Nurse Opioids

Nurses are directly affected by the opioid crisis on many levels. Addressing and managing pain is a cornerstone of nursing diagnosis and treatments. Nurses utilize many non-prescription methods of pain management such as repositioning, ice, heat, massage and guided imagery. Registered nurses who are not certified nurse practitioners do not prescribe pain medication, however, addressing the ripple effect of opioid overuse and abuse falls back to nurses in numerous venues of medicine.

As a nurse in an outpatient medical clinic, nurses can be caught in the middle of angry patients wanting their prescription opioid refilled and the physician who is refusing to refill the medication. These same nurses are often called upon to explain and enforce an "Opioid Medication Contract" with patients for refills of narcotics, which often places the nurse in a hostile situation with patients or their families.

Nurses employed in a Pain Management clinic typically case-manage a group of patients with chronic pain conditions such as spinal or nerve injuries. These specialized nurses work closely with physicians, behaviorists, anesthesiologists and pharmacists to create individual pain management plans for patients. Often times, pain management clinics include acupuncture as a method for reducing and managing pain without medications.

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In the Emergency Department (ED), nurses are exposed to patients who have overdosed on opioids, those who are seeking medical attention for fake illnesses to gain access to narcotic medications, and patients who have sustained injuries or illnesses requiring treatment for pain. This can be extremely challenging, as nurses are faced with the ethical dilemma of treating the patient's report of pain against the objective evidence of opioid dependency and abuse. Many organizations allow nurses to directly refer patients to substance abuse programs without a doctor's order, which gives nurses the ability to recommend care beyond the emergency department.

In the psychiatric or mental health arena, nurses are part of care teams who determine if an opioid addiction is really a mental health issue and the patient is self-medicating in order to calm the internal storms of the complex. For example, Psychiatric Nurse Practitioners use validated tools to assess patients' mental status and, along with ongoing treatment, will prescribe antipsychotics or mood stabilizers that should help patients as they wean off narcotics.

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Historically, both nurses and the field of medicine in general have played a role in the opioid crisis across the nation. As regulatory agencies of the 1980s and 90s pushed for "Pain as the Fifth Vital Sign," nurses and clinicians were expected to treat patients' pain levels, regardless of any objective data. Patients could present to a medical facility claiming to have 10/10 back pain with no objective data such as an abnormal pulse, blood pressure, or MRI results and the clinician was expected to treat the stated subjective pain level.

The tide is slowly turning to approach pain management as a care team in an attempt to reduce the opioid crisis while offering more alternative treatments for pain. Nurses continue to play a significant role in managing this epidemic and seeking non-pharmacological ways to treat pain.

Amanda Bucceri Androus, RN, BSN

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