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Nurses find new ways to combat opioid epidemic

As efforts to address the opioid epidemic have intensified in recent years, Angela Clark, MSN, PhD, RN, CNE, and her research team started noticing an unprecedented trend — an increasing number of people who needed emergency services after receiving naloxone (Narcan), an opioid antagonist used for complete or partial reversal of opioid overdose.

The overdose victims were arriving outside the emergency department, which meant nurses were walking outside the ED to aid these incapacitated patients. Clark knew nurses had not been trained to respond to these situations, and their safety was at risk.

Clark, a professor of nursing at the University of Cincinnati, decided to develop a training program to teach nurses how to protect themselves while leveraging their medical expertise.

“Nurses are trained to put the patient first, while police are trained to put safety first,” said Clark, whose team launched the Be-SAFE program in 2017.

Nurses started learning to ask drivers if they had any weapons, to step outside the car and to drop the keys away from the car. The training also suggests asking how much Narcan had been administered, how long the patient has been unconscious and other medical questions.

Training like this is just one example of the new skills nurses are learning as they respond to the nation’s opioid epidemic, which has led to the deaths of more than 400,000 people in the U.S. since 1999, according to the Centers for Disease Control and Prevention.

Overdoses have become the leading cause of death among Americans under 55, killing more than 70,000 in the U.S. in 2017. Clark has conducted numerous studies focused on educational interventions that address the opioid epidemic, and she believes nurses have a critical part to play in the effort to tackle this national crisis.

“Nurses are in a unique role because we have close access to patients,” Clark said. “We are the first to see them when they walk in, the last to see them when they are discharged, and the caregivers who spend the most time with inpatients.”

Helping patients who are ready for treatment

Clark also recently received funding from the Ohio Department of Mental Health and Addiction Services to train nurses, pharmacists, social workers and health professional students how to use an intervention that helps them understand a patient’s willingness to pursue treatment for opioid use disorder.

The intervention, known as SBIRT (Screening, Brief Intervention and Referral to Treatment), equips healthcare providers to ask open-ended questions such as “How ready are you for treatment?” rather than “yes” or “no” questions that can quickly end a conversation. If patients are not ready for treatment, providers can use brief negotiated interview techniques to discuss and identify barriers preventing them from readiness.

“Through these conversations, nurses may discover that patients do not want to pursue treatment due to caretaker responsibilities or other barriers,” Clark said. “We can connect them with resources in the community to help support them in long-term recovery.”

Implementing alternatives to opioids

Nurses can not only help patients navigate the healthcare system to pursue recovery, but also prevent the onset of opioid use disorder and combat the opioid epidemic. At St. Joseph’s Health in New Jersey, nurses, physicians, pharmacists and administrators worked together to launch a program in 2016 that trains providers how to use alternatives to opioids when treating pain.

The program is called ALTO (Alternatives to Opioids), and the team initially developed protocols for specific conditions that have been shown to benefit from non-opioid treatments for pain: renal colic (kidney stones), abdominal pain, lower back pain, headaches, musculoskeletal pain and extremity fractures. The alternatives to opioids include lidocaine, nitrous oxide, nerve blocks and Ketamine.

opioid epidemic - Cathlyn Robinson, RN

Cathlyn Robinson, RN

Nurses have been crucial to the success of the program because they explain to patients why they are receiving alternative medications for their pain, says Cathlyn Robinson, MSN, RN, CEN, a clinical education specialist in the emergency department at St. Joseph’s Health.

“Patients learn that opioids may not be the best choice for problems like back pain because narcotics mask the pain rather than treating the problem,” Robinson said. “Anti-inflammatories and muscle relaxants are now the first line of treatment.”

For conditions like renal colic or abdominal pain, nurses have learned how to administer lidocaine intravenously, which is traditionally used to treat cardiac arrhythmias. The dosing and concentrations are different when the medication is used to treat pain, and “learning how to program the IV pumps using the new drugs can be complicated,” Robinson said.

The program has successfully decreased opioid use in the ED by almost 50%. Up to 75% of patients have achieved adequate pain relief with the alternative therapies, though the team still administers opioids when this medication is the best pain treatment option.

opioid epidemic - Janine Llamzon, RN

Janine Llamzon, RN

“We are being more deliberate and mindful about what we give patients in the emergency department,” said Janine Llamzon, MS, RN, AGNP-c, CEN, NEA-BC, director of nursing for emergency services at the hospital. “If someone is in acute pain from a laceration or fractured femur, we may still administer opioids. But nurses have a different mindset now about treating pain and they use a more holistic approach.”

Schooling nursing students on opioid epidemic

opioid epidemic - Peggy Compton, RN

Peggy Compton, RN

While training nurses to treat and prevent opioid use disorder is critical, Peggy Compton, PhD, RN, FAAN, an associate professor at the University of Pennsylvania School of Nursing in Philadelphia, was eager to incorporate more coursework about this topic in the nursing school setting.

“All nurses should be prepared to intervene, and medical and nursing schools have been remiss in providing substance use training beyond alcohol dependency,” Compton said. “The lack of training has been pretty profound.”

In response, the nursing school launched a new interdisciplinary undergraduate elective in 2018 called “Opioids: From Receptors to Epidemic.” Students in the course learn about the history of the epidemic, the neuroscience of addiction and the larger policy issues such as lack of access to treatment. Compton also teaches students how the disease model applies to opioid addiction, which she hopes will help them adopt a therapeutic approach as opposed to a criminal or moral approach when they treat patients.

“These patients have been marginalized in our society and also in the academic curriculum, yet more people are dying from this chronic illness than diabetes,” Compton said. “My hope is that the students will become advocates for these patients in the future.”


Take these courses to learn more about opioid use:

Responsible Opioid Prescribing, Chronic Pain, and Addiction
(1.5 contact hrs)
The goal of this continuing education program is to provide nurses with information about best practices in the prescribing of controlled substances, including safe and effective prescribing, administering, and dispensing of controlled substances to the patient with chronic pain.

Patient Counseling: Preventing and Combating Opioid Misuse
(1 contact hr)
With the current opioid epidemic, learn critical information professionals need to know to assess the nature of patient’s and client’s opioid use, provide education and/or counseling for opioid use, and refer persons to applicable resources for substance misuse or abuse.

Heroin: The Illegal Opioid
(1.5 contact hrs)
The history of diacetylmorphine (heroin) along with current epidemiological data and overdose statistics together illustrate the dangers associated with use and abuse of, dependence on, and addiction to this drug. Characteristics of heroin such as its appearance, chemical structure, administration, metabolism, and mechanism of action are addressed in this continuing education module to elaborate on how the drug elicits such a strong, unique euphoric effect compared to other opioid medications. Additionally, various treatment approaches for the management of acute and chronic heroin use are discussed.

By | 2019-12-17T14:50:09+00:00 December 11th, 2019|Categories: Nursing news|5 Comments

About the Author:

Heather Stringer
Heather Stringer is a health and science freelance writer based in San Jose, Calif. She has 20 years of writing experience and her work has appeared in publications such as Scientific American, Discover, Proto, Cure, Women and the Monitor on Psychology.

5 Comments

  1. Avatar
    M W December 12, 2019 at 2:08 pm - Reply

    Where is the class for Responsible treatment of Chronic Pain patients? Or the class showing that there is NO data that finds causation between Rx opioids and addiction? Or the class explaining 100 million Americans have chronic pain- 20-50 million needing opioids to manage their serious debilitating intractable pain because nothing else works? And that those addicted to opioids number around 2 million so the patients in the ER are far more likely to actually be patients in pain, not addicts! Where is the class about the pain patients being forcibly tapered or refused care by pain management doctors and primary care physicians? Denied even regular care services? Where is the class to help them- while in the ER, and to also find long term service? Where is the class teaching nurses that Chronic pain patients are NOT addicts, NOT misusing thier Rx opioids, and do NOT have OUD? They are people suffering and trying to survive!!
    Where is the class that shows the CDC said multiple times thier guidelines were NOT for ER/Hospital settings?? And that doing so is misapplication of thier guidelines?
    No, instead you will teach nurses to deny pain management and hurt patients. Studies show Rx opioids do work. There are not studies showing Rx opioids cause addiction. There are studies showing ER medication does NOT lead to addiction! There are also studies showing untreated pain causes Chronic pain! And heart issues, brain damage, adrenal problems, and more. The studies claiming NSAIDs & IV Tylenol work on serious pain are horrible BS! They are not proper studies, they do not use patients in serious pain, and they make claims they can’t back up. But instead of reading these studies, you just jump on them?
    It’s clear why. Because you’ve been paid by PROP. You’ve bought into the harmful and discriminatory idea that pain patients are addicts, or addicts “in waiting”. So you will now teach nurses to treat all patients judgementaly, not compasionately or ethically. You’ll call it so, but the actual research shows otherwise. Where is the class about the damage medical gaslighting does? Because you will be lying to patients. Where is the class on medically induced PTSD? Because telling pain patients who need Rx opioids to live that you refuse & forcing them to suffer is traumatic! Forcing them to go through ALTO procedures and ignore their diagnoses is traumatic! Why are you pushing nurses to traumatize pain patients??
    I’m glad you’ve published this discrimination program. It will make it essier to sue your school and the nurses who harm patients from your ideology.
    The data that is truthful is out there. Patients are already dying and suiciding from lack of care- the kind you are pushing. This data will show you knowingly taught nurses to discriminate and deny care. It will show you are complicit in iatrogenic harm and death.
    https://www.painnewsnetwork.org/stories/2019/12/10/us-facing-syndemic-of-opioid-overdoses

    https://cergm.carter-brothers.com/2019/12/08/medical-boards-and-physician-practice-poll-2019-part-1/

    https://www.painnewsnetwork.org/stories/2019/12/3/tell-the-truth-about-the-opioid-crisis

    https://www.acsh.org/news/2019/12/02/iv-tylenol-good-moose-urine-post-op-pain-control-14429

    https://academic.oup.com/painmedicine/article/19/4/793/3583229

    https://www.dailywire.com/news/khan-china-fentanyl-and-the-new-opium-war?utm_source=facebook&utm_medium=social&utm_campaign=benshapiro

    https://www.usatoday.com/story/news/health/2019/04/24/opioid-pain-pills-crackdown-doctors-prescriptions-cdc-fda/3562373002/

  2. Avatar
    maria forman December 12, 2019 at 5:20 pm - Reply

    I am wondering when the lie that this epidemic and the ODs are from prescribed opioids will stop. All current data and research shows prescriptions opioids were not and are not responsible for the epidemic or current ODs. It was and is illicit drugs. All if this info is easy to find especially for a medical professional. There is less than 1% chance for addiction so not a good reason to let patients suffer.

  3. Avatar
    William December 12, 2019 at 9:49 pm - Reply

    So another site that completely ignores the fact that ILLICIT FENTANYL and polymorphic overdoses are to blame for over 98% of all these deaths. Out of 75,000 overdoses since 2016 only 1.7% had legal prescriptions. We do not have an “opioid crisis” we have a “NARCOTICS CRISIS” never mind all of the people who use these medications correctly and never mind it’s addicts shooting up illicit drugs are the majority overdosing, lets take away pain patients, cancer patients and elderly patients medications away. Even now they have dropped prescribing massively and production massively… overdoses are SKYROCKETING. The entire state department decides to look the other way on the illicit street drugs because the states wouldn’t be able to sue for millions and Indivior wouldn’t be able to swoop in and save the day with THEIR OPIOID. Haha this whole thing is so ridiculous and while you keep writing articles that fan the flames of a made up epidemic, people who actually need these meds and use them responsibly are becoming disabled, not able to work and dying. Please for the love of God, stop calling it an opioid crisis and call it what it is, a “Narcotics Crisis”

  4. Avatar
    DARLENE NELSON December 29, 2019 at 1:07 am - Reply

    As a Level I ER RN i find this article most irresponsible and discouraging. It is unethical and without cause to deny opiates to the patient in severe pain, such in renal colic. We have a duty to advocate for patients in severe pain and to appropriately manage severe pain. The risk of respiratory or vital sign depression leading to death should not be a risk in any ER. And addiction is a mute point in short term opiate use. This article also irresponsiblly equates opiate pain pill use as equilivant to street drug use. The vast majority of overdoses arriving to ERs from opiates are from injectable illegal opiates not pain pills. There is no law and no guideline that mandates the denial of opiates for severe pain in the acute care setting.

  5. Avatar
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