About 78 people die from opioid overdose everyday. Since 2000, the total death count has accumulated to nearly a half a million people. Centers for Disease Control and Prevention (CDC) also reports that out of all opioid overdose deaths, nearly half are a result of prescription opioids. In order to address the opioid crisis, medical professionals and patients must be properly educated on the matter.
WHAT NURSES CAN DO
No pressure, but nurses play a pivotal role in the opioid crisis. Once a patient is prescribed opioids to manage their pain, it is imperative to follow through with pain management. And pain management is only as effective as its communication. Let the patient know that the objective of the opioid is to get them back to a productive life, and a pain-free one may not be possible.
The key is non-confrontational language when working with irritable patients, especially those with chronic pain. The US department of Veterans Affairs’ Guide to Pain Management and Opioid Safety provides some examples of non-confrontational phrases:
- Instead of: “There’s nothing wrong with you” Use: “We can’t measure your pain with tests”
- Instead of: “Accept your pain” Use: “Expect pain to be a small part of your life”
- Instead of: “You’ll have to live with pain” Use: “We want you to live better with pain”
- Instead of: “Nothing can be done” Use: “No medical solutions does not mean no solutions”
An increase in dosage is an increase of risk
If the prescribed dosage is just not enough, consider a rotation in opioids in order to avoid an increase in dosage. Benefits to an opioid rotation include a possible improvement in side effects and efficacy. In fact, reports indicate that 50–80% of patients found that their pain control was either maintained or improved after rotating opioids. However, a rotation doesn’t necessarily mean switching from one opioid to another. A short-acting opioid can be rotated with a long-acting medication.
Know the risk factors
According to the Guide to Pain Management and Opioid Safety, there are a few precautionary steps a nurse can take to spot risk factors in patients to prevent opioid abuse. It may be obvious, but reviewing a patient’s mental illness and drug use history is one of the most effective ways to find if your patient is at risk. When reviewing drug use histories, take your time and keep an eye out for drugs that contain sedative properties. And be sure to communicate the dangers of certain drug combinations with your patients.
Have a suspicion your patient is addicted or is misusing the prescribed opioids? Suggest performing exams, such as a urine drug test (UDT), the Opioid Risk Tool (ORT), or the Screener and Opioid Assessment for Patient with Pain-Revised (SOAPP-R). Most patients who are prescribed opioids undergo a UDT once a year, but the frequency should be increased if they’re at risk. Once abuse is confirmed, stop the opioid immediately. And educate your patient on the effects of withdraw and their options on how to cope.