by frankieleon/ via flickr
It was widely reported in the past week that there have been steady declines in the number of opioid prescriptions in the U.S. for the past three years, with the declines the steepest in some of the states considered to have the worst opioid misuse crises.
This is good news, suggesting that efforts to address some problem areas like renegade pain clinics prescribing for profit, patients who go from doctor to doctor seeking opioid prescriptions, and the diversion of legitimate opioid prescriptions may be starting to bear fruit.
A balanced overview of the situation can be found in this New York Times article. The authors also acknowledge that patients in pain are now facing new hurdles to pain relief, quoting the director of one prominent medical school’s program on pain research education and policy: “The climate has definitely shifted. . . . It is now one of reluctance, fear of consequences and encumbrance with administrative hurdles. A lot of patients who are appropriate candidates for opioids have been caught up in that response.”
Much of the reporting on the opioid epidemic lumps all people who take opioids into one big statistical brew. While startling and alarming numbers about overdoses from legal and illegal opioids steal the headlines, little media and scholarly analysis focuses on the lower likelihood of opioid misuse or overdose seen in the large subset of patients who do not have a history of opioid misuse and/or mental illness, are not taking illegal opioids like heroin, and not using opioid medications that they were not prescribed.
Nurses owe it to themselves and their patients to have an informed, undogmatic understanding of opioids and their use. With this in mind, AJN has upcoming articles on opioids and their use with different patient populations, including a July CE that will take a comprehensive look at the appropriate and safe use of opioids in treating chronic pain. In the meantime, here are several recent articles of note about opioid medications.
A significant percentage of prescription opioid overdoses occur among people taking drugs for which they do not have documented prescriptions. Renee Manworren helps nurses understand and help prevent drug diversion in a recent CE article, “Nurses’ Role in Preventing Prescription Opioid Diversion.”
“I’m Worried About People in Pain,” the January 2016 AJN Viewpoint essay by nurse and pain management expert Carol Curtiss, expresses concern about increased stigmatization being encountered by pain patients as well as the unintended effects of new restrictions on doctors’ prescribing. Curtiss notes that the new climate has resulted in increasing numbers of physicians who are not prescribing opiates at all.
And in “Ethical Practice with Patients in Pain,” nurse and ethicist Doug Olsen explores several hypothetical patient scenarios. Olsen urges nurses to eschew easy answers:
The complex nature of pain complicates efforts to provide treatment that is ‘just right.’ Nurses must understand that complexity if they are to make ethical decisions in the care of patients who experience pain.
Feel free to let us know about other aspects of this topic you’d like us to explore.
Hello,
My name is Alejandro Sanchez and I am currently in nursing school. This issue has been of particular interest to me. I have had many encounters with patients who have required opioids for pain management throughout my clinical rotations. My sister is also the office manager at a pain management clinic. Through my own experiences and the countless stories I have heard, it is clear to me that there is great dogma about opioid use for chronic pain management. It is common to put all long-term opioid users under the same drug seeking umbrella. I understand that over-dispersion of opioids is a concern in many countries, due to the fact that many clients abuse their medication in a pathological manner. However, I believe the stigma that has emerged regarding opioid use has impeded many patients from seeking adequate forms of pain relief. It is also important to note that many patients who are labeled as drug addicts are simply responding to a physiological dependence created by chronic opioid use. Many patients who have chronic pain also deal with other life stressors, such as unemployment, unsatisfactory social relationships, and depression. Some patients turn to opioid abuse as a coping mechanism simply because their other needs are not being addressed. I am happy to see that the numbers indicate opioid over-dispersion is being addressed, but I also agree that nurses should be taking an unbiased approach when treating patients that require long-term pain medications. As noted by this blog, by increasing our understanding of opioids and treatment management – we better serve our patients. I greatly thank you for composing this post.