As health care providers, it is crucial to know how to identify, how to prevent, and how to educate patients on opioid addition.
Learn How YOU Can Be the Change
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The Problem
Access to both prescribed and non-prescribed opioids has increased greatly in the last 20 years.
This spike in opioid prescription has increased healthcare costs, as opioids are more expensive than non-opioid analgesics, and require closer monitoring.
From 1999 to 2010, fatal opioid overdoses quadruples from about 4,000 to 16,000 deaths.
The CDC reported that for every unintentional overdose death related to an opioid analgesic…
- 9 people are admitted for substance abuse treatment
- 35 visit emergency departments
- 161 report drug abuse or dependence
- 461 report nonmedical uses of opioid analgesics
Why is Opioid Use/ Abuse Dangerous?
- Death/ Unintentional overdose
- Dependence
- Physical dependence
- Psychological dependence
- Financial strain
- DIfficulty in relationships
- Increased healthcare costs
- Increased health risks
Note: When opioids are prescribed to outpatients, side effects are less controlled, medication diversion can occur, and risk of dependence is heightened due to decreased supervision.
Who is at risk?
- Those suffering from mental health disorders or substance abuse disorders
- Young adults have highest rate of opioid abuse and dependence
- Middle age adults have highest rate overdose and death from opioids
- Low socioeconomic class
- Men have higher rate than women
- Caucasian are at highest risk
What can Health Care providers do?
EDUCATE!
It is the responsibility of all healthcare providers to educate themselves about the opioid epidemic, reduce risk in their daily practice, and equip patients with the facts they need to stay safe.
Let’s start here.
What is an opioid?
Mechanism of Action: reduces neuronal cell excitability and transmission of nociceptive impulses
Side effects: analgesia, sedation, mood changes, physical and psychological dependence, tolerance and sense of euphoria
Legal or illegal: both!
What drugs are classified as opioids?
- Fentanyl
- Morphine
- Dilaudid
- Oxycodone
- Heroine
- Codeine
- Methadone
1. The first step in reducing opioid misuse is to prescribe opioids conservatively
2. Providers should set a clear goal for opioid weaning
Discuss that with the patient, while warning them about risks for opioid dependence. That process should be performed even when opioids are prescribed once for post-operative reasons, so that abuse and diversion is prevented rather than just reacted to. Overall, such education helps patients exercise caution when using opioid medications, and motivates them to wean themselves so that insidious addiction does not set in. All who receive an opioid prescription should be informed about side effects, overdose, and safe medication storage as well.
3. Use evidence based tools to determine need
While opioids should be prescribed carefully, they are sometimes truly needed for pain relief. Fortunately, providers can use evidence-based tools to determine a patient’s risk of misusing prescription opioids, such as a semi-structured clinical interview. The interview addresses patients’ emotional concerns, substance abuse history, and social factors, which are considered together to determine risIf a particular patient who needs opioids is also at high risk for abuse, they can be identified through such an interview. Providers can then monitor such patients closely through pill counts and drug screens based on agency policy, and support them with psychosocial resources.
4. Prescription drug monitoring programs
Providers can also use prescription drug monitoring programs to assess a particular patient’s opioid use history. They are maintained by state governments, and indicate how many physicians and pharmacies a patient has obtained opioids from. It is crucial for providers to check those databases before prescribing opioids, not only to protect the patient and community, but their own professional integrity as well.
5. Assess risks
As with all high-risk medications; prescribers, nurses, and pharmacists should identify patients at particular risk for adverse effects, and observe the six rights of medication administration. If the patient, medication, indication, dose, route, and timing are considered by all providers involved, errors and sentinel events are far less likely to occur. Special patient populations to consider include opioid naïve patients, who should be started on minimal doses and monitored carefully for adverse effects. Providers should also know that opioid analgesic use increases elderly patients’ risk for fractures, cardiovascular events, and hospitalization. That necessitates a careful evaluation of risk vs benefit when providing opioids to geriatric clients.
6. Tertiary prevention
Finally, tertiary prevention is an important step in addressing the opioid crisis, as an immense number of people are already affected. Community-based rehabilitation programs such as narcotics anonymous are expanding to support recovering addicts. In recent years, first responders and community members have been armed with naloxone or “Narcan” in a public health effort to reverse overdoses. In some communities, individuals at risk of opioid overdose, their family members, and residents of high-risk neighborhoods are being trained to use narcan. They are then given doses of Narcan to use in case of emergency, and may receive information on opioid cessation resources as well.
Detecting Inappropriate Prescribing of Opioids and Medical Errors
- incorrect patient selection (opioid-naive patients
- off-label us
- incorrect indication (eg, “as needed” use of extended-release formulations
- incorrect dosage
- conversion errors
Evidence Based Interventions
Primary Prevention is Key!
- Improving the way physicians prescribe opioids will aid in preventing abuse.
- There needs to be a more regimented system across the the country
- Community based preventions
- Increasing prevention of addictive behaviors through education and multifaceted policies
- Education centered around: proper use of opioids, weaning off of and storage of opioids; the benefits, side effects, and risks associated with opioids
- By giving children education on the risks and dangers of opioids, increasing their decision making skills and resisting peer pressure they were 31% more likely to not be using gateway drugs in high school.
- Community drop off sites for prescriptions that are no longer being used so they will not go into circulation. I
- “National Perscription Take Back Day” or local pharmacies having drop off boxes for expired, unused and/or unwanted medications.
Alternative Pain Management
Lets focus on other ways to manage pain first before the prescription
- Massage therapy
- Music
- Smartphone Apps
- Anti-anxiety medications
- Warm/cold packs
- Group therapy sessions
The goal: cut back on unnecessary opioid use
Alternative Treatment for Stress/ Anxiety
Everyone is different in what helps relieve their stress but there are many different ways to achieve relief
- Aromatherapy
- Massage therapy
- Music
- Counseling
- Meditation
- Exercise
- Support system
- Deep Breathing
Resources
Netcare Access Crisis Hotline: 614-276-CARE (2273).
Opiate Crisis Line: 614-724-HOPE (4673)
Central Ohio Area of Narcotics Anonymous
1313 East Broad Street, Columbus, Ohio 43205
Phone: 614-252-1700
Website: http://www.nacentralohio.org/
Website to find a meeting: http://www.nacentralohio.org/meetings.php
SMART Recovery
Phone: 614-439-1813 (Dan)
Website: http://www.smartrecovery.org/meetings_db/view/showalpha_state.php?search=O – Ohio Meetings
Celebrate Recovery Meetings (Faith Based)
61 S. Powell Avenue
Website: www.celebraterecovery.com
Westgate United Methodist Church
Sunday 11:00 AM
Heroin Anonymous
Website: www.heroinanonymous.org
Closest location is Reynoldsburg
Safe Point
Phone: 614-460-1406
Website: www.safepointohio.org
Participants have access to the following services:
- Syringe access and safer injection use education
- HIV/STI/Hepatitis C testing and linkage to care
- Primary medical care
- Drug intervention treatment referrals & counseling
- Overdose prevention education
- PrEP referrals
- 22G syringes for the trans community
Pass along this information to your co-workers, employer, and patients!
Additional Resources for Health Care Providers
The American Academy of Addiction Psychiatry
The American Academy of Addiction Psychiatry (AAAP) consist of health professionals whose mission include promotion of high quality evidence-based screening, assessment, and treatment for substance use disorders, dissemination of evidence-based research to clinical practice and public policy, education for the safe and humane treatment for those with substance use disorders, and providing evidence-based addiction education to health care professionals.Their website has information about furthering education and training, resources for patients, and a list of practitioner resources, including but not limited to various educational resources, support resources for safe opioid prescribing, overdose prevention toolkits, and CDC podcasts on alcohol screening and brief counseling.
https://www.aaap.org/practitioner-resources/
Community Anti-Drug Coalitions of America
Community Anti-Drug Coalitions of America (CADCA) is a leading substance abuse prevention organization, representing over 5,000 community-based coalitions across the United States and in 22 countries who work to create safe, healthy, and drug free communities. CADCA’s resources include a wide range of tools and publications related to prevention and reduction of alcohol, tobacco, and other addictive substances use
http://www.cadca.org/resources
Centers for Disease Control and Prevention
This area of the CDC’s website focuses on opioid overdose training for providers, supplying a variety of information and training for both patients and healthcare providers. Some of the information available to patients include content regarding other alternatives to opioids that can help pain management. Healthcare provider resources include interactive learning specifically for prescribing opioids and how to aid in the prevention of overdose and misuse.
https://www.cdc.gov/drugoverdose/training/index.html
Evaluation of Assessment Tools used in Assessment of Opioid Use and Abuse
This article compares and evaluates twenty-five different screening tools for assessment of opioid addiction risk in noncancer patients for pain clinicians to use in practice. The authors stress that when using a screening tool, the clinician must assess the psychometrics and intentions of each tool in order to get the appropriate result. For example, ORT, DIRE, and SOAPP screenings may be most viable in assessing patients for opioid abuse potential when considering long-term opioid therapy. Other screening tools are assessed and categorized based on patient population and other considerations, allowing for practitioners to choose the best tool that fits their patient’s needs.
American Psychiatric Nurses Association
The American Psychiatric Nurses Association has online educational resources that provides information for nurses on effective treatments for opioid use disorders. There are three targeted audiences, which include registered nurses, psychiatric-mental health RN’s, and advanced practice nurses, delivering the educational material to the audience based on their scope of practice. In order to access this resource you must register, for free, with the APNA.
https://www.apna.org/i4a/pages/index.cfm?pageid=3310
Common Screening Tools for Predicting Patients At Risk for Violating Opioid Medication Policies
This study investigates various measures pain management centers and providers use to assess risk of violating opioid medication policies, otherwise known as aberrant drug-related behavior. The results show that the clinical interview combined with the Screener and Opioid Assessment for Patients with Pain is the most sensitive test. Ultimately, it was concluded that intensive opioid treatment for those who are at high risk for aberrant drug-related behavior is possible, but it requires many resources, as monitoring would involve weekly visits & pill counts, increased psychological and social work interventions, and frequent urinary drug screens.
The Management of Opioid-Dependent Patient’s Pain in the Clinical Setting
This study provides relevant statistics regarding the opioid crisis, definitions/criteria for abuse vs. dependence, and also information regarding the stigma revolving around this topic. The research focuses on management of opioid dependence in the hospital setting, making it a relevant tool for healthcare providers in caring for these patients. Inadequate training for healthcare professionals, particularly nurses, was noted as a barrier to getting patients the highest quality of care. The study outlined a measure to screen for opioid abuse/dependence in order to implement primary prevention and rapid detection of abuse in order for early intervention.