Opioids are powerful painkillers that are prescribed for the short-term management of extreme pain. The most types of Opioid include morphine, codeine, and methadone. They are popular because they mimic the function of endorphins by acting on the opioid receptors to naturally relieve the body of pain. They also cause a euphoric high like feeling, without which the user experiences withdrawal symptoms. The drugs may be abused by people who continue to take them after their prescription is over (FDA, 2017).
There has been an alarming increase in the number of people who are abusing opioids. This is because opioids have some factors that make them addictive. They are also cheaper and more readily available than illicit drugs. The past decade has seen an increase in the number of people who have become addicted to one form of opioid or another. A large number of these patients have died of opioid overdoses. This is because the healthcare industry embraced pain management as one of the features of quality healthcare. This state of affairs has necessitated the formation of healthcare policy to monitor and regulate the use of opioids.
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The hospitals should be at the center of the formulation of an opioid health care policy. Indeed, many hospitals have put in place internal policies that govern the prescription of any form of the opioid. Hospitals have employed strategies such as screening patients for the presence of high-risk conditions that may be exacerbated by the use of opioids. Such patients were given alternative pain relievers. Most hospitals also follow the clinical pathway protocols strictly. They begin pain relief programs by administering non-opioids before they proceed to an opioid analgesic. Intravenous or oral opioids are then given as a last resort when pain cannot be managed by any other means. Internal hospital policies have been formed by these strategies (Jukiewicz et al., 2017).
The US Food and Drugs Administration (FDA) have also been working on ways to limit the use of these drugs. Its advisory committee is considering classifying the drugs afresh. This move is expected to affect all drug makers. A risk assessment paradigm is being used to gauge every new opioid for abuse-deterrent properties. In addition to the 2013 (ER/LA) labeling, the FDA has put in place measures to classify the opioids that are immediate release or fast acting. The move will also include safety precautions and some information to create awareness amongst potential users of opioids. Other measures that the FDA has put in place include making strong post-market requirements, availing abuse deterrent solutions to manufacturers and reviewing the over the counter classification (FDA, 2017).
The war against opioid abuse cannot be waged by one body alone. This is why an article written in the journal of nurses suggests a multifaceted approach to deal with this issue. The body of nurses ascertained that chronic pain was a part of the health industry and that pain management was key to its resolution. Many have credited opioids with the significant improvement, though the team approach within hospitals is responsible. However, in an emergency setting, the health care provider does not have time or capacity to consult the team. For example, a patient who was nursing a fractured limb may come to the emergency room complaining of severe pain. The attendant will then be under pressure to prescribe some opioids for him since his current regime is not working. This will then become his new source of medication since the center is too busy and there is little time for consultation or background checks (FDA, 2017).
Some existing policies have been set up to address opioid-related concerns. Different hospitals and states have various policies that guide the use and prescription of opioids. However, they raise more problems because each addresses the opioid abuse issue from a different point of view. Each body uses this substance in the way they see fit, and at the end of it all, they do not have the collective imperative to address the overall problem of addiction and overdosing (Kasarla, 2017).
A closer look at some of the state and federal policies currently in use shows that there are glaring disparities between prescription rules, monitoring programs and opioids related strategies. Some states have the policies, but there is no enforcing agent. Others do not have an explicit pain management hierarchy. The worst conditions are in those states that have more than one policy with conflicting directives. It becomes impossible to choose what is relevant to apply or monitor. This state of affairs points to the urgent need for a national healthcare policy on the prescription and use of any form of opioid (Jukiewicz et al., 2017).
A good starting point is ascertaining the origin of opioids. A research study that was carried out in 2012 found that about 82.5% of opioids in use were obtained from prescriptions. The prescription rates were highest in states that had poor healthcare outcomes. Those states also recorded the largest percentage of people who engaged in physical or manual labor to make a living. This sort of lifestyles automatically led to physical challenges that manifested as pain. The poor health care system did not provide a robust team network that facilitated consultation before prescribing pain relievers (Mcelrath, 2017).
This kind of scenario requires strict and rigid structures that will force internal change through an external monitoring system. The ideal policy will begin with a nationwide campaign that creates awareness of the interpretation and assessment of pain levels. This will help in the accurate prescription of non-opioids that are adequate in the management of certain levels of pain. In addition to this, the prescribing agent will be able to assign the appropriate opioid should it be necessary. This will reduce the chances of addiction to the patient as well as lessening the dependence on opioids. The Advanced Registered Nurse Practioner (ARNP) would be the best candidate for this training. When this has been done, a tracking system can be used to monitor how the ARNP adheres to the guidelines based on pain levels. They should also be in charge of coordinating the patient education on effects of opioids. The overall hospital staff will be responsible for carrying out rehabilitation in the patients that are being treated for opioid addiction (Jukiewicz et al., 2017).
This will comply with the Comprehensive Addiction and Recovery Act through which the United States Drug Enforcement Administration (DEA) allowed mid-level practitioners to handle the prescriptions of buprenorphine for opioid addicts. This is a measure put in place to bridge the gap that is caused by shortages of specialist staff. This will help solve the problem of treatment of addicts because most physicians in the Federal register are situated in urban areas. The DEA transitions the mid-level practitioners into Drug Abuse Treatment Act (DATA) waived practitioners who are now able to deal with the problem in their location. All the involved institutions must use a National Provider Identifier Standard (NPI) for purposes of tracking the implementation of the nationwide policy. The policy will address both the treatment of the addicts and prevent the emergence of new addicts. The cooperation of the different nationwide bodies will be vital to the success of the policy. This national policy will work if it takes precedence over the current federal and state laws that exist (Mcelrath, 2017).
References
FDA (2017) FDA Opioids Action Plan. U.S. Food and Drug Administration. Retrieved from https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm484714.htm
Jukiewicz, D. A., Alhofaian, A., Thompson, Z., “Gary, F. A. (2017). Reviewing opioid use, monitoring, and legislature: Nursing perspectives. International Journal of Nursing Sciences, 4(4), 430-436. Retrieved from https://www.sciencedirect.com/science/article/pii/S2352013217300571
Kasarla, M. (2017) the opioid epidemic and its impact on the healthcare system. The Hospitalist. Retrieved from https://www.the-hospitalist.org/hospitalist/article/149858/mental-health/opioid-epidemic-and-its-impact-health-care-system
Mcelrath, K. (2017). Medication-Assisted Treatment for Opioid Addiction in the United States: Critique and Commentary. Substance Use & Misuse, 53(2), 334-343. doi:10.1080/10826084.2017.1342662
