How to respond to opoid addiction?

nursej22, MSN, RN · Jul 23

You listen to their concerns, and clarify what they believe the consequences are. Then, you can educate about why the patient is prescribed opioids, what are the alternatives, and what the actual adverse effects and risks are.

Tenebrae, BSN, RN · Jul 23

Inwardly I think "they are dying FFS"

Take several deep breaths before proceeding

I would use the analogy of the old fashioned weigh scales, the ones you have to put weights on the other side to balance both trays. Pain puts the weigh scales out of balance, by giving memaw some morphine or other pain relief we are simply rebalancing the scales.

I would also be fairly blunt that not adequately medicating for pain their loved one will suffer.

I once had a patients daughter accuse me of medicating their mum to keep her quiet (oxycocone for chest pain not resolving with other meds). I said bluntly 'for that to be true your mum would have to be noisy and calling out. That is simply not the case, she is the quietest patient on this wing. I gave the oxycodone finally after giving mylanta, paracetamol, GTN spray with no effect. Your mum is finally sleeping after 3+ hours'

didn't ask but wanted to when the daughter got her nursing or medical degree✌️

Home Health Columnist / Guide · Jul 23

I explain that pain can be part of clients disease process, doctors/NPs start with the lowest dose to keep client comfortable and increase dose only when pain increases and patient needs more med to be comfortable when non-medication efforts: music, meditation, relaxation exercises, heat/cold, warm bath, massage, repositioning doesn't help. Pain that ISN'T treated can cause more problems: withdrawal from family, shortness of breath, anxiety or worse.

A person may develop tolerance, but just like diabetic or someone with high blood pressure may need increased medication to control their disease, we treat the pain to provide comfort and as functional as possible. I followup with " What are your concerns about opioid addiction. Do you know someone who was addicted?"

Barbara Karnes RN has a great booklet "Pain at End of Life: What You Need to Know About End of Life Comfort and Pain Management" cost is only $4.00 -- great bargain; my prior hospice program in 90's had it as educational pamphlet along with her "Gone from my Sight" booklet explaining dying experience.

Dispelling Myths of Opioids

Does Dying Hurt?

Common Misconceptions about Morphine and End-of-Life Medications

End-of-Life Care With Families of Addiction

Great question. Hope this info helps.

FolksBtrippin, BSN, RN · Jul 25

I respond this way:

Addiction is a complex illness that compels a person to take a drug they don't need even though it is harming them. Your mom needs the morphine and it's not harming her so she's not addicted.

If they ask about whether their person could become addicted in the future:

Your mom has a terminal illness that will always cause pain, so she will always need the morphine, and she will need increasing amounts of morphine as she becomes more ill, and also as her body becomes tolerant to the morphine. Tolerance is often mistaken for addiction but tolerance is not addiction. People who need morphine need more over time and that's okay. I don't see mom ever not needing the morphine, so addiction is not a concern for her.

Most people, even many nurses do not understand addiction, so I try to be tolerant and educational and not get on my soapbox or get mad.

I did make a mistake one time. I had a good relationship with an LPN at a nursing home and thought I could joke around with him. Big mistake. He did not want to give our hospice patient morphine who was Geri chair bound, and could not wheel herself. I asked him why and he said that he didn't want her to become addicted. I said well, what exactly are you worried about? Like if you are worried that she'll sell her body on the street corner, that's easy just don't wheel her down to the street corner. And he did not think this was funny and it soiled our relationship forever.

FutureNurseMU · Jul 25

FolksBtrippin said:

I respond this way:

Addiction is a complex illness that compels a person to take a drug they don't need even though it is harming them. Your mom needs the morphine and it's not harming her so she's not addicted.

If they ask about whether their person could become addicted in the future:

Your mom has a terminal illness that will always cause pain, so she will always need the morphine, and she will need increasing amounts of morphine as she becomes more ill, and also as her body becomes tolerant to the morphine. Tolerance is often mistaken for addiction but tolerance is not addiction. People who need morphine need more over time and that's okay. I don't see mom ever not needing the morphine, so addiction is not a concern for her.

Most people, even many nurses do not understand addiction, so I try to be tolerant and educational and not get on my soapbox or get mad.

I did make a mistake one time. I had a good relationship with an LPN at a nursing home and thought I could joke around with him. Big mistake. He did not want to give our hospice patient morphine who was Geri chair bound, and could not wheel herself. I asked him why and he said that he didn't want her to become addicted. I said well, what exactly are you worried about? Like if you are worried that she'll sell her body on the street corner, that's easy just don't wheel her down to the street corner. And he did not think this was funny and it soiled our relationship forever.

Very nicely put.

mmc51264, BSN, MSN, RN · Jul 25

I like what others have said. There is a difference between addiction and dependence. I had that issue with my father when he was put on palliative care. My mother and I had to convince him that he was getting medication to make him feel better; not suffer so much (I was not a nurse at the time). We had the hospice nurse explain it to him as well and he accepted it.

I still see many pts that don't want to take pain meds when they have painful injuries (I am on an ortho/trauma unit). I tell them they are on medication short term so that they can heal and do rehab. It's so sad to also pts whose families will not allow the pt to have pain meds ( a peds pt or an altered older pt. 😞 )