NR 506 Policy-Priority Selection

NR 506 Policy-Priority Selection

NR 506 Policy-Priority Selection

I have been having a difficult time choosing my healthcare policy priority, mainly because I am worried that it is one that is being talked about by everyone lately. However, with that being said, I have chosen the Opioid Epidemic or the Opioid Overdose Crisis. I have chosen this  topic because it specifically has been a problem I have witnessed with patients, and people within surrounding communities.  It also is something that could be reduced if laws were different.

According to the National Institute on Drug Abuse (2018),  Each day 115 Americans die from opioid overdoses, which means nearly 42,000 people die annually from a preventable cause.  I grew up in a town of 1,000 people, so for me to see this amount of people die annually is baffling.

The estimated total “economic burden” for the US each year is $78.5 billion a year, as per The Center for Disease Control and Prevention, (2017). This is said to include the misuse of opioid prescriptions, cost of healthcare, loss of productivity, addiction alone, and the involvement of criminal justice (National Institute on Drug Abuse, 2018).

I think that as far as sources of healthcare policy, this policy would be at the Organizational level, because it would be required to meet FDA requirements, and have multiple organizations involved in decision making as  well as including  multiple organizations’ data. This would be a public policy.

This topic is important to me, because as nurses we all have a few patients that we say we will never forget. One of these patients for me was a 21 year old. He was admitted for altered mental status and was on a Narcan drip.  Once he began to wake up he told us that he had just tried a pill and this is what happened to him.  He stated it was his first time, and he had no previous history of drug abuse.  The doctor then decided to discharge him this day, and everyone chalked it up to a young college kid making a stupid choice and trying a pill that was given to him.”  Not 12 hours later the same young 21 year old ended up in the ER. He was being coded en route to the hospital, and after a long attempt at resuscitation, he did not make it.  This patient had access to Fentanyl patches and was apparently cutting them open and eating them.  This was a definite eye opening experience for me.  There are also been newspaper reports in a surrounding community about five to 10 Narcan kits being used each weekend.  It just amazes me that this situation has gotten so out of control over the last several years.

References:

National Institute on Drug Abuse. (2018). Opioid overdose crisis. Retrieved from: https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

 

The Center for Disease Control and Prevention. (2017). National Vitals Statistics System, Mortality. Retrieved from: https://wonder.cdc.gov

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I think that there should be required follow up between the provider and patient once opiods are prescribed.  All too often a patient is discharged from the hospital with narcotics and the provider does not do any type of follow up other than refer them to follow up with their primary care provider. I think all providers whether it be inpatient/hospital setting or primary care providers, should be required to follow up with all of their patients who are on prescribed opioids. I  also think there should be documented non-opioid treatment attempts on all chronic opioid users as well.

With this being said, I do not think that opioids should not be used for acute patients. For example, if I came into the

NR 506 Policy-Priority Selection
NR 506 Policy-Priority Selection

my physician’s office with a kidney stone or after I threw my back out, I would not expect them to attempt non-pharmacological treatment.  In instances like these, a small amount of narcotics should be able to be prescribed, but then the physician should be required to follow up within a given time frame, whether it be 24 hours or a week.  I think because the FDA is a federal agency, this should be done by everyone and not just by certain states. Of course, to make a change it’s not easily done at that level, so I think it would have to start slowly. I think I would first propose it to all hospital employed providers at my hospital. After that change was implemented and there was time for adequate data to be obtained, i would branch out to other facilities, and then eventually to the state level.

Many physicians will prescribe a patient a narcotic for an acute pain, but then continue to refill the medication for years “just because.” This contributes to the problem. I worked with a nurse years ago who had back pain and went to her PCP and was prescribed Norco. She became dependent on the Norco, and eventually  stole Dilaudid, Morphine, Norco, and many other drugs from the hospital. Of course she was caught and her license was disciplined, but the point is, this prescription started innocent, but due to a lack of follow up from her physician, the medication was continued to feed a habit, which could have been avoided had there been stricter follow up.

If the physicians were required to follow up and have documentation that was supportive of their reason for continuing the prescription, the numbers may decrease.  At a certain point, the physician could then potentially refer the patient to a pain specialist for some sort of treatment that was not an opioid.

I agree that the opioid addiction problem has escalated to a very concerning level.  It’s frightening that an illegal substance is actually fairly easy to obtain.  What makes me crazy is that if I want to buy sudaphed for nasal congestion I have to provide my license and there is a limit to the amount any one person can purchase per month.  If I was prescribed a narcotic I can pick it up from the pharmacy without any identification and a family member or friend could also pick it up for me.  Many people are addicted to pills but heroin users frequently start with a pill addiction and then move to heroin because in many cases it’s easier to obtain.  You talk about changing laws to help and I agree.  In Illinois we have something called the IL PMP which stands for the Illinois prescription monitoring program which collects information on controlled substance prescriptions dispensed in Illinois.  Previously our doctors had to register to view the site and they would have to log in to look at the past 12 months of filled prescriptions.  It was one more step when there was a concern for one of our patients who was in the ER asking for pain medications and a concern with seeking behaviors.  Currently a link to the PMP is available in every patients chart so we can easily look up what they have had filled, when, quantity, and if they’ve been seeing multiple doctors to write scripts.  Pharmacists can also use it and contact the prescribing doctor if they have a concern.  I feel that this helps to decrease the amount of prescriptions written, but it’s dependent on many factors.  The doctor has to review the record and personally decide if they think the patient is prescribed too much of the substance.  The patient can register under any alias without an ID and obtain prescriptions from different ER’s without a license to verify who they are and the PMP will not reflect accurately what that person has filled.  It’s a difficult situation because there are many chronic pain patients who need these drugs and the abuse has caused them to appear as “addicts”.  Maybe requiring a photo ID (state issued) for anyone receiving and filling a controlled substance would be a good first step.  Our hospital outpatient offices just started taking a photo that links to patient charts and when the patient comes in for a visit their picture will appear next to their name.  It’s a great verification.  Maybe the state issued ID could be accessed with a patient entering their ss# if they don’t have ID on them?  Like they do at certain department stores when you don’t have your store credit card on you lol!  It’s a huge problem that I feel requires small steps at many different levels.