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Opioid Use Disorder and Nursing Care.

In health care, nurses at all levels of licensure may be called upon to administer opioids for the purpose of pain reduction, and nurses licensed as advanced practice registered nurses (APRNs) may be called upon to order these drugs under certain circumstances in compliance with state law. It is important for nurses to recognize that there are differences between acute and chronic pain. Although numerous definitions of chronic pain were found in the professional literature, Treede et al. (2015) defined chronic pain as persistent or recurrent pain lasting longer than three months. Typically, chronic pain involves pain that persists past the normal time required for the tissue to heal (International Association for the Study of Pain, 1986 as cited in Dowell, Haegerich, & Chou, 2016). Additionally, nurses must be aware of both the physical and psychological aspects of pain and the importance of treating each as appropriate. Failure to appropriately treat the psychological aspects of chronic pain may contribute to opioid use disorders.

Opioids are a class of drugs that includes prescription pain relievers such as morphine, hydrocodone, or oxycodone as well as illicit drugs such as heroin. Opioids are known for their addictive potental. In 2016, 11.8 million people over the age of 12 years reported that they engaged in the misuse of opioids in the previous year; 11.5 million of those people engaged in the misuse of prescription pain relievers (Substance Abuse and Mental Health Services Administration [SAMHSA], 2017, p. 20). Rudd, Seth, David, and Scholl (2016) further reported that 63.1% of all drug overdose deaths involved an opioid. As a result of the increasing incidence of misuse of opioids and overdose deaths involving opioids, numerous health organizations have declared this to be an epidemic. Nurses in almost all health care settings must be prepared to care for patents with opioid use disorder.

Nurses at all levels of licensure must be aware of the implications of the opioid epidemic for the practice of nursing. It is important to recognize that misuse of a prescription drug is not necessarily the same as abuse of that drug. Behaviors such as taking a drug without a prescription of one's own, taking a higher dosage of a prescribed drug than was prescribed, or taking a drug more frequently than was prescribed all constitute misuse. SAMHSA (2017) reported that more than 40% of individuals obtained the drugs they misused from a friend or relative (p. 24). When performing a health history and assessment, nurses should keep this information in mind when eliciting a patent history related to substance use and be certain to ask patents whether they have ever borrowed or obtained medicine from a friend or family member and whether they took the drug as prescribed. Nurses should also be aware of issues that may occur as a result of misuse of opioids, such as health problems from side effects of the drug, symptoms of physical withdrawal, diminished social functioning, and failure of the patent to meet responsibilites at work, school, or home. When nurses obtain information regarding possible substance misuse, they have a responsibility to document this information under Board Rule 217.11(1)(D)(i).

Nurses are required to collaborate with their patents, other members of the health care team, and, where appropriate, patents' families [Board Rule 217.11(1)(P)]. Patents often confide in nurses and share information with them once the nurse-patent relationship has been developed. This can include sharing information with the nurse that the patent has not shared with other health professionals. It is important that nurses work together with other members of the team who are providing care to the patent to be certain the patent receives the needed care. Nurses should know and recognize how signs and symptoms of opioid use disorder may affect other co-morbid conditions the patent may be experiencing or mask signs and symptoms of other conditions.

APRNs who care for patents who suffer from opioid use disorders may find themselves in the position of needing to provide medication assisted therapy. APRNs may obtain a waiver from SAMHSA that will allow them to prescribe buprenorphine to a limited number of patents by completing 24 hours of continuing education approved by SAMHSA and then submitting the appropriate request for waiver. Additional information is available on the SAMHSA website at: htps://www.samhsa.gov/medication-assisted-treatiment/qualify-nps-pas-waivers.

It is incumbent upon all nurses to be aware of the opioid epidemic and be mindful of the signs and symptoms of opioid use disorder. Nurses need to be prepared to support their patents who may be experiencing opioid use disorder by recognizing appropriate signs and symptoms, documenting their observations, and working with appropriate members of the health care team in the best interest of the patent.

References

Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain--United States, 2016. Morbidity and Mortality Weekly Report Recommendations and Reports, 65(RR-1), 1-49. DOI: htp://dx.doi.org/10.15585/mmwr.rr6501e1

Rudd, R. A., Seth, P., David, F., & Scholl, L. (2016). Increases in drug and opioid-involved overdose deaths--United States, 2010-2015. Morbidity and Mortality Weekly Report, 65(50-51), 1445-1452. DOI: htp://dx.doi.org/10.15585/mmwr.mm655051e1

Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www. samhsa.gov/data/

Texas Board of Nursing. (2017). Rules and regulations relating to nurse education, licensure & practice. Retrieved from

http://www.bon.state.tx.us/laws_and_rules_rules_and_regulations.asp

Treede, R.-D., Rief, W., Barke, A., Aziz, Q., Bennet, M. I., Benoliel, R.,... Wang, S.-J. (2015). A classification of chronic pain for ICD-11. Pain, 156(6), 1003-1007. htp://doi.org/10.1097/j. pain.0000000000000160
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Publication:Texas Board of Nursing Bulletin
Article Type:Report
Date:Apr 1, 2018
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