Prescribing Opioids Research Paper

Opioid addiction is so prevalent in the healthcare system because of the countless number of hospital patients being treated for chronic pain. While opioid analgesics have beneficial painkilling properties, they also yield detrimental dependence and addiction. There is a legitimate need for the health care system to provide powerful medications because prolonged pain limits activities of daily living, work productivity, quality of life, etc. (Taylor, 2015). Patients need to receive appropriate pain treatment, however, opioids need to be prescribed after careful consideration of the benefits and risks.

Nurses should be encouraged to question the doctors if a wrong drug is prescribed. They should also restrain from taking verbal orders. Written signed orders should be mandated.

The use of opioids and other drugs continues to gradually increase in the United State. According to Centers for Disease Control and Prevention (CDC), the number of overdose deaths involving opioids has quadrupled since 1999” (CDC website). Individuals are abusing prescription opioids such as oxycodone, hydrocodone, and methadone. Prescriptions opioids that are supposed to be used as pain relievers, cough suppressants and for withdrawal symptoms are being use by individuals in order to feel relaxed or for the overwhelming effect of euphoria. These types of drugs are to be taken orally, but people are snorting, smoking, and injecting them in order to get a better high. I have personal encounters with opioid drugs and opioid abuser on a regular

While our major access to these drugs is doctors, we cannot simply lay blame on them, as there is not enough knowledge about these treatments to correctly appropriate drugs, and therefore extra is given (Hemphill 373). Alexander of the Department of Epidemiology of the Journal of the American Medical Association, states that “There are serious gaps in the knowledge base regarding opioid use for other chronic nonmalignant pain” (Alexander 1865-1866), which leads to the unfortunately large number of leftover drugs. In fact, the main place that people get their drugs are from leftover prescriptions (Hemphill 373).

The capstone project investigates and explores nurses’ role in helping to address the opioid epidemic through evidence-based patient and family education. A PICOT statement and PICOT question was formulated based on a topic-related evidence review and using the guidelines provided by Asiam and Emmanuel (2010) and the center for Evidence-Based Medicine (CEBM) (2017).

There is no question that the alarming rate of deaths related to opioid overdose needs to be addressed in this county, but the way to solve the problem seems to remain a trial and error approach at this point. A patient is injured, undergoes surgery, experiences normal wear and tear on a hip, knee or back and has to live with that pain for the rest of their life or take a narcotic pain medication in order to improve their quality of life and at least be able to move. The above patients are what narcotic pain medications were created for, a population of people that use narcotic pain medications for fun is what is creating a problem. Narcotics are addictive to both populations, however taking the narcotic for euphoric reasons is not the intention of the prescription that the physician is writing. The healthcare system needs to find a way to continue to provide patients that experience chronic pain with the narcotics that work for them while attempting to ensure the Drug Enforcement Agency (DEA) doesn’t have to worry about a flood of pain pills hitting the streets by granting access to the population with a substance abuse problem.

The United States currently faces an unprecedented epidemic of opioid addiction. This includes painkillers, heroin, and other drugs made from the same base chemical. In the couple of years, approximately one out of twenty Americans reported misuse or abuse of prescriptions painkillers. Heroin abuse and overdoses are on the rise and are the leading cause of injury deaths, surpassing car accidents and gun shots. The current problem differs from the opioid addiction outbreaks of the past in that it is also predominant in the middle and affluent classes. Ultimately, anyone can be fighting a battle with addiction and it is important for family members and loved ones to know the signs. The cause for this epidemic is that the current spike of opioid abuse can be traced to two decades of increased prescription rates for painkillers by well-meaning physicians.

Not only did insufficient staffing contribute to the causes of this particular event, but human error also played a significant role. When Mr. B arrived at the ED, he was hyperventilating. His leg “appeared shortened.” He had edema in his calf, ecchymosis, limited ROM, and he rated his pain at a ten out of ten. Mr. B also had a history of prostate cancer, impaired glucose tolerance, elevated cholesterol and lipids, and chronic pain. He was admitted to the ED with a plan to relocate his hip. Dr. T ordered diazepam 5.0 mg to be administered through IVP and then just five minutes later ordered 2.0 mg hydromorphone to be administered because it appeared that the diazepam was not having the intended sedating effect. Again, just five minutes later, Dr. T was still not satisfied with the level of sedation and instructed the nurse to

It is important for our culture in western society to educate doctors on how to modify and limit their prescribing behavior so that less people become dependent on opioid medication. Doctors must start limiting and monitoring the number of opioid prescriptions they administer to patients. Limiting the number of prescriptions will lower the chances for potential abuse within patients, as well as lower the ease of access and circulation of opioid medication on the streets.

In fact, there was thought to be more of a need for them. Before the last two decades, opioids were used for cancer related or acute pain. However, in the 1990s chronic non cancer patients got attention because people nationally felt there was a shortage in patients receiving opioids, thus making them deprived of adequate pain management. Because of this, clinicians were encouraged to treat chronic non-cancer pain and patients in hospice care more often than they were used to. It was also encouraged to use high doses of opioids for long periods of time (Cheatle). The idea that providers seemed overly cautious about these medications caused a large increase in opioid prescriptions from health care providers. Threat of tort and litigation for some doctors that were deemed for not prescribing enough to alleviate pain of patients was also a concern for doctors This quickly turned a shortage of prescription opioids into a national prescription opioid abuse epidemic in under twenty years. From 1999 to 2010, the amount of prescription opioids sold to hospitals, pharmacies, and doctors offices quadrupled, and three times the number of people overdosed on painkillers in this time (Garcia). While some patients have benefitted from the increased sales and loose guidelines of prescription opioid analgesics, the increasing in opioid misuse, abuse, and overdose is truly daunting. As a nation, we need to back track, and

Doctors and clinical prescribers have discovered their role in curtailing the increased opioid prescriptions in America. It is without a doubt that they play a role in facilitating the opioid misuse endemic in the past by being enablers of the situations. When patients ask for pain medications, they do not take time to analyze the pain complaints or suggest alternative medications other than opioids. Even in instances when one doctor declines to offer a patient an opioid prescription for their pain needs, the patient is likely to find another who will give the prescription. However, there has been wide recognition of the opioid misuse endemic such that clinical prescribers are practicing more vigilant prescribing and are advocating opioid-free

It has become standard practice for physicians and other prescribers to write a months’ worth of opioid medication for minor, short-term pain conditions. Just two decades ago, opiates were viewed by the medical community as dangerous, addictive and were limited to use only for patients with acute trauma, for end-of-life care, and in cases of cancer pain. Current prescribing practices provide an excess of prescriptions annually, enough for every man and women in the U.S. to have a bottle of opiates (ASAM, 2016). The same formal oath that practitioners pledge to “First, to do no harm,” also advocates that regardless of the treatment focus on disease or ailment, above all, it is a human life that requires sympathy and care. The risks and adverse

In the United States, there has been upward swing of opioid abuse over the past decade. Overdose deaths involving opioids – both prescription pain relievers and heroin – almost quadrupled between 1999 and 2014. Well-intentioned efforts to curb prescription opioid abuse have yielded new policies with unfortunate, unforeseen consequences for the 15% of the US population that suffer from chronic pain – nearly 45 million people.

Roughly 100 million Americans suffer from chronic pain with an annual cost of $600 billion dollars in health care and a limited number of pain specialist physicians (Harle, et al., 2015). The conditions require the daily use of opioid medications which are being prescribed by primary care providers and providers in the ED. Along with multiple prescribers of opioid medications, the number of prescriptions for these medications has quadrupled from 1999-2013 in correlation with an increase in deaths related to opioid use (Greenwood-Ericksen, Poon, Nelson, Weiner, & Schuur, 2016). The significant increase of opioid related deaths and complications is commonly being referred to as the prescription opioid epidemic and to blame for the most unintentional deaths in the US (Smith, et al., 2015). Though responsible for administering and prescribing opioids to provide pain management, nurse practitioners in the ED have limited patient history and are placed under time constraints. Improved education regarding pain management, clinical practice guidelines and the use of resource tools like the Prescription Drug Monitoring Programs (PDMP) have been proven effective for reducing opioid related complications (Greenwood-Ericksen et al.,

All too often and in far too many cases the treatement of pain is becoming the problem. Painkiller addiction has been an epidemic for more than a century and continues to corrupt both the youth and adults of America. While opioids started out with a purpose of pain management, it has now become an industry. Without a stronger regulation of the prescription of pain medicine, doctors will continue to promote the negative effects it has on the users and their loved ones.