Nurses are facing an opiate crisis in the country. The effects of the opioid crisis spreads across families and individuals because of their impact on the family unit or direct drug abuse (Painter, 2017). Patients who are experiencing drug abuse problems are seen in all nursing practices, and it allows nurses to develop a rapport through patient-nurse relationships, and it provides a safe environment where patients can disclose their drug abuse problems (Painter, 2017). Nurses also have a role in creating awareness in local communities by working with families affected by the opioid crisis, sharing the adverse effects of the crisis, and advocating for change (Painter, 2017). The impact of opioid and other forms of drug abuse include the rising costs to criminal justice systems, healthcare providers, public services, and its effects on communities and families. It is critical to analyze nurses’ role in preventing and addressing the opioid epidemic.
Over the past 15 years, prescription overdose related deaths rose by about 400% (Painter, 2017). Additionally, the CDC state that there are over 130 people in the US who die daily because of opioid overdose (Painter, 2017). Their statistics also show that opioid overdose is the primary cause of drug-related deaths in the country. The financial and emotional effects of the opioid crisis affects every person in the society. Various local, federal, and state policies were developed to deal with the opioid crisis. It is significant to note that societal perceptions regarding substance use have changed because outdated models were replaced by evidence-based practice models. People are accepting that the opioid crisis is affecting every person regardless of their wealth, gender, race, ethnicity, or color.
Delegate your assignment to our experts and they will do the rest.
Opioid Crisis in the US
It is evident that the US has an opioid epidemic. Overdose deaths in the US tripled between 1999 and 2014 (Rummans, Burton, and Dawson, 2018). There were over 60000 drug-related deaths in the US in 2016, and opioid overdose was responsible for most of the overdose deaths (Rummans, Burton, and Dawson, 2018). Due to the opioid-related deaths, the life expectancy in the US decreased for the first time in comparison to other OECD countries since 1999 (Rummans, Burton, and Dawson, 2018). The opioid epidemic involves both illegal (non-prescription) and prescription use of opioids, such as morphine, tramadol, codeine, methanol, and fentanyl. Most synthetic opioids, such as fentanyl, are illegally produced and distributed. Due to the significant rise in the availability of both illegally obtained and prescribed opioids over the past three decades has caused a rapid increase of opioid misuse and deaths.
Notably, opioids have been available in the US for several decades, and opioid misuse grew over a long time. War veterans who experienced severe injuries, during the Civil War, were often offered morphine for pain relief. However, during the late 1800s, many local and international pharmaceuticals began manufacturing synthetic opioids to address the increasing demand for opioids. It is during this period that heroin also became available. Due to the fact that opium derivatives were addictive, the US restricted opium importation to medical purposes only (Rummans, Burton, and Dawson, 2018). The US and other countries proposed and became members of the International Opium Convention that supervised the sale, importation, and manufacturing of opioids by 1912. However, due to the rising cases of heroin misuse, the 1924 Heroin Act banned the possession, sale, and production of heroin regardless of its uses even for medical purposes. Nevertheless, the opioid issue continued, especially after the World War. Veterans who experienced severe combat injuries were offered opioids to relieve their pain, but most of them continued misusing the opioid even after the war. Due to the rising demand for opioids in the US, more opioids like hydrocodone and oxycodone were manufactured and marketed during the 1970s as relief of cancer and acute pain (Rummans, Burton, and Dawson, 2018).
Figure 1 shows concerning statistics regarding the US. While the CDC states that 130 people die to opioid overdose in the US every day, Samet and Kertes (2018) insist that the deaths could be as high as 142 daily. The opioid crisis was considered a public health emergency by President Donald Trump in 2017 (Samet and Kertesz, 2018). The global opioid epidemic is attributed to the addictive components in opioids and the high frequency that they are prescribed and misused as painkillers. Although many physicians are under scrutiny regarding opioid prescription, the legal alternatives are unavailable. Furthermore, synthetic and dangerous versions are manufactured and distributed in the black market across international borders, especially fentanyl (Samet and Kertesz, 2018).
As shown in figure 1, the United States is the largest opioid consumer globally. Moreover, they consume approximately 80% of opioids produced globally (Painter, 2017). Opioid abuse is about 1.5 times more common than other types of cancer collectively and more prevalent than some common diseases, such as diabetes (Painter, 2017). Furthermore, opioid abuse is more prevalent than tobacco use. As mentioned earlier, substance misuse disorder costs the government approximately $442 billion annually while the opioid crisis accounts for $78 billion annually in lost productivity, criminal justice, and healthcare costs (Painter, 2017). Due to the increasing opioid abuse, the leading cause of deaths in the US for people younger than 50 years is drug overdose (Painter, 2017). Also, opioid abuse is a serious issue for Americans aged between 15 and 24.
By 2016, there were more opioid-related deaths per year in comparison to deaths caused by kidney disorders, influenza, and pneumonia, as well as firearm and vehicle deaths (Painter, 2017). However, regardless of the concerning statistics regarding opioid-related deaths, only 10% can access services and help regarding their condition. In the past, opioids could only be prescribed because of acute pain caused by surgery or injury or severe pain attributed to terminal conditions or illness. Additionally, physicians were quite hesitant to give opioid prescriptions for other issues, and there were growing concerns regarding addiction. Moreover, physicians were wary of state board disciplinary investigations and actions if they provided opioid prescriptions liberally. There were many physicians who raised concerns about opioid prescriptions for relieving acute pain in the 1980 New England Journal of Medicine (Painter, 2017). They raised concerns that 4 out of the 11882 people who were given opioid prescriptions became addicted to opioids.
On the other hand, the World Health Organization (WHO) supported a more aggressive opioid prescription for pain relief. A research that was published in the Journal Pain in 1986 and the finding established that opioid maintenance therapies could be a more effective, safe and beneficial option when relieving pain attributed to surgery, injury, or terminal illness (Painter, 2017). Within a few years, opioid prescriptions were not restricted to acute pain caused by terminal conditions or illnesses, surgery, and injury but could also be prescribed by physicians when treating chronic pain. The actions caused a constant rise in opioid prescription for any patient who had 'pain.' Additionally, some studies suggested that opioids could play a critical role in medical treatment of chronic non-cancer pain (Painter, 2017). Furthermore, several states removed sanctions for physicians who gave opioid prescriptions, and by 1995, there were over three million opioid prescriptions annually (Painter, 2017).
Due to the continued pressure, opioid prescriptions increased to approximately eight million annually in 1996 and 11 million in 1999 (Painter, 2017). By 2016, about 62 million patients received at more than one opioid-related prescription. The increased opioid prescriptions were caused by numerous researches conducted throughout the 1990s, claiming that non-cancer and cancer pain has been inappropriately addressed and treatments were insufficient. Additional research in 1991 showed that approximately 42% of outpatients with metastatic cancer were not prescribed adequate pain therapy (Painter, 2017). Insufficient pain therapy was also linked with other vulnerable populations, such as critical care trauma patients and AIDS patients. The pressure caused the Joint Commission, in 2001, to announce new standards regarding pain treatment that focused on the need to assess patients’ pain levels. Due to the focus on treating pain, opioid prescription increased significantly.
Although retail pharmacies, pharmaceutical companies, insurance companies, and medical governing bodies had honest and good intentions of improving healthcare delivery through pain management, their actions contributed greatly to the opioid crisis. Additionally, physicians prescribed large doses of opioids so that they could limit refill requests. On the other hand, some pharmaceutical companies charged less for larger refills in comparison to smaller refills, while some insurance companies restricted high priced and non-addictive pain-relieving agents (Painter, 2017). Ultimately, millions of patients got large opioid prescriptions when they only none or few were required. Additional research showed that 80% of opioid addicts had received opioid prescriptions before their addiction (Painter, 2017). When physicians began limiting opioid prescriptions, the black market thrived as the new source of cheaper and more potent agents such as fentanyl and heroin. Also, opioids could be shared among family members. All in all, physicians, pharmaceutical companies, and medical governing bodies could have had good intentions, but their actions caused negative outcomes. Nurses have to understand the opioid crisis epidemic in the country and their responsibility in preventing further abuse of opioids.
The Role of Nurses
The breadth and depth of the opioid prescription and abuse id quite deep. A research published in the JAMA in 2016 noted that there was a significant variance in the level of opioids prescriptions because the most commonly prescribed opioid was hydrocodone at 78% and oxycodone at 15.4%. At least 1000 people arrive in emergency departments every day for treatment regarding one of the prescription opioids. By 2014, approximately two million people in the US were dependent or abused prescription opioids. Furthermore, more than 50% of opioid overdose deaths were associated with prescription opioids. In addition, it is important to mention that opioid overdose deaths were highest among Americans whose age is between 25 and 54. However, a research highlighted in the 2015 American Journal of Preventive Medicine insisted that opioid prescription in the US had reduced by about 5.7% and the reduction was associated with the growing concerns about opioid abuse and addiction (Manworren and Gilson, 2015). Meanwhile, nurses should be well aware of all the necessary steps they should take to avoid legal action because of opioids.
Assessing the Patient Carefully
Nurses should match patient medication with the individual needs of a patient. The assessment starts with a detailed and comprehensive medical history that highlights the list of previous and currently prescribed drugs (Manworren and Gilson, 2015). A nurse should ask about the history of substance use disorders that could be present in the patient’s family or the patient. If the nurse is considering opioid prescription, they should evaluate the patient’s psychiatric status. In addition, the patient should complete a physical exam while considering the symptoms and signs of substance abuse, such as poor oral hygiene, traumatic lesions, or advanced periodontitis. However, if the patient’s chronic pain is already being managed, a nurse should contact and consult with the necessary health providers.
Screening and Referring Patients
One of the most effective models of following up substance abuse is referred to as Screening, Brief Intervention, and Referral to Treatment (SBIRT). It is a technique that ensures patients with substance abuse disorders or any individual at risk of developing opioid abuse disorder can receive assistance. Nurses have an important responsibility in detecting patients with opioid abuse disorders through the National Institute on Drug Abuse Quick Screen (NIDA). However, if a nurse suspects substance abuse disorders, they should remain non-judgmental and empathetic when referring patients to additional evaluation and treatment (Chou et al., 2015). Furthermore, nurses should closely monitor and evaluate patients’ use of prescribed opioids to prevent potential addiction or overdependence while referring chronic pain patients to specialists or pain management centers (Chou et al., 2015). Also, it is important to record and document the referral in their health records. Moreover, they should consider referring patients who are requesting opioids beyond the period when the medication is necessary.
Applying Evidence-based Pain Management
For nurses to protect themselves against legal action as well as proving optimal patient care, nurses must use evidence-based pain management. It involves offering alternative non-steroidal anti-inflammatory drugs (NSAIDs) as patient’s first prescription of pain relief and medication, such as ibuprofen. Some studies suggest that NSAIDs are as efficient as opioids in pain management, especially when they are combined with acetaminophen. However, before a nurse prescribes NSAIDs, they should verify that the patient is not taking anticoagulants such as aspirin. In addition, the nurse should check for renal or hepatic impairment. It is significant to note that nurses should consider completing education courses regarding pain therapy so that they can offer evidence of their skills and knowledge if they face legal action (Chou et al., 2015).
Educating Patients
Nurses have a responsibility to educate people, especially patients, about the roles and risks associated with pain medication. Patient education should also evaluate alternative pain medications and why non-opioids are preferred in pain management (Costello and Thompson, 2015). The education should also entail written and verbal instructions that highlight the name of the drug, its storage, risks associated with the drug, and how long it should be taken. Furthermore, it should also explain how unused drugs can be discarded and how patients can access areas used by the Drug Enforcement Administration (DEA) to collect controlled substance drugs (Costello and Thompson, 2015). Additionally, the instructions should states that pain medication, especially opioids, should not be shared with family or friends because a survey showed that more than 20% shared their pain medication with other people (Costello and Thompson, 2015).
Manworren and Gilson (2015) state that drug diversion is the illegal use or sharing of legitimately prescribed drugs. Due to the high level of opioid diversion in the US, it is crucial for nurses to teach patients the negative effects or risks associated with opioid diversion. They should teach patients that prescription medication should only be used as they were prescribed by healthcare providers and not for other reasons, such as facilitating sleep or relaxing. Also, medications should only be prescribed for one patient’s use and not for any other individual. Sharing medication is dangerous and violates the law according to the Controlled Substances Act. In addition, prescription medicines, especially opioids, should be secured so that they can only be used by the patient to whom the drugs were prescribed (Manworren and Gilson, 2015). Notably, the most common source of diverted opioids is family members and friends.
For nurses to prevent opioid prescriptions from being accessed by unintended people, disposal, and storage techniques should be addressed during prescription, follow-up, and disbursement (Opioid Epidemic, 2018). Nurses should educate patients and their families regarding proper disposal and safe storage methods. Patient education should be a constant procedure throughout the pain management and should be presented to patients and their families in culturally appropriate content. Opioid prescriptions must be placed beyond children's sight and reach, and patients should close the cap immediately after use. Also, house guests and family members must store the opioids in lockboxes or locked cabinets to avoid unintended access and use. In addition, the Safe Homes Coalition (SHC) advises patients to keep their opioid medication in their original containers so that they can avoid mixing medicines in one bottle (Opioid Epidemic, 2018).
Notably, nurses should educate patients about the disposal of unused opioids. They should ensure that patients read and follow the disposal process that are often provided with the medicine (Thomas et al., 2015). However, if the disposal guidelines are unavailable, the FDA has endorsed three actions:
Disposal in the household trash: when disposing of opioid medication, the patient should mix the drugs with unpalatable substances, such as coffee grounds, dirt, or cat litter (Opioid Epidemic, 2018). The mixture should be sealed in a plastic bag and thrown in the garbage can. However, the patient must erase personal data from the medicine bottles before disposal.
Medication take-back programs: there are two main types of such programs, one occurs during periodic events involving national prescription drug take-back while the other type involves DEA-registered collections sites such as law enforcement facilities and pharmacies.
Flushing: some opioid prescription drugs can be flushed down the toilet if alternative programs are unavailable.
Preventing Stigma in Special Populations
There is a stigma associated with substance abuse disorders and treatments that affect different caregivers, patients, and communities, and it may cause some patients to withdraw from treatment or others may ignore life-saving medical services (Opioid Epidemic, 2018). Nurses should consider applying their knowledge and skills in different circumstances, such as secondary exposure situations involving newborns and their mothers. The importance of addressing stigma is increasingly beneficial to expectant mothers. Within the past ten years, there have been increasing incidences of maternal opioid use and its effects, such as neonatal abstinence syndrome (NAS) (Opioid Epidemic, 2018). Due to the increasing incidences of NAS, nurses should improve their abilities in identifying and treating such patients in outpatient facilities when necessary. Some of the relevant interventions may involve community-based plans that help pregnant expectant mothers and training for women and nurses offering prenatal services (Opioid Epidemic, 2018).
For several decades, methadone has been considered the best alternative when treating maternal opioid use (Opioid Epidemic, 2018). Various researches suggest that when pregnant women are maintained on methadone, it may help in reducing adverse pregnancy outcomes associated with withdrawal and the many health risks associated with the illegal use of opioids. Some recent studies suggest that buprenorphine has proved to be efficient in preventing NAS similar to methadone.
Addressing Secondary Exposure
The rapid increase in opioid overdoses poses a threat to nurses due to the potential for exposure as the first respondents. Nurses should educate other health care providers about how to take caution at hospitals, clinics, and other health care institutions when treating opioid abuse or overdose, especially situations involving fentanyl and any of its analogs. It is significant to note that there is a great risk for secondary exposure, especially through a needle stick, inhalation, ingestion, and mucous membrane contact (Opioid Epidemic, 2018).
To ensure opioid overdose patients receive quality and timely care while protecting healthcare providers, nurses need specialized training that focuses on having on-scene risks assessments addressing fentanyl or any of its analogs. The National Institute for Occupational Safety and Health (NIOSH) proposes that first responders, especially nurses, should use Personal Protective Equipment (PPE) to prevent exposure from patents. Some of the PPE includes powder-free nitrile gloves (Opioid Epidemic, 2018). However, when nurses are expecting high levels of exposure, they can use filtering face piece respirator in addition to eye and face protection. Nurses should be able to identify symptoms of secondary exposure from opioids, such as life-threatening respiratory depression. Furthermore, when nurses or any other person encounters illicit opioids, they are advised to immediately remove their clothes and use water and soap to wash the contaminated areas carefully. It is important to note that no bleach or alcohol-based solutions should be used when washing areas contaminated by opioids. Moreover, all contaminated clothing must be washed separately from others (Opioid Epidemic, 2018).
Tracking Opioid Use
Although there is no accepted model or standard for monitoring short term opioid use, nurses should monitor patient’s compliance through random drug screening and using PDMPS when practical, especially those receiving extended-release opioids. Furthermore, the FDA proposes that healthcare providers should have a primary role in tracking opioid use. PDMPS are operational in all states apart from Nebraska and Missouri. PDMPs allows dispensers, users, and prescribers to track prescribed opioid use and other controlled substances given to patients. If a nurse observes several prescriptions from different practitioners or received from multiple pharmacies, it may be an indication of non-medical use or opioid diversion (Manworren and Gilson, 2015). In addition, the nurse should contact the patient and other healthcare providers to ensure the patient gets help.
There are many variables regarding state PDMPs about administering agencies, regulatory, healthcare, and law enforcement agencies who can access essential patient information (Manworren and Gilson, 2015). The other issues describe the frequency and method which the prescription information can be reported, its ease of use, and how the information will be made available to other users. In a bid to promote the use of PDMPs and promote consistency in identifying opioid diversion, there are some essential program characteristics that include:
Developing reliable patient risk scoring techniques
Real-time data submission
User education
Confidentiality maintenance and data security
Point of care data access
Expanding user access to information and data
Integrating electronic healthcare records
Authorization of law enforcement
Interstate data sharing
Furthermore, nurses have a role in random urine drug screening for patients who were given opioid prescriptions and at high risk of misuse or abuse. Screening has a primary role in assisting nurses to ensure drugs are only given to the right patients and that diverted or illegal drugs are not used by patients who are on controlled substance prescriptions. Studies on urine drug screening reveal that people with a family record or history of psychiatric disorders or drug abuse are at a higher risk of drug abuse, especially opioids. Identifying such patients can have a crucial role in identifying patients with these characteristics so that it can guide urine testing throughout pain management and treatment. However, there is limited evidence showing that urine screening can enhance nurses’ ability to identify diversion or improve clinical outcomes. Additional factors should be considered during urine drug testing such as testing specificity and sensitivity and the ability of clinicians to identify particular substances and not the legitimate drugs that could interfere with the validity of the outcomes. Just as random urine drug screening and nurses’ access to PDMP information can be beneficial in identifying actual and potential opioid diversion or the non-medical use of analgesics and opioids, nurses are in an ideal status to assist in determine the actual amount of opioid analgesics that is necessary and required for some common painful conditions (Manworren and Gilson, 2015).
Advocating For Policy Changes
Nurses should advocate for policy changes regarding the use of opioids so that they can manage the opioid epidemic in the country. For nurses to be influential, they should perceive themselves as skilled caregivers with the responsibility and capacity to impact America’s future health and wellness. Notably, the nursing profession is based on a framework that values everyone in a holistic way while seeking to advance and foster people’s healthcare across all levels in the community (Araba et al., 2014). To achieve a society that is free from the opioid epidemic, nurses should advocate for policies that identify, define, and integrate quality standards regarding pain management and the use of opioids.
Through policy, nurses can influence standard processes and practices that will ensure the quality of healthcare. Additionally, policy shapes care that is provided currently and in the future. Furthermore, it will define the resources that will be allocated to the delivery of care and implementation of programs that will manage the opioid epidemic. Nurses’ roles have grown in every healthcare process and setting, and they must play a unique role in influencing and formulating policy, according to the Institute of Medicine (IOM). Moreover, the IOM 2010 findings and report that was titled The Future of Nursing identified and recognized the role and the importance of nurses to take leadership and improve healthcare quality ( Harper and Vlasich, 2016). Nurses should take an active role in policy formulation so that the current needs of challenging the opioid epidemic is addressed in educational programs at the doctoral, baccalaureate, and master's levels of training, in addition to advanced practice.
The current health care system consists of a set of regulations, policies, and laws managed by institutions, federal agencies, and private-sector insurers that place patients and nurses at the crossroads regarding their approach to pain management ( Abood, 2017) . The US Census Bureau statistics show that 8.8% of the American population is uninsured ( Abood, 2017). Unfortunately, a significant number of opioid addicts are uninsured, and it has affected their ability to receive help. Additionally, the Common Wealth Fund claimed that the US healthcare system might be poorly coordinated and it has driven up costs and put millions of patients at risk. Private insurers have a significant influence on prescriptions given to patients. As mentioned earlier, insurers often preferred more affordable and addictive opioids than costly and less addictive opioids.
Due to the increasing healthcare costs and variable quality of healthcare delivery, developing an effective national policy regarding the opioid epidemic is an issue of national urgency. However, the challenges facing the US healthcare system is not surprising to most nurses. Since nurses are often the first providers, they interact with patients at a personal level, and they observe how the inefficiencies of the healthcare system have affected the fight against the opioid epidemic. Furthermore, they see the need for effective and comprehensive changes in the healthcare policy so that it can address the current healthcare needs of the country ( Abood, 2017). Inability to formulate a national policy regarding the opioid epidemic will have adverse implications for different people and nurses who have to continue caring for people whose personal lives and their families have been affected by the opioid epidemic.
Nurses have a professional and ethical role of moving out of their comfort zone and move into the less familiar arena involving regulations and laws ( Greer Glazer and Ali, 2018). Although Painter (2017) mentions that the government spends approximately $78 billion in addressing the opioid crisis, the resources are inadequate to address the current level of the opioid crisis in the country. As time-consuming and challenging as policy issues may be, challenging the current health policies and accepting the responsibility provides a valuable chance to make an important difference and achieve personal satisfaction of being part of the team that brought better policies into the healthcare system to address nurses problems and opioid patients. Furthermore, advocacy will add an essential dimension to their professional careers, and it will reward them with the opportunity to influence and have more power over patient outcomes and care.
Effective advocacy that will cause changes in the current healthcare setting to address the opioid epidemic requires energy, power, time, and will, in addition to political skills. Florence Nightingale is an outstanding example of a nurse who demonstrated the ability and capacity to influence and shape healthcare policies. Many specialty nursing organizations provide policy workshops that are designed to help nurses understand the legislative processes and current healthcare issues (Bodenheimer and Bauer, 2016). Every nurse has the role of exploring possible policy changes, its pros and cons, and how it will improve healthcare delivery, especially regarding the opioid epidemic. Nurses can also testify in public meeting about the effects of the current healthcare policies and propose changes. However, addressing the opioid epidemic will need the collective power of all nurses. There are over 2.86 million RNs in the country, and their collective power and influence are adequate to influence changes. All in all, nurses should get out of their professional comfort zone and advocate for policies that will help fight the opioid crisis.
Conclusion
The essay has analyzed the role of nurses’ roles in fighting the opioid epidemic. The opioid crisis began with the honest need to treat pain caused by injury during wars and terminal illness, but opioids were later prescribed for simple' pain.' It developed into misuse of prescription opioids that caused the increased use of fentanyl and heroin. Private insurers, government agencies, and physicians played a primary role in causing the opioid crisis. Currently, there are about 130 deaths daily caused by opioid overdose in the US. Nurses are playing a crucial role in the large scale initiatives to address the problem. The impact of the opioid epidemic most people in the society because by 2016, more than 62 million Americans had at least one opioid prescription. Furthermore, there is a growing number of opioid addicts, and the illegal trade of opioids in the black market is growing daily.
Nurses have a role in assessing patients, preventing stigma, patient education, tracking opioid use, addressing secondary exposure, screening patients, applying evidence-based pain management, and advocating for policy changes. Nurses are often the first providers in the emergency room when patients are admitted because of an opioid overdose. Furthermore, nurses have developed relationships with the patients and their families, and they know the financial and emotional impacts of opioid addiction. It is significant to note that more than 50% of opioid addicts have had an opioid prescription in the past. Currently, there are over 2.6 million RNs who have the necessary skills in assessing the demand for pharmacologic pain relief and are the first respondents in facing the opioid issue. One of the most crucial responsibilities of nurses in the crisis is patient education so that they understand the benefits and risks associated with opioids, its usage, storage, and disposal. Also, education should explain the risks of opioid diversion. All in all, nurses have a primary role in advocating for policy changes that will determine how the country challenges the opioid issue.
References
Abood, S. (2017). Influencing health care in the legislative arena. OJIN: The Online Journal of Issues in Nursing , 12 (1), 2.
Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iranian journal of nursing and midwifery research , 19 (3), 315.
Bodenheimer, T., & Bauer, L. (2016). Rethinking the primary care workforce—an expanded role for nurses. New England journal of medicine , 375 (11), 1015-1017.
Chou, R., Turner, J. A., Devine, E. B., Hansen, R. N., Sullivan, S. D., Blazina, I., & Deyo, R. A. (2015). The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Annals of internal medicine , 162 (4), 276-286.
Costello, M., & Thompson, S. (2015). Preventing opioid misuse and potential abuse: The nurse's role in patient education. Pain Management Nursing , 16 (4), 515-519.
Greer Glazer, R. N., & Ali, A. A. (2018). Legislative: Family Caregiving Act: Healthcare Impact and Nurses' Role. Online Journal of Issues in Nursing , 23 (1), 1-5.
Harper, K., & Vlasich, C. (2016). Influencing health through policy: the dynamic role of nurses in the boardroom.
Manworren, R. C., & Gilson, A. M. (2015). CE: Nurses’ Role in Preventing Prescription Opioid Diversion. The American Journal of Nursing , 115 (8), 34-40.
Opioid Epidemic. (2018). The Evolving Role of Nurses. Issue Brief in American Nurses Association.
Painter, S. G. (2017). Opiate crisis and healthcare reform in America: A review for nurses. OJIN: The Online Journal of Issues in Nursing , 22 (2).
Samet, J. H., & Kertesz, S. G. (2018). Suggested paths to fixing the opioid crisis: directions and misdirections. JAMA network open , 1 (2), e180218-e180218.
Thomas, D., Frascella, J., Hall, T., Smith, W., Compton, W., Koroshetz, W., & Volkow, N. (2015). Reflections on the role of opioids in the treatment of chronic pain: a shared solution for prescription opioid abuse and pain. Journal of internal medicine , 278 (1), 92-94.
