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Kayla Coleman, Senior Nursing Student at SCOHS

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Hello,
My name is Kayla Coleman and I will present The Role of the Nurse and the opioid addiction epidemic as my capstone project. I chose this topic  because of the devastating impact it has on our patients, including newborn babies. In 2017, The Department of Health and Human Services declared opioid addiction a public health emergency. Deaths due to drug overdose are on the rise and are expected to get worse without our intervention. Through this poster presentation I will describe the opioid addiction epidemic and explain why it is a growing problem in America. I will discuss the highlighted literature and offer insight on the analysis of the nurse's role in this crisis. I will also provide recommendations to promote the nurse's participation to improve the issue and reflect on how concepts learned during my education at SCOHS has prepared me to transition into a leadership role for professional practice.

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Since the late 1990's, accidental deaths related to overdose of prescription opioids have tripled in numbers. In 2014, over 47,000 drug overdose deaths were reported in the United States. "The rate of drug overdose deaths increased significantly for both sexes, persons aged 25–44 years and ≥55 years, non-Hispanic whites and non-Hispanic blacks, and in the Northeastern, Midwestern, and Southern regions of the United States" (CDC, 2016). This opioid crisis also has big implications for the adolescent population as well as significant increases in usage among pregnant women resulting in drug withdrawal syndrome in newborns.
It is strongly believed that the root of this growing epidemic stems from the misuse of opioid prescriptions. An increase in prescribed opioids by health care providers have contributed to the widespread abuse of both non-prescribed and prescribed opioids. Several reputable resources believe the opioid overdose epidemic is getting worse.

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Natural and semi-synthetic opioids are a group of drugs which includes the street drug heroin and commonly prescribed pain relievers like morphine, oxycodone, hydrocodone, codeine and fentanyl. According to the U.S. Department of Health And Human Services, pharmaceutical drug companies were adamant early on that patients would not become addicted to opioid pain relievers. As a result, health care providers began to increase their prescribing rates, leading to the widespread misuse and increased rates of drug overdoses.
What do we know about the opioid crisis?

·      Roughly 21-29 percent of patients prescribed opioids for chronic pain misuse them

·      Between 8 and 12 percent develop an opioid use disorder

·      An estimated 4-6 percent who misuse prescription opioids transition to heroin

·      About 80 percent of people who use heroin first misused prescription opioids

·      Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states

·      The Midwestern region saw opioid overdoses increase 70 percent from July 2016 through September 2017

·      Opioid overdoses in large cities increase by 54 percent in 16 states

(National Institute on Drug Abuse, 2018).

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The nurse's involvement is important because most often it is the nurse who is first to encounter a patient who may be experiencing an overdose. "Registered nurses are qualified and well positioned to play a leading role in assessing, diagnosing, and managing patients battling addiction" (The Sentinel Watch, 2018).
Additionally, the nurse can help with educating patients during medication reconciliation, they can teach patients not to share medications with family members, and also educate themselves by completing continuing education courses regarding pain management. The nurse's involvement does help with improving the opioid crisis but it will not solve it.

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Bioethics and character virtues are some examples of leadership concepts that I learned during my education at Sentara College of Health Sciences. I feel that these two concepts would help me as a leader in the issue of opioid addiction or any situation in health care. Bioethics specifically relates to health care and how professionals should act during ethical situations. Virtue deals with nurse's individual characteristics. There are five virtues that are considered to be primary for health care professionals: compassion, discernment, trustworthiness, integrity, and conscientiousness.
Nursing is one of the most trusted professions. It is believed and expected that nurses possess all of these characteristics and more. As a nurse you are a leader and a manager. You are expected to be involved in every aspect of patient care including being fierce advocators for change and improvements in politics. Leadership is being able to effectively use your skills and knowledge to influence others to reach a common goal. A good nursing leader must possess the five virtues and uphold ethical and moral values of the nursing profession even when you feel challenged to get involved. Issues like opioid addiction may cause a nurse to question the need for intervention based on her personal values. A good leader must recognize this and remember to do what is right for the patient.

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If the nurse is already involved in the participation to improve the issue of opioid addiction, participation can be strengthened by:
1. Educating patients during the medication reconciliation process regarding tolerance, misuse, physical dependence and drug diversion. They should provide verbal and written instructions about the usage, dosing, adverse effects and how the medication is to be taken and how to dispose of it.

2. Nurses could advocate for change in policies that support expanded access to medication-assisted treatment for addiction and drug take-back programs. They could also advocate for the responsible distribution of the overdose reversal drug, naloxone.

3. Advance practice nurses that can legally prescribe medications should also consider non-pharmacological methods when treating for pain or use non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen.

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Currently in most settings nurses are conducting assessments and screenings, applying evidence-based practice with pain management, educating patients about pain medication precautions and referring patients as needed for further treatment and evaluation. Each state and individual hospitals have different protocols in place for recognizing and treating substance abuse. Some screening tools often utilized by  nurses are the National Institute on Drug Abuse (NIDA) quick screen and the Screening, Brief Intervention, and Referral to Treatment (SBIRT). Both screening tools provide methods for selecting the proper referral and treatment options needed to care for these patients. I feel that nurses are doing whatever they can within their scope of practice to improve the issue of the opioid addiction epidemic. (Minority Nurse, 2017).

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Commonly prescribed opioids originally thought to be harmless are now deemed highly addictive with potentially deadly consequences.  An increase in written prescriptions by providers contributed to widespread misuse and increased overdoses. As health care providers we must do what is legally, ethically and morally right to intervene and prevent this crisis from worsening. Some recommendations to improve this issue include: improving access to treatment and services, promoting for use of overdose-reversing drugs, strengthening awareness through education, providing support for patients and families and promoting evidence-based practices to improve pain management strategies. Nurses are in a unique position and play an important role in assessing, educating and advocating for the care of these patients.
Any questions about the presentation please ask or comment below.

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Some nurses may not be participating or may be limited in playing a role in the opioid epidemic based on their personal beliefs or values. Drug addiction and overdose is often looked down upon in our society and can present many challenges for the nurse. As nurses we must always remain neutral and non-judgemental when it comes to caring for patients with addiction. We must also remember that patients who are addicted to pain medications also need our help because their dependence on the medications is also a health crisis and is beyond their control. Nurses have an individual, ethical and legal responsibility for all patients that they care for. True advocacy for our patients means letting go of your personal beliefs and values and remaining committed to the care of the patients who need our help.

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Retrieved from: https://www.drugabuse.gov/sites/default/files/pdf/nmassist.pdf

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Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/infographics/dramatic-increases-in-maternal-opioid-use-neonatal-abstinence-syndrome

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Retrieved from https://www.hhs.gov/opioids

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Retrieved from https://www.nursingworld.org/~4ae212/globalassets/docs/ana/ana_nursings-role-in-opioid-crisis_2016.pdf