The opioid epidemic knows no boundaries. The epidemic is not limited to race, profession or socioeconomic status. Since 1999, the number of overdose deaths involving opioids (heroin and prescribed opioids) nearly quadrupled with more people dying from drug overdoses in 2014 than recorded in any prior year. The Centers for Disease Control and Prevention (CDC) reports that 78 Americans die every day from an opioid overdose. At least half of all opioid overdose deaths involve a prescription opioid.
Despite recent initiatives that have been put into place to curb the number of opioid related deaths, such as public availability of the opioid antidote naloxone, it is essential to address the root cause of the issue. According to the CDC, the three areas that must be targeted to address this epidemic relate to: 1) improve prescribing of opioids; 2) expand treatment of addiction; and 3) reduce access to illegal opioids. Nurses are uniquely positioned to combat this epidemic and play a pivotal role in the prescribing of opioids as well as steering those suffering from drug addiction to available treatment options and community services.
Education is an essential factor in reducing opioid deaths. Both health care providers and consumers must be aware of evidence supporting the correlation between prescription opioid use, and opioid use disorder and overdose, particularly with high doses and long-term use. It is important to note that the new evidence-based guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.
In April, Deborah Trautman, PhD, RN, FAAN, President and Chief Executive Officer of the American Association of Colleges of Nursing (AACN), the national voice for baccalaureate and graduate nursing education, was asked to provide remarks to the White House Champions of Change for Prevention, Treatment, and Recovery event in Washington, D.C. Recently, I reached out to Dr. Trautman with a few questions in an attempt to garner her thoughts about the opioid epidemic and the role that nursing plays in addressing this nationwide crisis. My questions, along with her answers to these critical questions follow:
According to the CDC, the amount of prescription opioids sold in the U.S. nearly quadrupled since 1999, yet there has not been an overall change in the amount of pain that Americans report. Deaths from prescription opioids--drugs like oxycodone, hydrocodone, and methadone--have also quadrupled since 1999. How can you explain this increase in prescribed opioids?
According to the Centers for Disease Control and Prevention (CDC), more Americans die each year from drug overdoses than in motor vehicle accidents, and the majority of those overdoses involve prescription medications. The National Institute on Drug Abuse has identified several contributing factors to the nation's prescription drug abuse problem, including a large increase in the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and widespread consumer awareness of available medications. These factors combined have resulted in greater "environmental availability" of prescription medications in general and opioids in particular.
What role does the nursing community play in this epidemic?
As the largest segment of the healthcare workforce, nurses play a critical role in treating and counseling individuals suffering from drug addiction. Advanced Practice Registered Nurses (APRNs), including Nurse Practitioners - the third largest opioid prescribing group for individuals with Medicare Part D according to the Centers for Medicare and Medicaid Services (CMS) - are committed to adopting responsible prescribing practices using the evidence-based guidelines advanced by the CDC.
What can the nursing community do to reverse this trend and address this crisis?
The good news is that results from the National Survey on Drug Use and Health indicate the rate of opioid prescribing peaked in 2012. With additional guidance put forth by the CDC Guideline for Prescribing Opioids for Chronic Pain, providers are more equipped than ever to prescribe opioids responsibly.
How do you see nursing education changing in the future due to this crisis?
Academic nursing is committed to protecting the public's health by taking decisive action to address the nation's opioid epidemic. AACN has led the national effort to enhance the education of students in APRN programs on safe prescribing practices. Over the past 3 months, more than 200 schools of nursing with APRN programs have pledged to educate their students on the CDC Guideline for Prescribing Opioids for Chronic Pain. The addition of this content compliments the information APRN students currently receive on such topics as pain management and substance abuse.
AACN is committed to working with the larger APRN community - including the American Association of Nurse Anesthetists, the American Association of Nurse Practitioners, the American College of Nurse-Midwives, the American Nurses Association, the National Association of Clinical Nurse Specialists, and the National Organization of Nurse Practitioner Faculties - to launch a new online educational series that will serve as a resource for practicing nurses, faculty, and students on opioid topics including: an overview of the current need to address opioid use disorder and overdose; integrating timely content into curricula; and the CDC's new prescribing guideline.
How can consumers partner with their health care provider to address this nationwide problem?
Nurses are patient advocates who are well-positioned to help steer those suffering from drug addiction to available treatment options and community services. Consumers are encouraged to seek the expertise of nurses who typically know best when it comes to navigating the healthcare systems.
In your opinion, what is the biggest myth about the opioid crisis?
Prescription opioids are an essential part of treatment for many individuals. It's important that any policy changes that may be coming do not deter providers from prescribing opioids in appropriate situations or challenge the progress health providers have made in pain management in the last decade.
In summary, the opioid crisis in the U.S. can only be averted through a collaborative effort of health care providers, consumers and community resources. The CDC offers Guideline Information for Patients to assist consumers with understanding the opioid crisis and to learn how they can partner with their provider to receive effective pain management.
Dr. Ruth Tarantine is currently dean of nursing for Colorado Technical University. With over 25 years of nursing experience, she holds a master's degree in nursing from the University of Pittsburgh, and a doctorate of nursing practice from Chatham University.