Opioid Crisis: 5 Options for Action

[Lane Therrell FNP, MSN, RN, NP]

The opioid crisis is running rampant in rural and urban communities alike across the United States today. According to US government sources, more than 115 people die each day in the US from opioid-related drug overdoses, and that number is rising at an alarming rate. Whether the drugs are legally prescribed or illicitly obtained, the misuse of an addiction to opioids has become a public health crisis with serious social and economic consequences.

In our day-to-day practice as nurses and healthcare professionals, we are duty-bound to administer and prescribe opioid medication appropriately. Meanwhile, the US Department of Health and Human Services (HHS) has established 5 major priorities for managing the opioid crisis by developing better: 1) addiction, treatment, and recovery services; 2) access for overdose reversal drugs; 3) case surveillance and data collection; 4) support for research on pain and addiction; 5) pain management best practices.

Beyond ensuring medication guideline compliance by prescribing and administering opioid medications properly, what more can we, as nurses, do to combat the opioid crisis? Here are 5 additional options for taking action:

Get free or low-cost Narcan Nasal Spray (if you qualify)

Narcan® (naloxone hydrochloride) nasal spray is an opioid antagonist medication for emergency treatment of opioid overdose. Did you know that ADAPT Pharma, the manufacturer of Narcan, makes it available at a discount, and even free of charge to qualified professionals? While this medication is not a substitute for emergency care, having it readily available for immediate use in high-risk situations, can save lives.

ADAPT offers a 40 percent discounted Public Price of $75 per two-dose carton for qualifying government or nonprofit organizations, including law enforcement, first responders, educational institutions community groups.

The program has recently expanded to provide two free cartons to every high school and four free cartons to every Title IV-eligible degree-granting colleges and universities in the US. You must apply to receive your free Narcan.

Even if you work at a place that already takes advantage of this program, you likely know or are involved with another organization that could benefit. Spread the word. This is one way to increase access to medication-assisted treatment.

Choose CEUs on opioid crisis-related topics

When choosing the CEUs you need to maintain your nursing license, be sure to consider educational opportunities related to opioid use and misuse, overdose treatment, pain management, opioid alternatives, and related topics. This includes best use practices for opioids and details of treatments for those with opioid use disorder (addiction), as well as safe prescribing and administration practices. All aspects of prevention, treatment, and recovery as well as pharmaceutical and non-pharmacological alternatives are fair game.

One resource where you might search for these types of topics on is Nurse CE 4 Less. A variety of other resources for obtaining CEUs are also available.

Follow the current research

Research on opioids, pain management, and related topics will no doubt play a critical role in ending the opioid crisis. To open a window on the world of opioid and pain management research, check out this article about current research approaches and opportunities from the National Institute on Drug abuse (NIDA). This article leads to resources that keep it interesting and easy to understand.

Numerous peer-reviewed and open-access journals exist on topics related to the opioid crisis, providing a steady stream of scholarly input to keep you abreast of the research. You might want to check out: The Journal of Pain & Symptom Management, Pain Research and Management, Pain Management Nursing, Journal of Addiction, American Journal of Health Promotion, Health Education Research, and Journal of Pharmacology Research, Pharmacology Journal, and The Journal of Clinical & Experimental Pharmacology, just to name a few.

Remain alert for news reports about recently published research studies and follow them to the original source. A recent study published in Health Services Research concluded that opioids are not responsible for improving health-related quality of life for individuals with non-cancer chronic pain, a finding which could be instrumental in shifting long-standing medical rationales that have supported over-prescribing.

If you're a nursing student, following the current research means you'll never be at a loss for great paper topics. And if you're a career nurse, checking out what's new keeps helps keep your professional opinions and focus fresh and interesting.

Join the (inter)professional conversation

Look for opportunities to engage in discussions and exchange ideas with other nurses. Sharing your thoughts and comparing notes about how different nurses solve similar problems enhances your practice and benefits your patients.

You can talk to your colleagues in real time or weigh in on existing discussions online. There have been at least two intriguing conversations related to pain management recently on allnurses.com. One was a discussion of an article, "Can Pain Be Prevented," and another was a thread related to medicinal cannabis. Join an existing conversation by sharing your thoughts or consider starting an online thread of your own.

And, of course, don't forget to engage with other healthcare professionals outside of nursing. Your interprofessional colleagues have valuable expertise, perspectives, and insights to offer on opioids and pain management topics. When you seek the opinions of other health care professionals including physicians, physical therapists, pharmacists, and more-you'll expand your thought process and see the issues in a different light. And who knows? When you take the conversation beyond the break room, you may discover new ways of sharing data, upgrading evidence-based strategies, and forging innovative partnerships that can lead to game-changing solutions.

Tell your personal story

Nurses are on the front-lines of the opioid crisis as it continues to take an intimate, personal, toll on our communities. Telling our personal stories is one of the most powerful ways we have to share the raw emotion and human element associated with the issues. Whether you have battled opioid addiction yourself or worked closely with those who have, your personal experiences can be meaningful and inspirational to others.

No matter where you stand politically, or what your level of experience, your story matters, and you can take action by sharing it. A public vehicle for telling these stories has been created at www.crisisnextdoor.gov. What are some other ways you might share your story?

To sum it all up, ultimately, everyone is affected by the opioid crisis. Wherever you live, work, or hang out, remember that your status as a nurse uniquely qualifies you to weigh in on the topic and provide reliable information and resources to the community at large. We are all affected by the opioid crisis, and we all play a part in managing and resolving it.

Questions for discussion:

What are some additional ways you can leverage your professional expertise to help manage the opioid crisis?

Sources and Resources:

About the Epidemic | HHS.gov

ADAPT Pharma® Expands Program Offering Free NARCAN® (naloxone HCl) Nasal Spray to Eligible Schools

allnurses discussion: CBD & Nursing Don't Mix

https://allnurses.com/general-nursing-discussion/cbd-amp-nursing-1154830.html

"All Scientific Hands on Deck" to End the Opioid Crisis | Nora's Blog, NIDA

Community Partnerships

https://www.narcan.com/partnerships

Crisis Next Door

https://www.crisisnextdoor.gov/

Health-Related Quality of Life among Chronic Opioid Users, Nonchronic Opioid Users, and Nonopioid Users with Chronic Noncancer Pain

https://www.ncbi.nlm.nih.gov/pubmed/29479700

Opioid Overdose Crisis

https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

Nurse CE 4 Less

https://nursece4less.com/CourseList

Rural America in Crisis: The Changing Opioid Overdose Epidemic

https://blogs.cdc.gov/publichealthmatters/2017/11/opioids/

Understanding the Epidemic

https://www.cdc.gov/drugoverdose/epidemic/index.html

[HiddenAngels]

This is a very touchy subject for me, not because of personal experience but mostly in my line of work. Too often I have seen patients code either at home and resuscitated by EMTs or at work, and we save them only to see them back in again after coding for a second or third time for abuse or misuse of narcs. It is heartbreaking.

[Not_A_Hat_Person, RN]

When heroin was devastating poor, brown, urban neighborhoods in the 1970s and 80s, it was a moral problem, and the solution was prison. Now that white kids in small towns are getting addicted, it's a public health problem.

Heroin Has Never Discriminated-But America's reaction to addiction sure has.

[DrFred]

The impact of opioids in the nursing profession is epidemic. A good friend had two sisters, both nurses, both overdosed and died from opiate addiction. Anonymous help can be found at Online Recovery | Safe Treatment From the Comfort of Your Home. Dr. Fred

[JKL33]

The impact of opioids in the nursing profession is epidemic. A good friend had two sisters, both nurses, both overdosed and died from opiate addiction. Anonymous help can be found at Online Recovery | Safe Treatment From the Comfort of Your Home. Dr. Fred

Well that's true enough, isn't it.

But if your implication is that nurses struggling with their own personal opioid additions is "epidemic," I will invite you to provide some evidence. "I knew of" and "I heard about" don't count. As far as I can tell, you are someone who stands to benefit from the mischaracterization of events that are bound to happen in a harried environment, or when situations call for alternate prioritization.

I am all for keeping patients safe and also helping nurses who need help. But nearly every article or commentary I have read on this topic relies on bullish*t examples of "activities that suggest diversion" along with a confessional or two from someone who actually had a problem or knew about someone who did.

What needs to be investigated are the processes and extremely tight staffing that have nurses running to the point of knowing that excellent care is not being given, and the business priorities that take away from proper patient care. As far as I can see, at least a portion of the public dialog about nurses and diversion has to do with healthcare institutions preemptively deflecting responsibility for any of the problems of their "business of healthcare" routine.

They don't like the way it looks when it takes too long to waste a medication (because people are run ragged and are not just pleasantly standing around waiting to witness your or my waste), or any of the other aberrancies that come with not having proper time and resources to do the job the way they want it done this week. But the implication that controlled substance administration sometimes doesn't happen exactly according to policy because nurses are diverting left and right at epidemic proportions?? Uh, no, that would be ********.

Exaggeration of the problem to whatever extent it exists is absolutely a no-brainer for healthcare corporations.

Obviously even the thought of this makes me furious.

[Lane Therrell FNP, MSN, RN, NP]

That is an EXCELLENT point, Not_A_Hat_Person. I never thought of it that way, but yes, definitely.

[Lane Therrell FNP, MSN, RN, NP]

Anonymous help can be found at Online Recovery | Safe Treatment From the Comfort of Your Home. Dr. Fred

Thank you for the great resources, DrFred.

[Lane Therrell FNP, MSN, RN, NP]

What needs to be investigated are the processes and extremely tight staffing that have nurses running to the point of knowing that excellent care is not being given, and the business priorities that take away from proper patient care.

Your comment speaks to a problem that is even bigger than opioids, addiction, or diversion. In many ways, healthcare seems to have forgotten why it exists in the first place -- to help PEOPLE. Not to benefit shareholders, or populations, but to meet the health needs of individuals. We'll continue to have these kinds of insoluble institutional problems in healthcare until we can get back to focusing on the fundamentals.

[Lane Therrell FNP, MSN, RN, NP]

For those of you following this topic, a well-done overview was published in the Washington Examiner today: Can Washington Fix the Opioid Crisis? The graphics are powerful, the examples are compelling, and unlike so many articles on opioids, it carries an optimistic tone. This article is well worth your time to read.