Nurses Have a Pivotal Role as Patient Advocates in the Opioid Crisis
As the current landscape of opioid pain control becomes more complex, oncology nurses remain vital to safe and effective treatment. During a session on Wednesday, April 10, 2019, at the ONS 44th Annual Congress in Anaheim, CA (https://congress.ons.org/), Tonya Edwards, MSN, MS, RN, FNP-C, of the University of Texas MD Anderson Cancer Center in Houston, and Timothy Tyler, PharmD, FCSHP, FHOPA, of Desert Regional Medical Center’s Comprehensive Cancer Center in Palm Springs, CA, discussed the challenges of opioid pain management (https://ons.confex.com/ons/2019/meetingapp.cgi/Session/2027) as well as actions nurses can take to protect patients.
Nurse Opioid Education and Management Strategies
Edwards emphasized oncology nurses’ role in educating patients about the safe use of opioids. A proactive, two-way communication model in which patients feel comfortable calling nurses by phone can improve quality of life.
“Bidirectional communication builds patient trust,” Edwards said. “Communication with nurses allows for coordination of pertinent care, opioid education, medication review, and counseling and identifies the need for referrals.”
Urine drug tests (UDTs) provide a powerful communication tool to discuss potential dangers of aberrant drug behaviors. However, Edwards cautioned that UDT results can lead to painful opioid withdrawal or compromise patients’ ability to receive appropriate therapy from future physicians.
“Every patient deserves a nonjudgmental response if the UDT has unfavorable results against the opioid prescribing plan,” Edwards said. “We must make sure the results are interpreted correctly.”
All patients treated with opioids have some degree of risk, and signs of aberrant behavior may be difficult to detect in those who initially demonstrate adherence. Risk factors include:
- Younger age
- Male gender
- History of mental health or substance abuse disorders
- Alcohol or tobacco use
History of “Opiophobia”
Tyler explained that in the early 1900s, laudanum and morphine could be purchased over the counter in U.S. drug stores. As a result, hundreds of thousands of Americans became addicted.
Today, the U.S. Food and Drug Administration (FDA) has a risk evaluation mitigation strategy (REMS) for opioid prescription (https://www.fda.gov/drugs/drugsafety/informationbydrugclass/ucm163647.htm). Although REMS ensures safe use through appropriate patient selection, monitoring, and education, flaws in the program limit its effectiveness. For example, adhering to REMS may add a significant workload burden to healthcare providers, reducing the likelihood of opioids being prescribed at all.
The Centers for Medicare and Medicaid Services (CMS) Roadmap to Address the Opioid Epidemic (https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Opioid-epidemic-roadmap.pdf) can help nurses navigate those challenges. The elements include:
- Prevention: Manage pain using a range of effective treatment options, with less reliance on opioids
- Treatment: Expand access to treatment for opioid-use disorder
- Data: Use actionable data to inform prevention and treatment efforts, as well as identify fraud and abuse.
Although the CMS roadmap is a great starting point, Tyler advised nurses to take caution, especially when considering non-opioid treatment options. “An alternative is not always better in every respect. There are trade-offs, and we must continually educate patients and providers to this point,” Tyler said.
As pain management becomes a focus of future research, Tyler said that nurses owe it to patients to advocate wisely. “As we start grappling with opioids and how best to deal with the current crisis, I know nurses will be advocates for relief of suffering and prevention of toxicity, even when everyone else is trying to remove or even further restrict the drug access,” Tyler said.