Integrated Experiences III Formal Paper: The Nurse’s Role in the Opioid Epidemic
Brief Excerpt: After hearing Kerri Barton’s presentation about opioid use and harm reduction earlier this semester, I was moved to start exploring the nurse’s role in the current drug crisis. So often, it seemed, my patients in clinical had struggled with some type of drug use, whether it be alcohol, opioids, or other substances, and I was interested to learn how nurses can individualize care to meet the needs of these clients—or better yet, take steps to prevent addiction from happening in the first place. The following paper details my findings on the role of the nurse in preventing, identifying, and treating opioid use.
It is difficult to comprehend the staggering impact of the opioid epidemic on millions of individuals in Maine, the United States and beyond. Today, with drug overdoses landing at the fourth leading cause of death in America, and most of these coming from opioids (Judd et al., 2023), it is clear that the crisis is only worsening. In 2020 alone, for example, deaths related to opioid use increased by 41% (Judd et al., 2023). Though solving this epidemic will require a multifaceted approach involving the collaboration of professionals from a variety of disciplines, the contribution of nurses in all fields cannot be overlooked. Nurses wear many hats—not only are they caregivers, but also educators and patient advocates, placing them in a prime position to address the current epidemic. As a whole, the role of the nurse in the opioid epidemic involves looking at the situation using both primary, secondary, and tertiary prevention strategies that take into account the complex and multidimensional nature of substance use disorders and addiction.
Before considering how a nurse should address this epidemic, it is worth discussing the background and statistics of the issue. Opioid use rose dramatically in the late 1990s, when prescriptions became more widespread and heavily marketed by drug companies (Higgins & Simons, 2018). Prior to this, opioids were not heavily utilized due to a recognition of their potential for abuse and addiction. However, attitudes largely shifted beginning in 1995, when controlled-release oxycodone made its debut on the market and the companies producing it did so at rapid rates (Higgins & Simons, 2018). Prescription sales quadrupled between 1999 and 2010, and when recordkeeping of opioid-related deaths began in 1999, increasing numbers were reported nearly every year. Since then, annual deaths have tripled (Judd et al., 2023). Additionally, certain populations are at higher risk for addiction and overdose. These include individuals without a college education, those with untreated mental illness, and Caucasians or Native Americans (Judd et al., 2023). Moreover, opioid use is highest in the Northeast, Midwest, and Appalachian regions—primarily rural areas—and a staggering 27% of drug overdose deaths worldwide come from the United States, despite it only accounting for 4% of the global population (Salmond & Allread, 2019). Though the highest instances of opioid overdoses came from those in the 25-34 year old range (and predominantly male), the crisis affects all ages, with a 2019 article reporting that women between ages 40 and 64 represented the “fastest growing demographic for rates of death and emergency department visits” (Salmond & Allread, 2019). It is clear that no population is immune from the effects of the opioid epidemic, and addressing it will require an understanding of its impacts on all demographics.
It has been said that the best way to treat a disease or disorder is to prevent it from happening in the first place. Indeed, from a nursing perspective, primary prevention involves taking steps to reduce the risk of disease, whether it be through education or preventative care. When considering this with regards to opioid use and addiction, two primary themes emerge: early education and monitoring of drug access and prescriptions. The first, education, is a task that all nurses should be familiar with. However, education also goes beyond informing patients. Nurses, too, should strive to educate themselves on best practices regarding substance use prevention, opioid use, and addiction. Studies have shown that nursing students rarely have adequate exposure to substance use disorder, both in coursework and real-world examples (Ginther & McNally, 2024). Moreover, this lack of education surrounding treatment for addiction can lead to the stigmatizing language, bias, and inadequate care (Ginther & McNally, 2024). Further education, both in nursing schools and workplaces for practicing RNs, can aid nurses in better caring for patients with substance use disorder and facilitate better outcomes. Nurses should also be trained to recognize early signs of addiction, manage emergency situations, and act according to best practices (American Nurses Association [ANA], 2018). The next step, education for patients themselves, should be tailored to meet the needs of the individual. For example, a client prescribed opioids for pain management should be taught about signs of abuse, the risk of addiction, and local resources (Higgins & Simons, 2018). Nurses in a variety of specialties can utilize their platform to maximize impact. For example, public health nurses can provide community education about addiction and emergency response to overdoses (Salmond & Allread, 2019). School nurses can speak to classes, families, and individuals about drug use. Nurses working in all fields can take special care to teach those with prescription opioids about proper use, and also employ non pharmacological strategies to mitigate pain (ANA, 2018). Additionally, nurses can educate themselves on appropriate uses and doses of opioids for pain management. Though they themselves aren’t responsible for prescribing medications, it is valuable to have an understanding of proper use and dosing, and potentially serve as a final “check” before the drug is administered. For example, opioids for acute pain should be given in a supply that lasts no longer than three days (Higgins & Simons, 2018). As a whole, the nurse’s role in addressing the opioid crisis on the level of primary prevention involves spreading awareness and education, as well as monitoring for opioid access and proper use.
Secondary prevention involves early screening for and detection of a condition before it can become disabling or dangerous. These screening and identifying tests are generally directed at individuals who may be at higher risk for the condition in question (Higgins & Simons, 2018). When considering opioid use, a strategy to facilitate early detection is the use of prescription drug monitoring programs, or PDMPs, which allow healthcare professionals to view all of a patient’s prescriptions for controlled substances through a computerized database (Higgins & Simons, 2018). This subsequently identifies patients who may utilize multiple providers or organizations in an attempt to receive more opioid prescriptions. These PDMPs, which are used in nearly every state, are meant to be checked frequently and prior to any prescription of opioids (Higgins & Simons, 2018). An additional secondary prevention strategy involves utilizing primary care to screen for substance use disorders, especially among high-risk populations (Salmond & Allread, 2019). For individuals who have difficulty accessing primary care on a regular basis, resources such as school-based health centers or free mobile health clinics may be necessary. These screenings can include questionnaires such as the SBIRT tool, which serves to identify individuals at risk for substance use disorders. Finally, secondary prevention strives to reduce a disease’s effects in its earliest stages. Those who may be experimenting with opioids or beginning to use these substances inappropriately are the primary patient demographic here. Nursing interventions include performing screenings for comorbid conditions such depression and anxiety, initiating referrals to services such as rehabilitation or counseling, and providing non-judgmental support that meets the patient where they’re at and facilitates a positive recovery process (Salmond & Allread, 2019).
The final step is tertiary prevention, which aims to reduce the consequences of an illness or disorder once it has been diagnosed and is progressing (Higgins & Simons, 2018). For opioid use disorder, this involves preventing overdose deaths, infections, and other physical and mental complications (Salmond & Allread, 2019). The role of the nurse in this stage of treatment primarily involves providing care for these individuals. This can include harm reduction, such as ensuring access to naloxone, employing motivational interviewing techniques for behavioral change and goal setting, and utilizing a support network of counselors, peers, and providers (Salmond & Allread, 2019). Moreover, nurses assess for manifestations of complications, such as blood-borne infections and increasing levels of tolerance. It is clear that opioid use disorder is extremely difficult to treat. After all, addiction is defined as a chronic disease, with these drugs inducing changes in the brain (Higgins & Simons, 2018). Fortunately, there are steps nurses can take to both reduce the risk of complications and act in the event of an emergency.
Viewing the treatment of opioid use through the lens of primary, secondary, and tertiary prevention is a valuable tool for nurses when caring for different patient populations. However, it is also worth noting that the strategies outlined above are not a comprehensive list of nursing interventions for opioid misuse. Instead, the nurse should tailor his or her care to meet the needs of the individual patient. Additionally, in all phases of prevention, the nurse must learn to care for patients with opioid use disorder without judgment of bias. The stigma surrounding this illness can be a major barrier to quality treatment (Ginther & McNally, 2024), and it is the nurse’s role to understand the complexities of addiction and treat each patient with respect, regardless of choices they have made in the past. Setting these patients up for success looks like using person–centered, holistic care, avoiding stigmatizing language (including words such as “addict”) and instead employing person-first language (such as calling a patient a “person with opioid use disorder”), and addressing one’s own implicit bias (Ginther & McNally, 2024). These principles apply regardless of what type of situation the patient is facing, and nurses should be prepared to act accordingly.
The opioid use crisis shows few signs of resolving, or even slowing down. However, the nurse can play a major role in facilitating changes in individual lives, and in public health and education. Through a variety of different strategies, as well as collaboration with a wide range of professionals in other fields, it is possible to make a change. Though the situation can feel overwhelming or even hopeless, it is always valuable for a nurse to remind themself that making a difference in a single life changes the world for one person.
