Introduction
Deaths from the use of drugs continue to increase worldwide. Opioids account for a significant number of these deaths. Opioids are frequently used in the management of chronic pain in various hospital settings. However, their use requires strict criteria that seek to enhance the safety of patients. This approach is important because opioids have a narrow therapeutic range, and also have numerous adverse interactions with other drugs if co-administered together. This paper provides a summary of an opioids prescribing module as elaborated in the Center for Disease Control (CDC) website.
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Center for Disease Control Guideline for Prescribing Opioids for Chronic Pain
Chronic pain is one of the major challenges that many patients face in the United States. Although many pain medications exist, many patients experience extreme pain in some cases that call for the consideration of alternatives such as opioids. This model by Haegerich, Dowell and Tauben (2016) elaborates on the use of opioids for the management of chronic pain, as well as the precautions that should be considered before initiating its use. About 11 percent of Americans with chronic pain are managed using opioids (CDC, 2020). There are three conceptual areas in the consideration for the initiation of opioids treatment for chronic pain. These areas are: determining when to start and continue with the treatment, selection of the correct opioid medication, and assessment of risk and managing side effects. Other pharmacologic and non-pharmacologic modes of treatment should be considered as first-line for the management of chronic pain. Opioids should be used as second-line treatment after the other options have failed. The opioids should also be used in cases where it has been determined that their advantage exceeds the disadvantages in each patient. The guidelines also recommend that they should not be used alone, but rather in combination with other pharmacologic and non-pharmacologic options. Clinicians should consider treatment goals for each patient before initiating treatment.
These goals should rotate around pain management and functionality. Clinicians should also discuss the treatment, benefits, and possible risks with the patient before treatment is commenced. Clinicians should assess the effects of long-term use of opioids to individual patients before starting them on treatment. It should be determined whether the benefits to the patient will outweigh the harms that could be experienced (Dowell et al., 2016). Treatment should, therefore, be started once the clinicians are certain that the benefits will significantly outweigh the risks. In the initiation period, immediate-releasing opioids should be employed. In the prescription of opioids, the lowest doses possible should be used, provided they are effective for the given patient. Considering that long-term opioid use is usually preceded by use for acute pain, only the required dose should be used to avoid addiction.
The clinician should also set the criteria for termination of the use of opioids in the management of a patient’s chronic pain. This approach is also possible through the establishment of a proper “exit strategy” for stopping opioid therapy in each patient. This is especially important in cases where opioids cause harm to the patient or prove to not be helpful. In such cases, the opioids should be tapered off, rather than being stopped immediately. In patients using benzodiazepines, opioids should not be co-administered until the benzodiazepines are discontinued. Patients should be assessed on their previous substance use. This can be done by using single-screening questions and other validated screening tools such as the Alcohol Use Disorders Identification Test (AUDIT). This method is important as it helps in determining a patient’s proper health history, as well as allow for effective communication between clinicians and patients about prior drug use.
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Clinicians should embrace effective communication in this area in order to fully cater for the needs of the patients. Communication with patients involves informing them of situations and behaviors that could put them at risk. For example, informing them that the use of alcohol while using opioids can lead to respiratory depression, which may result in sudden death. Communication in this area also entails motivating the patient to change their behavior in a manner that facilitates treatment. This happens in cases such as when a clinician would like to encourage a patient to commit to tapering off their opioid use. One of the major precautions that should also be considered before initiating opioids is if the patient has been using any other opioid drugs. Clinicians should confirm this by conducting a urine test on the patient. This will help with preparing for proper opioid use management.
Proper management is essential when it comes to patient safety with drug use. Most patients who die of opioid overdose often have a history of high total daily dosages, as well as having obtained opioids from various sources. Although patients may not report overdoses, urine test results can reveal this information and help improve patient management. A patient’s history helps in preventing situations where those with opioid abuse are put on other opioids for the management of their pain. Also, alcoholics are identified on time for proper management before initiation of opioid therapy. Clinicians should discuss with patients the risk of overdosing, and highlight to them the best way to be safe while using the drugs.
Plan for Prescribing Opioids as an Advanced Practice Registered Nurse (APRN)
Nurses should be at the forefront of managing patients in all settings. From the above summary of the CDC opioids prescription module, it is apparent that Advanced Practice Registered Nurses should be adequately prepared to provide quality services to patients with chronic pain. Although opioids are a good option in the long-term management of patients with chronic pain, other first-line safer options should be explored first. This approach is important because opioids are associated with many risks and disadvantages in the long-term, including addiction to drugs.
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An APRN should also take an elaborate history of a patient before administering opioids. Important elements to be captured in history include the use of alcohol, as well as any use of antidepressants such as benzodiazepines. A combination of alcohol and opioids could be lethal, due to their effect of compromising respiration. A nurse should also have a protocol that guides steps for determining harm in a patient, and a work-up that shows how to remove the patient from the opioid therapy. Communication is an important part of this process, and aids in better understanding, and ensuring that the patient can safely taper-off their use of opioids. Overdoses should be minimized for the safety of the patient by proper patient education, as well as having adequate stock of naloxone for emergency cases (Purviance et al., 2017). Proper management of addition to the drug should also be developed for each patient.
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