My Role in Nursing and the Opioid Crisis

As a pain management nurse, my biggest concern is the rise of prescription drug misuse or addiction, especially among younger adults. The opioid epidemic is one of the most important and serious public health crises the nation is facing today. Education is a key part to the opioid crisis for both healthcare providers and patients.

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My Role in Nursing and the Opioid Crisis

Nursing is a profession that entails not only caring for patients, but also educating and advocating for patients, because nurses save and uphold one’s life. I am a pain management clinical nurse.

Concerns as a Pain Management Nurse

As a pain management nurse, my biggest concern is the rise of prescription drug misuse or addiction, especially among younger adults. The majority of patients who come to a pain management clinic are prescribed opioids. In my pain management clinic, a team of multidisciplinary professionals including physicians, psychologists, psychiatrists, nutritionists, nurses, and occupational and physical therapists work together to provide the best quality care for chronic pain patients. The purpose of this multidisciplinary team is directed to improve emotional and functional capability as well as the quality of life for patients suffering from chronic pain.

What Treatment Options Are Available?

  • Interventional and alternative approaches
  • Nerve blocks
  • Electrostimulation
  • Music
  • Art
  • Acupuncture
  • Physical therapy

By providing education and appropriate treatment tactics, patients have the opportunity to limit or avoid long-term opioid therapy. The opioid epidemic is one of the most important and serious public health crises the nation is facing today. Education is a key part to the opioid crisis for both healthcare providers and patients. The consequences of dependence and addiction to opioids are devastating, therefore, patient safety and education is crucial to providing the best care with the least amount of risk and adverse effects.

The Economic Burden

The Centers for Disease Control and Prevention (CDC) estimated that the total economic burden per year of opioid prescription abuse alone is $78.5 billion, in which it includes costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement (National Institute on Drug Abuse, 2019). Fatal drug overdoses, to which opioids contribute to a significant degree, continue to increase yearly as there were 63,000 in 2016 (Srivastava et al., 2018). A perceived undertreatment of pain fueled the opioid epidemic, therefore it would be beneficial for treatment now to focus on psychotherapy, interventional procedures, and non-opioid therapies.

Recently, the federal and state governments have begun to the grasp the magnitude of the opioid crisis. The Centers for Disease Control and Prevention developed guidelines for prescribing opioids for chronic pain patients in order to regulate opioid prescribing (Soelberg et al., 2017). Other federal agencies (FDA, DEA, Department of Justice) have attempted to implement regulatory efforts through prosecution of illegal prescribing, approval of new and safe formulations of opioid medications, and regulation of the opioid drug market and pharmaceutical companies (Soelberg et al., 2017).

Patient Education

Educating patients is one of my main roles as a nurse. As a healthcare professional, the opioid crisis has made a direct impact in the patients I see and the community in which I live. Moreover, opioid misuse has also impacted my profession in which healthcare providers are placed in the crossroads deciding how to limit the prescription of opioids that are at risk of being misused by chronic pain patients while still upholding the responsibility to provide quality care to patients. Before we can educate and care for patients, we, as healthcare professionals, must first educate ourselves through appropriate training, guidelines, and awareness when it comes to opioid prescription. Making a real difference in one’s life is the single most rewarding part of a nurse’s job. Nurses play such an important role in the lives of patients as they spend the most time with patients and carefully follow their well-being.

As a nurse, I strive to better myself every day by finding the opportunity to learn something new and educate patients in order to provide the best possible care.

What have you, as a Nurse, faced when dealing with the opioid crisis?

Mendsaikhan Dagvadorj, RN

References

National Institute on Drug Abuse. (2019, January 22). Opioid Overdose Crisis. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

Soelberg, C. D., Brown, R. E., Vivier, D. D., Meyer, J. E., & Ramachandran, B. K. (2017). The US Opioid Crisis. Anesthesia & Analgesia, 125(5), 1675-1681. doi:10.1213/ane.0000000000002403

Srivastava, A. B., & Gold, M. S. (2018). Beyond Supply: How We Must Tackle the Opioid Epidemic. Mayo Clinic Proceedings, 93(3), 269-272. doi:10.1016/j.mayocp.2018.01.018
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MendDRN

About MendDRN

Mendsaikhan Dagvadorj, RN is a pain management Clinical Nurse.

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Specializes in Long term care.

I have a patient that has complicated list of problems R/T past abuse of chemicals of various sorts. Let's say metabolic encephalopathy to start. Medical management is keeping the possibility of her recovering enough to live on her own to some extent. (Not likely.) In the past, she's been a palliative care patient where they started her on heavier narcotics. She's told me she prefers the oxy meds to the morphine even though dose for dose the morphine is demonstrably stronger. Okay, maybe she's not metabolizing the morphine as well as she should. Of course, blood work has been done again and again. I told her the morphine should work, so she asked me for something stronger. I suggested, "What, like heroin?" And she said, "No, that never lasted long enough. "

The new pain management doc has gone the route of DCing any oxy, and going to All Morphine, All the Time advocacy. The usual caveats apply. The thing is that she's absolutely doped to the gills now, delusional, whiny, no safety awareness. We have Narcan available, but I don't want to pull out the big gun yet. Nurses on other shifts seem to wholeheartedly believe that even someone with her history, and her demonstrated hypochondria, can get any narcotic that is prescribed as long as it's within the orders. "Hold for lethargy" may as well be written in Latin. Apparently, walking in the hall with your eyes closed and wearing nothing below the waist is not worth documenting. She's even picking at her own skin as a result of the extra morphine. I'm the only nurse she trusts even when I tell her I'm holding back a narcotic due to her behavior. Not as a threat, but because of my nursing observations.

Guess I'm just venting here. I find I have to educate my fellow nurses even more than the patients at times. I'm even okay with the pain management doc DCing the PRN oxy, considering the current crisis, although I might have suggested that the doc actually read the relevant nursing notes before making changes to the regimen.

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