When the declaration of an emergency does no help mitigate the vagaries of an issue, it would be in order to consider it as a crisis. The opioid epidemic in the USA has been getting exceedingly worse every year, despite massive efforts to mitigate it. With tens of thousands of lives been lost and millions of others being ruined, it might be time to take a different approach in solving the crisis. Instead of handling the problem head-on as was done with the crack cocaine crisis in the 1990s, it might be more effective to break the issue down, segment it and handle each perspective at a time. For example, the bone of contention in the opioid crisis lies in how prescription opioids are used on a clinical setting including hospitals. It is a settled fact that opioids are a necessary pain relief medication. However, the fact that many patients to whom opioids have been prescribed end up developing addictions and even overdosing means that there is a problem regarding how they are dispensed in a clinical setting. To mitigate the opioid crisis from the perspective of clinically prescribed opioids, it might be necessary to develop a uniform protocol for pain management in hospitals and other health care centers.
Literature Review
The Need for A Protocol
Available commentary and expert opinions definitively indicate that opioids are absolutely necessary for the management and control of pain in a clinical setting. According to Rose (2017), focusing on the opioid crisis should not shroud the absolute necessity of opioids in hospitals and other clinical settings. The elimination of opioids would result in extreme suffering for hapless patients who are suffering from chronic conditions that cause acute pain for elongated periods of time. Similarly, eliminating or limiting opioids would complicate the obligation of clinicians and caregivers who have to deal with acute pain patients, more so those recovering from surgery and related procedures. Conversely, the research undertaken in Rose (2017) shows that with proper protocols for usage in place, it is possible for opioids to be used safely and effectively without resulting in addictions or overdoses. It is based, inter alia, on the conclusions made in Rose (2017) that an argument is being made for the establishment of best procedures and protocols for opioid administration, as opposed to the elimination of opioid use.
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Nature of the Protocol
After establishing that the use of opioids in a hospital setting is indispensable, the next critical step is to lay down protocol for how opioids can be safely dispensed in a clinical setting. Based on available research, the dispensing of opioids in a clinical setting works best when there are set protocols in place, as opposed to when issues are handled as and when they arise. A research conducted in China and reported in Cui et al. (2018) reveals that the safety and efficacy of opioid administration improve exponentially with comprehensive protocols being put in place. As per the research, in a hospital setting, proper protocols were developed in how to prescribe and administer opioid treatment. The nurses and caregivers in the hospital were then trained on how to administer opioids as under the set protocols. Safe use of opioids within the hospital was reported as and when the set protocol was used. The success reported in Cui et al. (2018) can be replicated in hospitals all over the USA with the development of protocols for opioid administration and the training of clinicians to follow those protocols.
Sparse Prescriptions
The nature and content of those protocols is also an important bearing factor on the issue of proper management of the opioid crisis from a hospital setting. The first critical issue is who should clinicians prescribe opioids to for pain management and what amounts should be prescribed. The instant issue has been effectively canvassed in Pino & Covington (2018), an expert opinion on prescription opioid administration to relieve pain. The said article advocates for clinicians to err on the side of caution, not speed when administering opioids. Opioids must be used sparingly and only on patients who are absolutely in need for them. For mild and intermittent pain, other available options for pain relief can be used. Further, even when opioids are administered, the least necessary dosage should be used. This means that the protocol used should limit the patients to whom opioids are administered as much as possible. There should also be a limitation of dosage. The reduction in the number of patients getting prescription opioids and the subsequent reduction of dosage will exponentially limit propensity for addiction and overdose, thus mitigating the opioid epidemic (Pino & Covington, 2018).
Vigilance by Clinicians and Care Givers
Reducing the propensity for addiction and overdose does not mean that overdoses and addictions will not happen, hence the need for close supervision of patients using opioids. Dispensing opioids to patients and supervising those who are using opioids will require clinicians to use some of the tactics used by psychologists. According to Cragg et al. (2017), a vigilant clinician or caregiver can be able to detect signs of impending opioid addiction or overdose. For example, there are certain social signs and cues that show that a patient is highly likely to abuse substances. Such social cues include having a history of substance abuse or involvement in the crime. For such patients, the protocol should provide either for the avoidance of opioid prescription of closer monitoring of usage. Further, based on the discussion made in Cragg et al. (2017), a caregiver or clinician can also be able to detect early signs of addition or potential of an overdose in a patient who has been using opioids. This latter perspective is most applicable to chronic patients who use opioids for elongated periods. The moment the cues for addiction or possible overdose are noticed, the protocols should provide for immediate discontinuation of prescription. It may also be necessary to wean the patient off the opioids and reverse the addiction.
Managing Troubled Patients
The high propensity or advent of an addiction or the detected potential for an overdose creates a dual-crisis for clinicians and caregivers, which should also be canvassed by the protocols. The duality of the problem lies in the fact that there is still a pain problem to be managed, yet the opioid option is still available. For the patients who have already been using opioids, a secondary crisis caused by withdrawal also presents itself. According to Rudolf et al. (2017), a protocol can be developed to assist such patients without exposing them to any more opioid-based therapies. For the pain, medications that are not based on any actual or synthetic opioids can be used. The social problems that have resulted in a propensity for substance abuse or overdose can then be managed using psychological therapy and counseling. The two approaches outlined above will effectively handle the dual problem of managing pain and managing social issues.
The Naloxone Perspective
However, for the patients who have serious addiction problems, the withdrawal process may be brutal. According to Rudolf et al. (2017), medication for the management of withdrawal symptoms such as Naltrexone can be used. Through the combination of the three approaches of the crisis caused by trouble patients with social issues that complex, opioid usage can be managed. Unfortunately, the suddenness and finality of death will sometimes interfere with the process of assisting troubled patients. Death is always a frustrating prospect in the management of substance abuse, more so when it happens through an overdose. It is to prevent the unfortunate eventuality of death that Morgan & Jones (2018) suggests the use of naloxone. The use of naloxone is one of the more controversial subjects when it comes to the clinical management of the opioid crisis. Naloxone is a drug used to reverse the effects of an opioid overdose and one that has the capacity to save lives after an opioid overdose. It has been argued that dispensing naloxone is a form of encouraging the illegal use of opioids. However, for the process of rehabilitating patients as outlined above to be successful, it is necessary to keep the patient alive. Having naloxone at hand can improve the chances of troubled patients lasting long enough for their opioid abuse issues to be resolved.
Conclusion
The current opioid crisis needs an urgent and effective solution from all perspectives including a clinical one, as prescription opioids also contribute to the opioid crisis. However, the clinical solution cannot involve eliminating opioid prescriptions as they are necessary for pain management. Instead, a comprehensive protocol should be put in place to ensure the proper administration of opioids to manage pain. Among the principals to be put in the protocol include limiting who gets an opioid prescription and how much is prescribed to them. Secondly, clinicians and caregivers should be vigilant to ensure that troubled patients do not get an opioid prescription and if they do, they are closely monitored. In the case of troubled patients, a combination of alternative therapy and counseling should be used. In extreme cases involving withdrawal, pharmacological interventions such as Naltrexone and Naloxone should be used to save lives as more substantive solutions are developed. A protocol with all these components should be developed, then clinicians and nurses be trained on how to adhere to it.
References
Cragg, A., Hau, J. P., Woo, S. A., Liu, C., Doyle-Waters, M. M., & Hohl, C. M. (2017). Risk factors for addiction among patients receiving prescribed opioids: A systematic review protocol. Systematic Reviews,6 (1). doi:10.1186/s13643-017-0642-0
Cui, C., Wang, L., Li, Q., Zaslansky, R., & Li, L. (2018). Implementing a pain management nursing protocol for orthopaedic surgical patients: Results from a PAIN OUT project. Journal of Clinical Nursing,27 (7-8), 1684-1691. doi:10.1111/jocn.14224
Morgan, J., & Jones, A. L. (2018). The role of naloxone in the opioid crisis. Toxicology Communications,2 (1), 15-18. doi:10.1080/24734306.2018.1458464
Pino, C. A., & Covington, M. (2018). Prescription of opioids for acute pain in opioid naïve patients. UpToDate, Inc.
Rose, M. E. (2017). Are Prescription Opioids Driving the Opioid Crisis? Assumptions vs Facts. Pain Medicine,19 (4), 793-807. doi:10.1093/pm/pnx048
Rudolf, G., Walsh, J., Plawman, A., Gianutsos, P., Alto, W., Mancl, L., & Rudolf, V. (2017). A novel non-opioid protocol for medically supervised opioid withdrawal and transition to antagonist treatment. The American Journal of Drug and Alcohol Abuse,44 (3), 302-309. doi:10.1080/00952990.2017.1334209
