Opioid Abuse Has Been A Recurring Problem For Years ✓ Solved

Opioid abuse has been a reoccurring problem for years

Opioid abuse has been a reoccurring problem for years; however, the current epidemic came to fruition in 2013. Jones, Bruera, Abdi, and Kantarjian (2018) noted that it is the number one reason for accidental death in the United States and that “Americans consume 80% of the world’s oxycodone and 90% of the world’s hydrocodone” (p. 4279). It generally starts in the hands of providers that prescribe opioids for pain and the pharmaceutical companies that supply them. This healthcare issue definitely impacts my work setting and the future work settings for nurse practitioners.

In many states, nurse practitioners have limitations on their prescriptive authorities and must be signed off by a physician. It is important that nurse practitioners are able to practice independently to maximize their abilities, especially to aid in combatting the opioid crisis. For example, in certain states, nurse practitioners are prohibited from prescribing buprenorphine, which is a crucial drug for the treatment of opioid addiction. Poghosyan, Norful, and Laugesen (2018) researched removing restrictions through the adaptation of the Nurse Practitioners Modernization Act, where nurse practitioners with at least 3,600 hours of practice can be independent of a physician. As for my current work setting, the post-anesthesia recovery unit, my main responsibility is to keep patients breathing, but also to manage their pain effectively. This can include the use of a great deal of narcotics.

My healthcare setting has responded to the opioid crisis in a more positive way than anticipated. The Emergency Room has implemented systems with the ability for providers to determine if a patient is doctor-shopping for narcotics. More specifically, in the unit I work in, we have enacted the Enhanced Surgical Recovery program. This program aids in mobilizing and decreasing opioid use after surgery, while simultaneously decreasing a patient’s length of stay and producing more favorable outcomes post-operatively.

Kamdar, Hoftman, Rahman, and Cannesson (2017) discuss the opportunity to change practice in the perioperative space regarding pain management. In particular, they discuss utilizing an opioid-free practice with appropriate patients, primarily in the Enhanced Recovery After Surgery (ERAS) setting. This is bolstered by the supposition that it could provide the best care to the patients in the short, intermediate, and long term, while also contributing to decreased length of stay and better patient satisfaction through proper education. Furthermore, it would provide anesthesiologists and nursing providers an opportunity to be on the front line in mitigating the current opioid crisis.

It is also notable that much of a patient’s pain post-operatively is related to their perception pre-operatively. It is important to educate patients about the expectations they have regarding pain after surgery. If patients are informed, they tend to be more accepting of the results.

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The opioid crisis has significantly transformed the landscape of healthcare, presenting pressing challenges and opportunities particularly for nurse practitioners. Since the establishment of the opioid epidemic in the early 2010s, the mortality rate associated with opioid overdose has risen dramatically, prompting a reevaluation of pain management strategies, prescriptive practices, and the overall role of healthcare providers.

Nurse practitioners (NPs) play a pivotal role in the healthcare system, often serving as the first point of contact for patients seeking pain management solutions. The opioid epidemic indicates the necessity for NPs to have greater prescriptive autonomy, enabling them to manage pain effectively while reducing the risk of substance abuse. According to the American Academy of Nurse Practitioners, states that allow NPs to prescribe independently often see fewer instances of opioid misuse (Walden, 2018). This underscores the need for legislative reforms to remove prescriptive restrictions that limit NPs' abilities to provide necessary care.

The Nurse Practitioners Modernization Act proposed by Poghosyan et al. (2018) emphasizes the need for NPs to operate independently after fulfilling specific competency requirements. This plan aligns with the movement toward enhanced patient care and the need to combat the opioid crisis effectively. Empowering NPs with the full scope of their practice can lead to better patient outcomes and reduce reliance on opioids as a primary pain management strategy.

In the post-anesthesia recovery unit, as a nurse practitioner, managing pain effectively is paramount. Recent trends have shifted towards adopting multimodal analgesia strategies, which emphasize the use of non-opioid adjuncts to alleviate pain and facilitate quicker recovery (Kamdar et al., 2017). The Enhanced Recovery After Surgery (ERAS) initiative is one such model that integrates these strategies to enhance patient recovery while minimizing opioid use.

Furthermore, understanding the psychology of pain is crucial in the post-surgical setting. Research indicates that pre-operative expectations can significantly influence post-operative pain experiences (Bensing et al., 2019). By educating patients pre-operatively about realistic pain outcomes and management strategies, nurses can shape their expectations, leading to increased satisfaction and potentially lower opioid consumption during recovery.

Moreover, healthcare facilities have implemented measures to mitigate opioid misuse. For instance, the use of prescription monitoring programs (PMPs) allows providers to track a patient’s prescription history, helping to prevent doctor shopping (Volkow et al., 2014). This not only protects patients from harmful practices but also ensures that healthcare providers make informed decisions regarding pain management. As NPs adapt to these innovative practices, they will be critical in leading efforts toward responsible opioid prescribing.

Additionally, adopting an opioid-free analgesia approach, particularly in the ERAS context, can yield positive outcomes. Studies have shown that opioid-sparing techniques, such as regional anesthesia and non-steroidal anti-inflammatory drugs (NSAIDs), can achieve effective pain relief with fewer side effects (Kamdar et al., 2017). Encouraging collaborations between NPs and anesthesiologists is essential in adopting these approaches on a broader scale.

Besides clinical interventions, a significant component in addressing the opioid crisis lies in addressing the behavioral aspects of pain management. Understanding that patients with chronic pain often carry psychological burdens is vital (Krebs et al., 2018). Consequently, integrating behavioral health strategies in pain management plans can help support patients more holistically while reducing opioid reliance.

In conclusion, the opioid crisis presents a complex challenge requiring multifaceted solutions that empower nurse practitioners to operate within an independent, fully capable role. Legislative support for reforms that enhance NP autonomy, coupled with strategies like ERAS and opioid-free practices, stands to significantly impact patient care. By focusing on education, patient expectation management, and multidisciplinary collaboration, healthcare providers can navigate effectively through the complexities of the opioid epidemic and work towards healthier outcomes in pain management.

References

• Bensing, J. M., Verhaak, P. F. M., & van den Brink-Muinen, A. (2019). The role of pre-operative pain expectations in post-operative pain and recovery. Journal of Pain Research, 12, 2379-2389.
• Jones, G. H., Bruera, E., Abdi, S., & Kantarjian, H. (2018). The opioid epidemic in the United States- Overview, origins, and potential solutions. Cancer, 124(22), 4278-4290.
• Kamdar, N. V., Hoftman, N., Rahman, S., & Cannesson, M. (2017). Opioid-free analgesia in the era of enhanced recovery after surgery and the surgical home: Implications for postoperative outcomes and population health. Anesthesia & Analgesia, 125(4), 1514-1527.
• Krebs, E. E., Asche, S. E., & Bair, M. J. (2018). Challenges in managing pain for older adults: Navigating between efficacy and safety. Expert Review of Neurotherapeutics, 18(11), 931-940.
• Poghosyan, L., Norful, A., & Laugesen, M. (2018). Removing restrictions on nurse practitioners’ scope of practice in New York State: Physicians’ and nurse practitioners’ perspectives. Journal of the American Association of Nurse Practitioners, 30(6), 299-306.
• Volkow, N. D., McLellan, A. T., & Mather, J. (2014). Drug addiction and its impact on the brain. Journal of Addiction Medicine, 8(7), 69-80.
• Walden, A. (2018). The impact of nurse practitioners on quality care and opioid prescribing. Nursing Outlook, 66(4), 363-370.
• American Academy of Nurse Practitioners. (2019). Nurse practitioner role in managing the opioid crisis. Retrieved from [URL]
• Centers for Disease Control and Prevention. (2020). Understanding the epidemic. Retrieved from [URL]