority of opioid diversion occurs among friends and family. Tell them that prescription medications should be taken only as prescribed, by the person for whom they’re prescribed. Inform patients that taking or sharing prescription opioids is a federal crime that violates the Controlled Substances Act.
  • Teach patients how to secure medications to prevent diversion.
  • Advise patients how to properly dispose of prescription pain medications as soon as they are no longer needed. Medication take-back programs are often available in local communities. The U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control website can help you locate a take-back program in your area.

We have a big battle ahead to end this epidemic, but with diligence and patient education, we can overcome the challenge. What experiences have you had with opioid diversion in your facility? What have you done to help control the problem? Do you have any successes you’d like to share with colleagues who are fighting the battle with you?

Leave us a comment below! 

 

 

 

References

American Society of Addiction Medicine. (2016). Opioid Addiction: 2016 Facts & Figures [Online]. Accessed June 2016 via the Web at http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

 

Center for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Mortality File. (2015). “Number and Age-Adjusted Rates of Drug-poisoning Deaths Involving Opioid Analgesics and Heroin: United States, 2000–2014” [Online]. Accessed June 2016 via the Web at http://www.cdc.gov/nchs/data/health_policy/AADR_drug_poisoning_involving_OA_Heroin_US_2000-2014.pdf.

Substance Abuse and Mental Health Services Administration (2014). “Results from the 2013 national survey on drug use and health: Summary of national findings” [Online]. Accessed June 2016 via the Web at http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDU

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2015). “Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health” [Online]. Accessed June 2016 via the Web at http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf

 

  • Those who will bother to look back to the timeline of this sudden public health emergency will find that it came in the wake of the debacle of 'Operation Fast 'n Furious', which left a Border Agent dead on the Mexican border and 2,000 American weapons in the hands of the drug cartels.

    The Dept. of Justice decided to 'refocus' the drug war from the illegal stuff coming over the border to the prescribing practices of educated, licensed clinicians for patients who have real pain.

    The DEA re-categorized opiates in the Fall of 2014, and it was predicted at that time that this action would result in a return to street drug use with a resultant rise in new cases of HIV and hepatitis.

    The 'new epidemic' started immediately and the story of Indiana's HIV epidemic was featured as the cover story in TIME magazine on June 15, 2015. At that time the city with the highest number of new cases was Atlanta, GA-home of the CDC.

    But the CDC has paid precious little attention to the new disease outbreaks and has instead pushed the opioid epidemic ahead of efforts to control the new viral outbreaks.

    We have battled HIV for the 40 years that I have been in the profession and now we have allowed it to re-emerge as a major threat for which current drug therapy may not be effective.

    Once upon a time in America medicine did not allow the government to dictate what, when and how they could prescribe medications.

    Apparently they no longer have the power or inclination to push back the bureaucrats.

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