NR 506 Discussion Policy-Priority Selection

I have been having a difficult time choosing my healthcare policy priority, mainly because I am worried that it is one that is being talked about by everyone lately. However, with that being said, I have chosen the Opioid Epidemic or the Opioid Overdose Crisis. I have chosen this topic because it specifically has been a problem I have witnessed with patients, and people within surrounding communities. It also is something that could be reduced if laws were different.

According to the National Institute on Drug Abuse (2018), Each day 115 Americans die from opioid overdoses, which means nearly 42,000 people die annually from a preventable cause. I grew up in a town of 1,000 people, so for me to see this amount of people die annually is baffling.

The estimated total “economic burden” for the US each year is $78.5 billion a year, as per The Center for Disease Control and Prevention, (2017). This is said to include the misuse of opioid prescriptions, cost of healthcare, loss of productivity, addiction alone, and the involvement of criminal justice (National Institute on Drug Abuse, 2018).

I think that as far as sources of healthcare policy, this policy would be at the Organizational level, because it would be required to meet FDA requirements, and have multiple organizations involved in decision making as well as including multiple organizations’ data. This would be a public policy.

This topic is important to me, because as nurses we all have a few patients that we say we will never forget. One of these patients for me was a 21 year old. He was admitted for altered mental status and was on a Narcan drip. Once he began to wake up he told us that he had just tried a pill and this is what happened to him. He stated it was his first time, and he had no previous history of drug abuse. The doctor then decided to discharge him this day, and everyone chalked it up to a young college kid making a stupid choice and trying a pill that was given to him.” Not 12 hours later the same young 21 year old ended up in the ER. He was being coded en route to the hospital, and after a long attempt at resuscitation, he did not make it. This patient had access to Fentanyl patches and was apparently cutting them open and eating them. This was a definite eye opening experience for me. There are also been newspaper reports in a surrounding community about five to 10 Narcan kits being used each weekend. It just amazes me that this situation has gotten so out of control over the last several years.

References:

National Institute on Drug Abuse. (2018). Opioid overdose crisis. Retrieved from: https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

The Center for Disease Control and Prevention. (2017). National Vitals Statistics System, Mortality. Retrieved from: https://wonder.cdc.gov

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS NR 506 Discussion Policy-Priority Selection:

I think that there should be required follow up between the provider and patient once opiods are prescribed. All too often a patient is discharged from the hospital with narcotics and the provider does not do any type of follow up other than refer them to follow up with their primary care provider. I think all providers whether it be inpatient/hospital setting or primary care providers, should be required to follow up with all of their patients who are on prescribed opioids. I also think there should be documented non-opioid treatment attempts on all chronic opioid users as well.

With this being said, I do not think that opioids should not be used for acute patients. For example, if I came into the my physician’s office with a kidney stone or after I threw my back out, I would not expect them to attempt non-pharmacological treatment. In instances like these, a small amount of narcotics should be able to be prescribed, but then the physician should be required to follow up within a given time frame, whether it be 24 hours or a week. I think because the FDA is a federal agency, this should be done by everyone and not just by certain states. Of course, to make a change it’s not easily done at that level, so I think it would have to start slowly. I think I would first propose it to all hospital employed providers at my hospital. After that change was implemented and there was time for adequate data to be obtained, i would branch out to other facilities, and then eventually to the state level.

Many physicians will prescribe a patient a narcotic for an acute pain, but then continue to refill the medication for years “just because.” This contributes to the problem. I worked with a nurse years ago who had back pain and went to her PCP and was prescribed Norco. She became dependent on the Norco, and eventually stole Dilaudid, Morphine, Norco, and many other drugs from the hospital. Of course she was caught and her license was disciplined, but the point is, this prescription started innocent, but due to a lack of follow up from her physician, the medication was continued to feed a habit, which could have been avoided had there been stricter follow up.

If the physicians were required to follow up and have documentation that was supportive of their reason for continuing the prescription, the numbers may decrease. At a certain point, the physician could then potentially refer the patient to a pain specialist for some sort of treatment that was not an opioid.

Thank you for your post. It’s funny that I did not read your post until after I posted my recent post, although we have similar thoughts. I have met too many people who are addicted to medications that were started on the medications due to an acute injury. I don’t share my opinions on pain with many people because I do not want to sound heartless. I think pain medications are a great thing when used appropriately. I never want my patients to go without their pain medications and be in an unreasonable amount of pain. But, I think sometimes people have unreasonable expectations related to pain. I often have post-op patients who think that it is reasonable to think that their pain level will be a “0” after surgery. I often attempt to educate patients that we would like to get their pain level down to an acceptable level, but that completely taking away all of their pain may not be possible.

I once had an acquaintance who had a history of drug abuse. He told me that his cousin (who was addicted to opioids) always told him to tell the nurse or doctor that his pain was a 10/10 or higher. He said, “she said then you get the good stuff.” It is so sad to me that this is how people think.

I have had many painful experiences in my life, but rarely take pain medications. I passed 30 kidney stones while pregnant with my daughter, 26 with my son, and I have passed 11 during this pregnancy. I have not taken anything other than Tylenol during any of those pregnancies. I also did not fill my prescriptions for pain medications post-operatively. I know that this is not how everyone handles pain, but because of my experiences with pain, it makes me less understanding for people who abuse narcotics.

I definitely agree with you that the providers need to be caring and empathetic to their patients so they are not living in pain, however this does get abused all too often. Like you, I do not know what the best solution is, but I agree something needs to be changed. That is why I will propose within my policy change that providers are required to follow up with all patients who are discharged with opioids/narcotics. I also think that only prescribing a limited supply (1 week’s worth) is a good first step, because then a follow up will be required prior to the patient getting any more.

I agree that the opioid addiction problem has escalated to a very concerning level. It’s frightening that an illegal substance is actually fairly easy to obtain. What makes me crazy is that if I want to buy sudaphed for nasal congestion I have to provide my license and there is a limit to the amount any one person can purchase per month. If I was prescribed a narcotic I can pick it up from the pharmacy without any identification and a family member or friend could also pick it up for me. Many people are addicted to pills but heroin users frequently start with a pill addiction and then move to heroin because in many cases it’s easier to obtain. You talk about changing laws to help and I agree. In Illinois we have something called the IL PMP which stands for the Illinois prescription monitoring program which collects information on controlled substance prescriptions dispensed in Illinois. Previously our doctors had to register to view the site and they would have to log in to look at the past 12 months of filled prescriptions. It was one more step when there was a concern for one of our patients who was in the ER asking for pain medications and a concern with seeking behaviors. Currently a link to the PMP is available in every patients chart so we can easily look up what they have had filled, when, quantity, and if they’ve been seeing multiple doctors to write scripts. Pharmacists can also use it and contact the prescribing doctor if they have a concern. I feel that this helps to decrease the amount of prescriptions written, but it’s dependent on many factors. The doctor has to review the record and personally decide if they think the patient is prescribed too much of the substance. The patient can register under any alias without an ID and obtain prescriptions from different ER’s without a license to verify who they are and the PMP will not reflect accurately what that person has filled. It’s a difficult situation because there are many chronic pain patients who need these drugs and the abuse has caused them to appear as “addicts”. Maybe requiring a photo ID (state issued) for anyone receiving and filling a controlled substance would be a good first step. Our hospital outpatient offices just started taking a photo that links to patient charts and when the patient comes in for a visit their picture will appear next to their name. It’s a great verification. Maybe the state issued ID could be accessed with a patient entering their ss# if they don’t have ID on them? Like they do at certain department stores when you don’t have your store credit card on you lol! It’s a huge problem that I feel requires small steps at many different levels.

I think the topic you picked is very important right now and the more people talking the more change there can hopefully be made. I grew up and currently live in the suburbs of Cleveland, OH, and have worked at one of the major hospitals in inner city Cleveland. There are a lot of drugs in this area, and not just in the city, but in the suburbs as well. The Opioid Crisis has really taken this area and the state of Ohio by storm. The CDC found Ohio to be the second leading state in drug overdose deaths in 2016.(CDC, 2017) This number continues to climb and I am not sure when it will start to get better. I do have a personal experience with this crisis in the fact that my oldest nephew died of a heroin overdose in 2015 at the age of 23. We were close growing up because we were only 8 years apart and my sister, his mother was 15 years older than me. This has been very hard on our family especially because we did not know what to do to help him when he was using, and so like so many families we had to experience the worst part of this epidemic. Besides this I have also been a nurse to many young patients in the hospital who had endocarditis due to the use of opioids intravenously. One patient on my floor was in their mid-twenties and was in because they needed a 2nd aortic valve replacement surgery due to IV heroin use. Before the patient was placed on the unit I worked on the patient ad her boyfriend had been shooting up heroin in the other hospital room she was staying in, but left AMA because boyfriend was kicked out of the hospital. I know a lot of people might disagree with me, the opioid addiction is a disease, and the death or addiction is preventable.

Since the passing of my nephew, my mom is very involved in different groups related working to fight the opioid epidemic, or have more successful outcomes. In the area I live in my mom has helped police stations be introduced to a program called Safe Passages. This program allows people to go to the police station and ask for help specifically for opioid addiction and they are found detox and treatment and it is paid for. It started with just a few police stations in my area and is spreading rapidly and has had success stories. The first person they had was a pregnant girl who turned her self in, no questions asked no trouble, was able to get help and has been clean for at least a year. In another hospital in my area they are trying to get to the people who overdose right away and offer them help. These are programs that are showing success and need to be spread all over the United States. Something else I believe is that there are a lot of players in the healthcare industry that have attributed to the opioid crisis. Pharmaceutical companies that had really pushed this drugs on doctors to prescribed them, insurance companies for being willing to cover the cost of these medications over alternative therapies, and the utilization of them from providers. In a study done about alternative therapies it was find that there were 44% of people were more likely to still be using opioids when being prescribed opioid analgesics within 7 days of discharge post-op.(White, Elvir Lazo, Lidia, & Xuezhao, 2017) I have seen that providers, especially now, want to use alternatives to medication to help with pain management, but a road block is insurance companies and being able to give some coverage to be affordable for patients. Not only are many alternatives covered or given enough time, but it cost with patient needing transportation, time off work, or just time out of their day. A pill that makes someone feel better is easier, but not better. Even though having to pay more upfront there is a long term benefit and would be cost effective. “A simple, safe, and effective non-invasive pain therapy without side effects could significantly reduce the dependence on oral opioid-containing medications in the post-discharge period after surgery. These non-pharmacologic therapies would also be cost-effective alternatives to opioids for treating chronic pain not responding to non-opioid analgesic medications.”(White, et al., 2017, p.8) We have all seen how opioid addiction has cost the healthcare system time and time again.

References:

The Center For Disease Control and Prevention. (2017). Drug Overdose Death Data. Retrieved from: https://www.cdc.gov/drugoverdose/data/statedeaths.html

White, P. F., Elvir Lazo, O. L., Lidia, G., & Xuezhao, C. (2017). Use of electroanalgesia and laser therapies as alternatives to opioids for acute and chronic pain management. F1000Research, 6http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.12688/f1000research.12324.1 Retrieved from https://search-proquest-com.chamberlainuniversity.idm.oclc.org/docview/1992878433?accountid=147674Links to an external site.

NR 506 Discussion Policy-Priority Selection