One of the biggest issues facing American healthcare providers is the opioid epidemic. While laws and regulations are in place to help with reform, the situation remains dire.
In 2016, more than 64,000 Americans died from drug overdoses – nearly double the amount of a decade earlier. Of those, more than 20,000 were related to fentanyl and other synthetic opioids, according to the National Institute on Drug Abuse. Between the years of 2002-2015, heroin-related deaths increased annually to about 13,000 in 2015 from about 2,000 in 2002.
Opioids are used as pain relievers and can be highly addictive if misused. Most are prescribed by a doctor, and include drugs like oxycodone, hydrocodone and morphine. Some patients also receive prescription fentanyl for severe pain.
A 2018 Centers for Disease Control study found that emergency room visits for opioid overdoses are up 30%, despite recent efforts to combat the epidemic. When patients are brought into the ER, their first evaluator is generally a nurse, who can play a big role in combating the opioid crisis.
Advocating for Patients
“This is really a fast-moving epidemic that’s getting worse,” said Dr. Anne Schuchat, acting director of the CDC, in an interview with CNN. “The increases in overdoses were seen in adults of all age groups. They were seen in men and women. They were seen in every geographic region in the nation.”
Patients from every walk of life come into ERs with opioid addiction symptoms. Some believe they can’t or simply won’t seek the help they need because addiction can be perceived as related to criminal behavior. Removing the stigma of addiction is a first step toward helping patients.
“From a national level, there’s a huge focus on the opioid crisis. What’s really sad is addiction is a disease process; yet, we have criminalized it,” said Dr. Roberta Christopher, an assistant professor at the Keigwin School of Nursing at Jacksonville University. “There has been a sharp decrease in funding for integrated mental healthcare as a whole. Even if someone is seeking help, there’s sometimes a six-month wait for an appointment to speak with a counselor. Access is a huge issue. Because we criminalized what really is a disease – I think we need to rethink the model of care/services for addiction.”
Nurses might need to reach out to patients and help them get access to mental health care or rehabilitation facilities or help them with new pain management strategies that do not involve the use of opioids. For example, if a patient suffers from chronic back pain, a nurse can help them enroll in a program that incorporates physical therapy.
Focusing on a plan with steps toward prevention of the opioid abuse, treatment of the addiction and an effective recovery effort gives nurses a way to help patients and also work toward fighting off the stigma that comes with addiction.
Continuing education is another way nurses can advocate for their patients, whether that be through attending conferences or getting a Master of Science in Nursing degree to learn about trends and new ways to fight the epidemic.
Advocating with lawmakers is also important. If the drug naloxone, which can prevent overdose deaths, can be more widely distributed, it can help reach those with overdose symptoms sooner.
Nurses can use their voices to be heard, whether it be through a professional organization like the American Nurses Association or by writing to their local representatives.
Congress recently approved $6 billion to aid in the fight against opioid abuse and help with mental health services but some feel that isn’t enough.
“If it were some other illness, we would be throwing exponentially more dollars at this than we are,” said Patrick Kennedy, a former Rhode Island congressman in an interview with The Hill. “We would be mobilizing significantly more federal resources toward tackling this. We would be marshaling every agency within the federal government to attack this.”
Protecting Themselves and Other First Responders
In August 2017, three nurses fell ill while cleaning up the room of an overdose patient. Authorities believed the illness was caused by exposure to fentanyl. The nurses had to be treated with Narcan, an opioid antagonist that counteracts the potentially deadly effect of an overdose. These cases show that medical personnel as well as law enforcement need to have protocols in place to protect themselves.
For nurses, it’s important to know the signs and symptoms of secondary opioid exposure. Knowing these and being able to recognize them can help potentially save lives after exposure. This is especially true with the rise of stronger opioids like carfentanyl, an animal tranquilizer that’s 100 times more powerful than fentanyl.
Signs and symptoms of secondary exposure, according to fentanylsafety.com, include:
- Altered state of consciousness, which may manifest through confusion, excessive drowsiness or nonresponse to pain or other stimuli
- Respiratory issues like slow, shallow breathing, blue lips or respiratory arrest
- Altered vital signs such as slower heart rate, low blood pressure or dizziness
Collaborating with Others in the Fight
Many cities are working to create a unified plan to fight the opioid epidemic. In Jacksonville, Fla., many educational and hospital leaders from all over north and central Florida met at Jacksonville University’s Patient Safety Forum to discuss the role they could play in the fight, highlighting innovative solutions and ways to improve patient safety.
Nurses and other healthcare providers can work with educators, law enforcement and mental health counselors to create integrated solutions that can help opioid addicts get the assistance they need.
“JU offers a mental health counseling program – the university is trying to increase programs, so we can increase the number of providers, resources and access – right now, there’s just not enough,” Christopher said.