Opioid Epidemic - EDs Fight Back!

This is a topic that has gotten a lot of press lately. We have all seen/heard about the opioid epidemic that is occurring in the US.

I was very fortunate recently to discuss this issue with Patricia Kunz Howard, PhD, RN, CEN, CPEN, TCRN, NE-BC, FAEN, FAAN. She's a member of the ENA Board of Directors and practices in Lexington, KY.

In Illinois, we have the Prescription Monitoring Program - do you foresee this becoming a federal mandate?

Kentucky has the "KASPER" Law which is similar to the IL Prescription Monitoring Program. I believe it is highly likely we will see a federal mandate related to monitoring of prescription drug use with related restrictions.

Opioid use especially carfentanil is a huge safety issue for EMS and ED personnel - what type of precautions do you recommend?

It is essential that EMS, law enforcement and ED personnel use extreme caution when encountering any substance, especially carfentanil as it can be absorbed through skin or mucous membranes. Appropriate use of personal protective equipment is essential to avoid exposure, as is avoiding confined spaces where the powder could be inhaled.

Police are now carrying narcan and using it frequently - do you see any implications if this is given in a non-OD incident? For instance, hypoglycemia?

We have not seen any adverse effects from Narcan administration by law enforcement officials. To the contrary, we are having to use such high doses of Narcan for carfentanil that the single dose administration carried by law enforcement may be insufficient to reverse clinical effects of this drug.

Is the pendulum swinging the opposite way? Are we NOT appropriately treating pain?

It has been my experience that we are being more cautious in our use of opioids, trying non-opioid agents as first line treatments before moving to opioids, and in those instances where opioids are needed, those doses are used much more short-term than in the past.

As providers, what advice should we give to patients that do require narcotics? ie...keeping them in a safe place, reporting, using them only for the amount of time absolutely needed, etc.

We should let patients know that it is important to minimize knowledge of opioids in your home, store them away from children or those who may be pose a danger to themselves. Limiting use of prescription drugs to severe pain for a very short duration will help decrease the likelihood of physical dependence.

The epidemic will be addressed in four different sessions at Emergency Nursing 2017:

• Opioid Addiction and Deaths Spiraling Out of Control
• ALTO I - Alternatives to Opioids - Intro to ALTO
• ALTO II - Alternatives to Opioids - ALTO Program Implementation
• Opioid Crisis and Information System Technology in the Emergency Department

The Opioid Addiction and Deaths Spiraling Out of Control session will educate nurses on the dangers of emerging drugs sold on the street like carfentanil, a synthetic drug often disguised as heroin. "Carfentanil is traditionally used as an elephant tranquilizer, so the amount needed to kill a human is frighteningly small," said Cathy Fox, RN, CEN, CPEN, FAEN, who will lead the session. "EMS, police and emergency department personnel can easily come in contact with a fatal dose without even knowing it, so it's imperative that they are able to recognize patients that are on this particular drug and take extreme measures to reduce their risk of exposure."

Carfentanil can be sold as powder, in pill form or on blotter paper and is five thousand times more potent than heroin. Healthcare workers who come into contact with an overdose victim of carfentanil can become lethally poisoned themselves, merely by touching the patient without the proper protective gear, or even by breathing in trace amounts of the substance.

"Our goal is to educate emergency nurses about what's out there and the risks they could face any time an overdose patient arrives at their facility for care," said Fox.

The ALTO I - Alternatives to Opioids - Intro to ALTO and ALTO II - Alternatives to Opioids - ALTO Program Implementation sessions will focus on breaking the grip of opioid addiction by cutting down on the number of prescriptions that are written in the first place. The sessions will be led by Dr. Alexis LaPietra, DO, and Kimberly Russo, BSN, RN, CEN, FN-CSA, of St. Joseph's Regional Medical Center in Paterson, NJ.

St. Joseph's was the first in the nation to implement the Alternatives to Opioids program (ALTO), which focuses on treating patients for pain without exposing them to opioids and the dangers of addiction.

The Opioid Crisis and Information System Technology in the Emergency Department session will highlight technology that can be employed in emergency departments to better identify and track patients who frequently seek opioid prescriptions.

"Unfortunately, some patients are very opportunistic in getting providers to write opioid prescriptions to them," said Eric Ringle, MS, RN, who will lead the session. "The good news is, there is emerging technology that allows us to track prescriptions much more closely, so it's less likely that patients can go from one place to the next to get these drugs."

Electronic Prescription Drug Monitoring Programs allow caregivers to share patient-specific information instantaneously. Whenever a patient is prescribed an opioid, their information is uploaded into a database that allows caregivers to more effectively track where a patient has been treated and how often he or she was prescribed opioids.

We all want our patients to have adequate pain control. However, we also have an obligation to provide this care in a responsible manner. By using alternatives to opioids and/or opioids for the least amount of time necessary, we are being safe providers.

Emergency Nursing 2017 is September 13 - 16 in St. Louis and registration is currently open.

Here is some more info:

Human Trafficking Recognition in the ED

Interview with Dan Nadworny, MSN, RN Point Person for the 2013 Boston Marathon Bombing