An opioid is a substance that is highly addictive and has similar psychological effects or properties to opium. In the US, opioid abuse has become a national crisis. According to the National Institute of Drug Abuse (NIDA), above 2 million people abuse opioids in the US. On average, it is reported that about 90 people die from opioids overdose every day. These drugs make the body feel like it needs the drugs to survive. From a prescription, one begins to need more and more dosages to cope up with the pain and achieve well-being. Once this happens, dependency sets in. The state of depending on these opioids is called addiction. It essential that before deciding to use opioids, one should explore other pain relief methods or consult a physician anesthesiologist to advice how safely to use opioids.
Emergency department nurses are the focal point in caring for individuals with pain-related issues. In the US, the crisis of opioid use has been on the rise. According to Barnett, this issue is because of the initial prescription of the drugs leading to a long-term continuation by the patient (Barnett, Olenski, & Jena, 2017). According to estimations, 20% of people taking opioids do not take their prescriptions as prescribed. According to statistics, 4 out of 5 new users of heroin started using the drug after misusing pain medication (CDC, 2018).
Delegate your assignment to our experts and they will do the rest.
PICO Question
Population: opioid dependent men and women.
Intervention: the social, behavioral, and medical services given through community partners’ collaboration.
Comparison: role of the emergency department in caring for opioid-dependent people.
Outcome: medication-assisted treatment in emergency departments, together with behavioral health services, reduce opioid abuse in the community.
Time: During pregnancy, that is the nine months and after birth.
In opioid-dependent men and women how effective is the role of the emergency department in caring for opioid-dependent people with pain-related issues compared to social, behavioral, and medical services given through community partners' collaboration in reducing opioid abuse in the community?
Significance of the problem
In the early 90s, pharmaceutical organizations reassured the medical society that they would not get addicted to opioid pain relievers. This led to a broad prescription of this substance. After a given period, it became clear that Americans were being addicted because they misused the drug. The overdose rate for opioids became much higher, and by 2017, the number of deaths was at 47,000. The leading causes of death was an overdose of heroin, prescription opioids, and fentanyl illegally manufactured. During the same year of 2017, a record number of more than 1.6 million were suffering from substance abuse connected to opioid prescriptions. Another more than five hundred thousand suffered from disorders from heroin use. This has created a crisis in the US due to the many deaths involved. Opioid usage has had a significant effect on the population of the US. Another tragic incident is that 80% of people using opioids end up using heroin.
Current healthcare practices
In light of the crisis on opioids, health institutions doing something to alter their protocols for pain management and curb opioid use for patients. Recently, the change in healthcare practices on opioids prescriptions has been implemented to about 98% of US hospitals. It has also been discovered that one of the changes was prescriber education. The other change was the use of new technology to implement the use of alternative measures and supervise opioid prescriptions, to manage acute pain. Currently, most healthcare institutions and professionals are employing policies that reduce opioid prescriptions.
Stewarding opioids is a policy program that looks to evaluate and make upgrades where it is needed. Through the stewardship program, hospitals try and compare the need for whether a patient would require opioid when being discharged. This ensures that correct prescriptions are given and only patients who really need the opioid is given the dose. Another stewardship practice that has been employed is the reduction of the amount of time taken to administer the opioid. Some hospitals have reduced this to 25% and are offering online courses to physicians on the prescription of opioids and at the same time educating patients alternative options of managing acute pain. The stewardship program includes only giving patients that non-opioid medication has refused to take effect or patients who non-opioid medication suggest that non-opioid therapy should not be used.
Another practice is the reduction of adverse outcomes. This practice mainly reduces the outcomes related to the oversedation of opioids. These undesirable results happened frequently and resulted in death if patients were not rescued. This has also been done by educating the physician on dosage adjustment techniques and dosage tolerance. This led to a reduction in the prescription of opioids at the end of treatment at the hospital. Another practice by hospitals is by diverting most resources in the management of opioids. This includes adding employees to help in curbing the opioid use and increased spending to reduce the opioid crisis.
How the problem affects the organization and patients’ cultural background
In the United States, it is quite challenging to go for a few days before getting news about opioid addiction and its adverse effects on the society and family members. For organizations, it has also become a severe issue. In the US, organizations have incurred more than $ 25 billion caused by prescribed opioids. This is as a result of workers not reporting to work, medical expenses, and less productivity from the employees (CDC, 2017). Reports have indicated that expenses for treating an employee with an opioid problem are three times higher than that of a non-user. It has been recorded that close to 72% of organizations the US state that they have been affected by the abuse of opioids. Some of the effects of opioid abuse at workplaces include, loss of reputation by the organization, the safety of other employees would be at risk and reduced productivity (Florence, Zhou, Luo, & Xu, 2016).
The abuse of prescription pills affects society in different ways. It is associated with sexual assaults, children being placed in foster care, and child abuse. In the community today, people abusing opioids are also associated with criminal activities. Opioids also affect families. It is a typical pattern where a member of the family is addicted. Negativism, having to put up with a drug-addicted family member, denial and parental inconsistencies are some of the things drug-addicted people have to go through. One resorts to opioid use to put up with the dysfunctional family. Opioid use also leads to children having to play the role of their addicted parents. In this case, the children usually lack basic needs, and that includes no health care and shelter. Addicted parents have a high chance of ending up in poverty with no housing and no health care, which acts as a hindrance even to get treatment for the addiction.
Literature review
Opioids are addictive and powerful pain relievers. The dependency on opioids affects close to 5 million Americans and causes more than 17000 deaths yearly. According to the research by CDC, death resulting from overdose has tripled since the late 90s to 2016. A large number of people dying from synthetic opioids such as fentanyl more than double between 2015 and 2016. On the leading cause of death in the US due to injury, it has been found that half of these are due to prescription drugs overdose. Opioids have lately been linked to the latest decline in the life expectancy in the US.
It is estimated that more than 2 million people in America had a disorder relating to opioids pain relievers. Nevertheless, just a few of these people opioid use prescription disorder get specialty treatment. This situation has also led to an increase in heroin use because opioid users switch to heroin use. This has led to a resultant increase in heroin use disorder. It has also led to an increased death resulting from heroin abuse (Kolodny et al., 2015). Pregnant mothers using opioids also give birth to infants dependent on the opioid. The use of these substances has also ruled to an increase in cases of hepatitis C and HIV.
Patient discomfort can prevent successes in the management of painful procedures that are present in the emergency department. It is important to use techniques that would alleviate anxiety and pain to a patient who is going through a low-risk procedure at the same time reducing recovery time and adverse effects. Therefore, emergency room procedures such as procedural sedation provide tools that are useful in the emergency department. In the ED, procedural sedation needs multiple agents combined to achieve a desired impact of anxiolysis plus analgesia (Shehab et al., 2016). A combination of an opioid analgesic such as fentanyl is frequently preferred in procedural sedation — continued treatment results in dependence on the opioid.
There exist the right treatment and prevention measures for opioid use and misuse disorder. However, these are used in a few instances in the US. A proposal by human and health services sort out to attend to this problem of opioids prescription and use of heroin. Today there exist strategies that are prioritized in curbing the opioids crisis. The first one is to enhance the accessibility of being treated and recovery services. Another approach is to promote drugs that increase the reversing of the effects in the event of an overdose. The third is to strengthen to comprehend the crisis through proper surveillance of public health. Another strategy is to pump resources into research that will help in pain and addiction. The final one is to use better practices in the management of pain.
There exist an effective treatment for the opioid disorder. These medications include buprenorphine. Even though these medications exist, they have been underutilized. Less than half of the public health sector offers a program for the treatment of opioid disorder. In hospitals where the medications exist, only a third of the patients actually are treated. It is essential to comprehend the hindrance factors that hinder the adoption of crucial treatment for opioid use disorder and the crisis of prescription pain relievers in the US.
Research shows that people who suffer from an opioid disorder on a detoxification plan and are strict in not using the drug end up going back to using the drug. It is a good thing to relapse when trying to get clean. However, this comes with its complications in some cases. An overdose on the opioid can cause death (Rudd, Aleshire, Zibbell, & Matthew Gladden, 2016). Therefore, it is vital to stay away from using opioids strictly. There is also medication to help in reducing the withdrawal syndrome that comes with not using the original drug. Drugs such as methadone are prescribed for the purpose of helping the patient in recovering from the use of the opioid.
Methadone acts on receptors for opioids in the brain. By doing so, it does away with the withdrawal symptoms and alleviates the craving of the drug. These receptors are the same ones that heroin activates. It slowly does away with the euphoria associated with the opioid. It has successfully been used for more than 39 years. Another drug that is used is buprenorphine that also works the same way as methadone but at a slower rate. It is tolerated well by patients because it reduces the symptoms of withdrawal and reduces the euphoric effect caused by opioid abuse.
Discuss two research evidence sources and two non-research evidence sources
Rudd, R.A., Aleshire, N., Zibbell, J.E., & Matthew Gladden, R. (2016). Increases in Drug and Opioid Overdose Deaths-United States, 2000-2014. American Journal of Transplantation , 16 (4), 1323-1327. doi:10.1111/ajt.13776
This article talks about the increasing opioid abuse-related deaths from the year 2000. It identifies that there has been a significant increase in the US between 2000 and 2014. It recommends the strengthening of safer prescription of opioid pain relievers. It also advocates for emergency room procedures such as medication‐assisted treatment combined with behavioral therapies. It also advocates for access to syringe service programs to prevent the spread of hepatitis C virus infection and human immunodeficiency virus infections.
Volkow, N. D., & McLellan, A. T. (2016). Opioid abuse in chronic pain—misconceptions and mitigation strategies. New England Journal of Medicine , 374 (13), 1253-1263.
This article talks about the adverse effects that have come as a result of using opioids as a mode of treating chronic pain. It identifies how men and women are affected by this medication and how they eventually become dependent on the drug. It suggests that it is no longer safe to continue with the old practices, and it requires change. It encourages the research of alternative means to alleviate chronic pain or management of prescription of opioids. It promotes research on pain and education of others about pain and addiction (Volkow & McLellan, 2016).
Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annual review of public health , 36 , 559-574.
This article addresses the death rate associated with over-prescription of opioid pain relievers. It addresses the relationship between heroin and opioid abuse. This article gives a relationship between the increase in death as a result of overdose from opioid use. It recognizes the crisis that is faced, especially by people in the US. It also concludes that efforts to curb this crisis by trying to adopt alternative measures have been ineffective. It says that individuals of middle age exposed to treatment by opioid use have had a high rate of morbidity and mortality.
Shehab, N., Lovegrove, M. C., Geller, A. I., Rose, K. O., Weidle, N. J., & Budnitz, D. S. (2016). US emergency department visits for outpatient adverse drug events, 2013-2014. Jama , 316 (20), 2115-2125.
This journal touches on the adverse effects of opioid dependency on individuals in outpatient recovery. It confirms that drugs associated with addiction in emergency departments have been opioids, and this has happened for more than ten years. It mentions that the rate of emergency department visits for opioid prescriptions has adversely been on the rise. It also affirms that opioid has caused a lot of deaths, and this has been well documented (Wikler, 2013).
Practice recommendation
From experience, it has been noted that prevention initiatives have attributed to a reduction in drug abuse. Evidence-based prevention of addictive behavior is a practice one would recommend. This is because it is essential to understand the problem in order to prevent substance abuse effectively. It is essential to state the fact that most people in the US who abuse prescription pain relievers do not have opioid use disorder. However, the use of these drugs puts the people around them at risk, and they could be harmed. Therefore preventing the misuse of drugs at an early stage is quite vital. The use of evidence-based prevention of addictive behavior is one of the policies that have worked accordingly in reducing substance or opioid abuse in society. It has been limitedly used in the fight against the epidemic of opioid used. If implemented well, then this could go a long way in further reducing the opioid abuse.
Implementation of the practice recommended
The use of evidence-based prevention of addictive behavior can be applied in many different ways. Implementation can be through tailoring evidence-based intervention to schools, families, and training and educating people to reduce the factors of risk. This can be done by lowering delinquency and enhancing factors that protect an individual, such as improving once motivation. This encourages a person to have high self-esteem, and therefore, can resist peer pressure.
Societies can also help in the implementation process of evidence-based prevention of addictive behavior. This can be done through a systematic approach of the public health sector that is concentrated on demographic and equity, which engages every step of society collaborating in decision making and being held accountable for change and actions. Another way the community can implement the strategy is by developing healthy children in society. Wellness funds could enhance this. This can be implemented by giving functioning support in the community and efforts made to support them. It is also seen that considering a child’s well being in public policies could help sustainable services funding.
A consistent definition of principles, practices, and programs would benefit prevention efforts. By implementing the affordable care act and enhanced monitoring of the community also create chances of prevention (Patrick, Fry, Jones, & Buntin, 2016). It is also important to demonstrate to the community how a certain procedure is conducted to show the responsiveness to a community. This will help improve how fast communities respond to other opioid substance abusers. Another thing is integrating health services related to behavior.
This has many advantages; these include engaging families, reduce cost, and enhance care quality. For instance, patients respond better to sessions for health care when it is taking place in a basic care setting instead of a specialized care setting. Therefore, a lot more effort should be made to improve primary health care systems. Schools should have an integrated health care system that is inclusive of socioeconomic, ethnic, and cultural diversities. A study shows that this small intervention was needed for the teacher, guardians, to be engaged in the implementation of substance abuse of opioids. The community anti-drug coalition of America is just one of the organizations that commit to service.
References
Barnett, M.L., Olenski, A.R., & Jena, A. B. (2017). Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use. New England Journal of Medicine , 376 (7), 663-673. doi:10.1056/nejmsa1610524
CDC. (2018, December 19). Understanding the Epidemic | Drug Overdose | CDC Injury Center. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html
Florence, C.S., Zhou, C., Luo, F., & Xu, L. (2016). The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. Medical Care , 54 (10), 901-906. doi:10.1097/mlr.0000000000000625
Kolodny, A., Courtwright, D.T., Hwang, C.S., Kreiner, P., Eadie, J.L., Clark, T.W., & Alexander, G. C. (2015). The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction. Annual Review of Public Health , 36 (1), 559-574. doi:10.1146/annurev-publhealth-031914-122957
Patrick, S.W., Fry, C. E., Jones, T.F., & Buntin, M. B. (2016). Implementation Of Prescription Drug Monitoring Programs Associated With Reductions In Opioid-Related Death Rates. Health Affairs , 35 (7), 1324-1332. doi:10.1377/hlthaff.2015.1496
Rudd, R.A., Aleshire, N., Zibbell, J.E., & Matthew Gladden, R. (2016). Increases in Drug and Opioid Overdose Deaths-United States, 2000-2014. American Journal of Transplantation , 16 (4), 1323-1327. doi:10.1111/ajt.13776
Shehab, N., Lovegrove, M.C., Geller, A. I., Rose, K.O., Weidle, N. J., & Budnitz, D.S. (2016). US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014. JAMA , 316 (20), 2115. doi:10.1001/jama.2016.16201
Volkow, N.D., & McLellan, A.T. (2016). Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies. The New England Journal of Medicine , 374 (13), 1253-1263. doi:10.1056/nejmra1507771
Wikler, A. (2013). Opioid Dependence: Mechanisms and Treatment . Berlin, Germany: Springer Science & Business Media.
