Introduction
The opioid crisis has become a substantial national problem for the US in the recent twenty years. Scientists say that in 2018 130 people died from opioid overdose daily, which is more than the level of deaths from car accidents (Neville & Foley, 2020). Moreover, according to the CDC, in 2019, there were an estimated 81,000 deaths from opioid overdose, the tendency that was followed by the increased deaths from fentanyl use in recent years (“Overdose deaths accelerating during COVID-19,” 2020).
The opioid crisis started in the 1980s and was caused by the misinformation spread by pharmaceutical companies and experts that opioids are effective as pain relievers and cannot be a reason for addiction (Neville & Foley, 2020). Nurses in the prevailing numbers of medical facilities were encouraged with illicit incentives to prescribe opioid pain relievers for patients with chronic pain, which resulted in growing numbers of opioid addicts. Heroin and other illegal drug abuse added to the number of people with opioid use disorder (Neville & Foley, 2020). Many people can become addicts after only one dose of medication, especially older people (Cox & Naegle, 2019).
The topic of the opioid crisis is influencing US society badly, given the increased mortality and OUD statistics. Teenagers and younger adults are the most vulnerable groups, and for older patients, OUD can lead to the most severe consequences (Neville & Foley, 2020). Even more sadly, there are dramatic data regarding prenatal exposure to OUD when newborns suffer badly from opioid withdrawal symptoms (Neville & Foley, 2020). Nurses spend a lot of time directly interacting with patients with OUD and, therefore, should find a practical way to share their compassion with these people (Horner et al., 2019).
They can provide high-quality immediate help by being appropriately educated, avoiding stigma, and implementing the core nursing values of empathy, communication, and critical thinking (Horner et al., 2019). This paper aims to present the scope of the opioid epidemic in the US, describe its detrimental impacts on society, and elaborate on the responsibilities and actions the nurses should take to perform their role as patient advocates adequately.
The Influence of Opioid Addiction on Society
Therefore, there are several main reasons for opioid addiction. Firstly, the patients of the healthcare facilities were treated with opioid pain relievers to decrease the chronic pain and manage the pain in after-surgical recovery. It was not until 2007 that the nurses throughout the US stopped prescribing opioids due to the utmost nationwide attention paid to the higher levels (Neville & Foley, 2020). Bit still, there are cases of patients’ exposure to opioids, which should be avoided as much as possible. Experts say that nurses should carefully weigh the necessity of opioid prescriptions and think of all consequences and risks of potential harm (Neville & Foley, 2020). It is also critical to adhere to the corresponding guidelines and standards.
Younger adults are the category that is most exposed to OUD, especially younger adults from the rural areas, who constituted up to 75% of all younger adults with OUD in 2017 (Painter, 2017). Sometimes, these people become addicts after receiving opioids as a pain reliever in medical facilities. Illicit drug abuse, like heroin and fentanyl addiction, is another major factor (Painter, 2017). Recent statistics show that the mixing of heroin or opioids with fentanyl is the most widespread reason for overdose mortality; it is also the most significant contributing factor to such mortality (Painter, 2017).
Fentanyl is a synthetic opioid drug, and it is becoming increasingly popular since it has up to 10,000 higher effects on the users than other opioids and barbiturates (Painter, 2017). Shocking statistics show that teenagers as young as 12 years can be exposed to opioids, which they receive as a pain reliever or otherwise (Neville & Foley, 2020). Therefore, the younger adults and teenagers are a particularly vulnerable group of the US population that should be educated on the risks of opioid use and be targeted through opioid abuse prevention campaigns.
OUD among pregnant women is another painful issue that should be addressed immediately. Many women start going through therapy when they get pregnant and receive anti-addiction medication. However, the newborns suffer from prenatal abstinence syndrome, which has dreadful symptoms like a breakdown of the skin, including dryness and damage, breakage, and pain associated with drug withdrawal, which adult addicts usually experience.
Most children receive treatment and successfully manage their symptoms, but the suffering is likely to take its toll on their health. Therefore, in general, pregnant women and women are a population that deserves special attention and should be educated about the risks of opioid use for infants. During treatment, they should be attended to carefully and empathetically, and nurses should avoid the ‘substance abuse’ stigma since these women are going through dreadful suffering (Horner et al., 2019). Experts notice that OUD should be perceived as a neurological and biopsychological illness, and the patients should not be perceived as having a ‘weak willpower.’
Groups of the population between 45 and 54 and older usually face the most severe consequences when being prescribed opioids as pain relievers (Cox & Naegle, 2019). Scientists assert that the risks include unexpected falls, fractures, and other potentially dangerous events (Neville & Foley, 2020). Nurses should be incredibly attentive to older groups and take this factor into account. Notably, programs to raise risk awareness and reduce the prevalence of prescribing opioids as medicines in health care settings have already led to significant declines in statistics. Hence, younger adults, pregnant women, and older adults are the most vulnerable groups in exposure to opioids and OUD.
How Opioids Became the Most Misused Drug in the Nation
As was already mentioned, opioids became the most misused drug in the nation since the country’s official opioid prescription resulted in the opioid crisis that is lasing since the 1980s. After an article was published in one major scientific medical journal on the safety of opioids and the lack of addiction in patients who suffer from chronic pain, this method of pain relief has become very popular (Rummans et al., 2018). Before that case, nurses prescribed opioids only in exceptional circumstances, such as acute or terminal pain. But a new trend has led to the fact that opioids began to be prescribed to treat any pain conditions.
Moreover, the quality of patient care began to be assessed under the control of patients’ pain. The remuneration of health workers began to depend on the patients’ perception of the possibility of pain relief. Therefore, nurses began to prescribe opioids more often, and patients took them for more extended periods, which led to addiction in large groups of the population (Rummans et al., 2018). Patients began demanding prescriptions for opioids and looking for illegal ways to meet their drug needs. Today, opioids are being prescribed with greater caution, but the situation has not yet been resolved. Therefore, chronic pain is still treated with opioids, although science proved multiple adverse effects, risks, and health consequences of opioid dependence.
Today, there is an acute need to reduce post-surgical opioid prescriptions in healthcare facilities. Scientists note that “opioids prescribed after surgery accounted for 5% of the 191 million opioid prescriptions filled in 2017” (Stulberg et al., 2019, p. 1). At the same time, scientists mention that “up to 80% of the opioid pills prescribed by surgical care providers remain unused,” which creates the preconditions for access to opioids among people with OUD (Stulberg et al., 2019, p. 1). Therefore, nurses who work with surgical providers should be particularly attentive and report the overprescribing.
The Impact of Nursing on Opioid Addiction: Recommendations to Combat the Crisis
Although the crisis is widespread and statistics show the highest rates of opioid overdose mortality and the prevalence of OUD, the opioid crisis can be handled. The prevalence of opioid dependence resulting from inappropriate health care policies has been identified as the leading cause of the crisis. Therefore, the medical institutions that have become the source of the problem must also be the solution. It is feasible if hospitals take responsibility for nursing education and if both hospitals and regulatory agencies carry out prescriber drug monitoring.
Nurses spend more time with patients who are treating OUD and therefore should receive adequate education about the causes and characteristics of addiction and avoid the formation of stigma toward patients (Horner et al., 2019). Nurses must understand the limitations of prescribing opioids and ensure that their activities comply with states’ legal requirements for opioid prescription. Therefore, the two main areas of nursing education are training on the reasons for OUD and training on the rules and regulations associated with an opioid prescription.
Interdisciplinary healthcare teams should make collaborative efforts to cope with the crisis. The training should include education on assessment, prevention, and early recognition of opioid abuse, and the hospitals should introduce these practices. There is also a need to educate nurses on how to support patients with pain self-management practices. Scientists speak of the need for changes in the curriculum on nurses’ education and present some important ideas, like improving the understanding of the reasons for OUD (Compton & Blacher, 2020). Noteworthy, the CDC’s latest recommendations include the following.
The agency recommends “expand distribution and use of naloxone and overdose prevention education” and “expand awareness and access to treatment for substance use disorders” (“Overdose deaths accelerating,” 2020, para. 11). CDC also encourages the medical facilities to “intervene early with individuals at highest risk for overdose” and “improve detection of overdose outbreaks to facilitate more effective response” (“Overdose deaths accelerating,” 2020, para. 12). Therefore, the CDC created the fundamentals for how medical practitioners should address the opioid crisis.
Collaborative efforts among the interdisciplinary healthcare team may include the general meetings of the staff where the opioid crisis-related issues would be discussed. Doctors and nurses should share their experiences of working with patients with chronic, acute, and post-surgical pain (Neville & Foley, 2020). Together they can develop effective supporting pain self-management strategies that will be then implemented in the healthcare facility. Notably, scientists admit that many healthcare facilities still use methadone to treat OUD, even though it has severe side effects (Jackson & Lopez, 2018).
At the same time, many states still forbid the use of buprenorphine which is a much safer option (Jackson & Lopez, 2018). Buprenorphine is known to prevent “withdrawal symptoms and cravings, abuse of other opioids, and requires less federal regulations for dispensing (can be prescribed in office settings) than methadone” (Neville & Foley, 2020, p. 8). Healthcare employees should also address the issue of taking care of OUD patients and carefully choose the medications.
It is also recommended that the medication facilities should implement prescriber drug monitoring. The prescriber is supposed to be utterly attentive to the age of the patients and the necessity of opioid treatment. Less acute pain should be relieved using other pain self-management and pain management strategies. It is especially true for older patients and for patients who are going through post-surgical recovery. There are plenty of guidelines on pain management, and the nurses should be encouraged to apply the rules and norms of nursing behavior prescribed by such documents.
Assessment, prevention, and early recognition of opioid abuse should be performed by nurses and should be considered an essential responsibility. Nurses should develop practical strategies to monitor their patients, including indications and reporting the symptoms of OUD. These strategies should be based on the periodical assessment of the patients’ well-being and receiving feedback from them, which could be implemented in simple questionnaires that the patients would be proposed to fill in.
The introduction of proper assessment strategies will lead to the prevention and early recognition of opioid abuse. The nurses should also monitor the patients who would not like the medical personnel to know that they have OUD-related problems. Asking for supplementary opioid medications and insisting on the prescription could signify latent OUD in patients. Therefore, the prescriber drug monitoring should include attention to how drugs are stored to avoid thefts.
Identifying the Mechanism behind Addiction
There is a particular mechanism behind the addiction related to inadequate prescription policy. Since 2007 most medical facilities adhere to the new norms and standards that discourage them from over-prescribing opioid medication. However, although there was a reported decrease in prescription opioid-involved death rates decreased by nearly 7% from 2018 to 2019, there are still numerous cases of OUD due to prescription reasons (“Understanding the epidemic,” 2021). Therefore, the nurses should be paying attention to adhering to prescription monitoring standards and guidelines and report the over-prescriptions.
There is also a need to understand the patient’s perspective since many of them suffer abstinence symptoms. Often patients with OUD get the stigma of the ‘drug addicts’ with the ‘lack of willpower,’ but this is untrue (Horner et al., 2019).
OUD is an illness, and patients who need treatment come to the medical facility hoping that their needs would be met and their boundaries will be respected. Patients with OUD may suffer tormenting symptoms, and there are chances that they will try to get the opioid medications in some illegal way or avoid treatment. But this resistance to treatment is a part of the OUD illness and should be met with understanding from the nursing personnel. Given that there are chances that patients will try to get the opioid medications using any possible means, the nurses should care the responsibility for appropriate storage and disposal of opioid medications. Sometimes the excessive dosages are stored in the healthcare facilities, and the nurses should keep track of these drugs to avoid incidents.
Summary of Action
OUD treatment is a part of the opioid crisis, and the high numbers of patients with OUD still receive methadone as a substitute for heroin or other opioids (Calcaterra et al., 2019). This situation is hazardous and undesirable since science has data on the many side effects of methadone, which is also addictive. An alternative to methadone is buprenorphine, a safe and effective treatment of OUD (Jackson & Lopez, 2018). However, many states have legal limitations on the use of buprenorphine, and these limitations should be lifted (Jackson & Lopez, 2018). There is still a conspiracy among the methadone producers, who do not want to lose their drug market share. Safe OUD treatment should be a priority for the nurses, healthcare facilities, and local governments. Therefore, I will write an open letter to the local government officials, where I will briefly present the issue and ask to lift restrictions on OUD with buprenorphine treatment.
Conclusion
Thus, the scope of the opioid epidemic in the US was presented, and its detrimental impact on society was described. The responsibilities and actions of the nurses were elaborated as well. The opioid crisis started with the negligence of the medical practitioners and should be ended by them. The role of the nurses is central in overcoming the opioid epidemic that increased during the coronavirus lockdown. The opioid crisis has had plenty of detrimental effects on society, causing OUD and overdose deaths among young and older adults. Therefore, nurses should take action to prevent the spreading of opioid abuse.
References
Calcaterra, S. L., Bach, P., Chadi, A., Chadi, N., Kimmel, S. D., Morford, K. L., & Samet, J. H. (2019). Methadone matters: what the United States can learn from the global effort to treat opioid addiction. Journal of General Internal Medicine, 34(6), 1039-1042.
Compton, P., & Blacher, S. (2020). Nursing education in the midst of the opioid crisis. Pain Management Nursing, 21(1), 35-42.
Cox, K. S., & Naegle, M. A. (2019). The opioid crisis. Nursing Outlook, 67(1), 3-5.
Horner, G., Daddona, J., Burke, D. J., Cullinane, J., Skeer, M., & Wurcel, A. G. (2019). “You’re kind of at war with yourself as a nurse”: Perspectives of inpatient nurses on treating people who present with a comorbid opioid use disorder. PloS One, 14(10), e0224335.
Jackson, H. J., & Lopez, C. M. (2018). Utilization of the nurse practitioner role to combat the opioid crisis. The Journal for Nurse Practitioners, 14(10), 213-216.
Neville, K., & Foley, M. (2020). The economic impact of the opioid use disorder epidemic in America: Nurses’ call to action. Nursing Economic$, 38(1), 7-15.
Overdose deaths accelerating during COVID-19 (2020). Web.
Painter, S. G. (2017). Opiate crisis and healthcare reform in America: A review for nurses. OJIN: The Online Journal of Issues in Nursing, 22(2).
Rummans, T. A., Burton, M. C., & Dawson, N. L. (2018). How good intentions contributed to bad outcomes: the opioid crisis. Mayo Clinic Proceedings, 93(3), 344-350.
Stulberg, J. J., Schäfer, W. L., Shallcross, M. L., Lambert, B. L., Huang, R., Holl, J. L., & Johnson, J. K. (2019). Evaluating the implementation and effectiveness of a multi-component intervention to reduce post-surgical opioid prescribing: study protocol of a mixed-methods design. BMJ Open, 9(6), 1-13.
Understanding the epidemic (2021). Web.