As you turn on the news in recent days, you would be hard pressed not to hear a story or a report on the opioid crisis in this country. Radio, TV, even social media are all covering this as an “epidemic.” Sadly, I heard that the CDC reported that 33,091 Americans died from opioid overdoses in 2015, which is almost three times the number of people who died in 2002. In addition, overdose deaths had increased over 200% in the 2000’s and approximately 168,000 adolescents were addicted to “painkillers” in 2014 alone. These are terrifying statistics.
What Are Opioids?
The common names for opioids include hydromorphone (Dilaudid), morphine, oxycodone (OxyContin), methadone, and hydrocodone (Lortab, Vicodin, Norco). Opioids are drugs that are manufactured with the primary purpose of treating pain. These can be classified as pure opioid, synthetic, or semi-synthetic drugs. Regardless of how they are classified, the result is the same. Opioids have a wonderful track record for effectively treating and controlling pain. Unfortunately, if not used properly or if abused, it can and does cause addiction and/or physical dependence.
We learn in nursing school that “pain is pain.” It doesn’t matter if it is acute pain from an injury or surgery, pain from a terminal illness, or chronic pain from debilitating illnesses and injuries. Pain is pain, and, as healthcare providers, we must continue to effectively, aggressively and compassionately treat pain. The difficulty is in doing this while reducing the potential for abuse, misuse, and diversion. I may be an optimist, but I truly believe we can do both.
We can and should continue to offer opioids as a viable option for pain control. However, we all know that we must be more diligent about who has access to these drugs. One group comes to mind: Young adults.
Young Adults and Opioids
Young adults age 18 to 25 are the biggest abusers of prescription opioid pain medications, ADHD stimulants, and anti-anxiety drugs. In 2014, more than 1,700 young adults died from prescription opioid drug abuse. This was more than the deaths that occurred from heroin and cocaine combined. Sadly, this doesn’t even include those who required hospital and emergency room admissions due to drug abuse and misuse.
Whether you are a patient requiring opioids to treat your pain, a mother with teen and/or young adults still living in your home, or a hospice or healthcare professional, we all must work together as team to reduce risk, unwarranted access, and, ultimately, drug abuse deaths. A major key is prevention, education, and identifying drug abuse early.
Preventing Opioid Abuse in Hospice-Care Settings.
As hospice healthcare professionals, we are required to follow very stringent rules and regulations when ordering, administering, tracking ,and disposing of narcotics.
We perform a narcotic count frequently (it is generally recommended during each visit). Hospice patients are expected to produce the narcotics and allow the nurse to count and record the quantity of the drug. This procedure monitors for discrepancies in the drug count and helps the nurse to assess the patient’s actual consumption and need for pain control measures.
Another preventive measure is the provision of medication “lock boxes.” This simple, but effective tool helps limit access to the medications and, ultimately, reduces unwarranted entry and access.
Quantity can be key. If abuse, misuse or diversion is a concern, limiting the quantity of the drug being delivered or prescribed to the patient can be an effective tool.
Effective drug disposal is another method to reduce the unwarranted access to opioids and narcotics. There are stringent, albeit conflicting regulations for hospices on the destruction and disposal of drugs with the intent of limiting access. Some drugs can be flushed down the toilet. There are specific drugs that have been deemed safe by the FDA for flushing. Another method includes removing the drug from their original containers and mixing them with an undesirable substance, such as used coffee grounds, dirt or kitty litter.
Identifying Drug Abuse in Teens and Young Adults
As for parents, educators and healthcare professionals, monitoring and supervision are critical for drug abuse prevention. Identifying drug use, misuse, and abuse early can save lives. However, anyone that has raised, is raising or caring for a teen knows how difficult it can be to tell the difference between the pangs of adolescence and actual drug use. Some classic signs may include:
- Declining grades
- Bloodshot eyes
- Mood swings
- Memory problems
- Loss of interest in normal activities, such as sports, church or family activities
- Withdrawing from social events and gathering
- Laughing for no reason
- Poor Hygiene
- Change in sleep patterns
- Change in appetite
- Missing curfew or skipping classes
- Change in appearance
- Change in social network or friends
In adults, the symptoms can include the above as well as other signs such as physical symptoms such as shaking, muscle cramps, tremors, chills, sweating, paranoia, dilated pupils as well as symptoms such as inability to concentrate, loss of jobs, inability to get along with others, stealing or borrowing money from others.
By being educated and informed, we all can take on the opioid crisis together. We can ensure that patients have their pain controlled while striving to prevent drug abuse. We have no other choice. There is too much at stake.
DeAnna Looper RN, CHPN, CHPCA
Crossroads Hospice & Palliative Care
Senior Vice President of Clinical Operations
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