The opioid crisis
The statistics are staggering. Thousands of deaths are reported each month. Deaths from synthetic opioids (fentanyl) are up 73%. Prescriptions for opioids have quadrupled. The number of Medicare beneficiaries with opioid use disorder is rapidly growing (primarily our patients over age 65); Medicaid beneficiaries have an even higher rate. The black market for these drugs is alive and well in our country.
There's a lot of “blame” being thrown around—from prescribers, to drug companies, to the Centers for Medicare and Medicaid Services for making patient perception of pain management a pay-for-performance issue, to The Joint Commission for its pain management standards, to insurers for lack of coverage, to our government for scarcity of interventions, and others. Are these factors? Probably all of them and more. In the end, it's up to all of us to help fix the problem however our roles and influence allow.
First, the biases and stigmas that we place on patients with opioid use disorder are unfortunate and prevalent. At the most local level, we can advocate for basic human rights and the respect these patients deserve. This is actionable in our own backyards, whether at home or work. Addiction is a disease just like diabetes, requiring lifelong treatment and support. The brain alterations of those with opioid use disorder don't allow simple will power to cure it in most cases. Our nursing care and efforts must continue to be based on maintaining our patients' dignity.
What about remembering that there's safe opioid prescribing and administration? Not all patients are drug-seeking or at risk for addiction from a short duration of effective pain relief. We shouldn't be swinging too far in the other direction and underprescribing or undertreating.
Another basic tenet of nursing practice is education for patients, families, prescribers (including NPs), staff, and each other. There's certainly much to learn: prudent prescribing, addiction prevention, opioid alternatives, naloxone use, nonpharmacologic pain management methods, pathophysiology, treatment options, and more. The American Nurses Association (ANA) recently released several revised position statements on substance use disorder, underscoring the educational needs of caregivers.
On a broader level, we should be advocating for access to care and treatment. We can't snap our fingers and expect addiction to disappear without intervention. There are resources available on multiple websites, including the ANA, other professional organizations, and coalitions.
As nurses, we can influence an individual patient's care, prescribers, community resources, and legislators. It's encouraging to see many local, state, and federal agencies actively working on interventions. States with required registries have significantly decreased prescriptions. First responders with access to naloxone have saved lives. Healthcare organizations with focused education on evidence-based pain management practices have lessened opioid utilization.
We can and should take individual, group, and advocacy actions to combat this public health crisis. This isn't the time to be complacent.