Arming frontline nurses to treat life-threatening overdoses
As nurses, we witness the national opioid epidemic daily. The rise in opioid abuse is skyrocketing and our hospital resources are stretched. Yet, when armed with the right resources we are uniquely positioned to combat the problem and its consequences.
Two specific initiatives within the emergency department could have a profound effect on opioid abusers if widely implemented: greater availability of naloxone coupled with more patient and family education, and strict adherence to prescription guidelines.
Naloxone reverses the respiratory shutdown that accompanies opioid overdose. However, despite four decades saving lives, many people fighting addiction and their loved ones may be unaware of it, and laws related to its use are inconsistent across the country.
Laws Can Vary
For example, Idaho passed a law that makes it easier for healthcare professionals to prescribe and dispense naloxone, shields laypersons from legal liability for administering naloxone, and allows third parties to receive prescription naloxone for potential use on someone else. Meanwhile, neighboring Wyoming has not passed a law expanding access to, or use of, naloxone – despite a near 13% increase in drug overdose deaths from 2013 to 2014, largely driven by increasing prescription opioid and heroin overdoses. While naloxone does not treat the underlying problem of addiction, it offers a lifesaving option when patients overdose.
Similarly, best practices for prescribing opioids have been carefully updated to reflect addiction risks. Yet as recently as 2012, the U.S. Centers for Disease Control and Prevention (CDC) found more than 258 million prescriptions were written for opioid medications, equating to 82.5 opioid prescriptions per 100 people.
The consequences of naloxone’s limited availability and opioid over-prescription are shocking. A July 2016 study from the nonprofit Fair Health found opioid-related health insurance claims have risen more than 3,000 percent since 2007. Sadly, overdose deaths have also risen. According to the CDC, more than 29,000 people died from heroin and prescription opioid painkillers in 2014.
The Need for Naloxone
Naloxone reverses an overdose by blocking the biological processes that slow, and may ultimately stop, breathing. Safe and effective, it can be administered not only in hospitals, but anywhere and by anyone who witnesses an overdose.
One obstacle to naloxone’s wider use is the lack of funding for the purchase and distribution of naloxone, and the training of first responders on its use. A powerful force in addressing this shortfall is the Comprehensive Addiction and Recovery Act of 2016 (CARA). The legislation, signed into law July 22, will increase naloxone availability as part of a wide-ranging response to the opioid epidemic including prevention, treatment, and support for those in recovery. It represents a true shift in patient care. CARA had broad bipartisan support, and is a testament to the national commitment to move aggressively to treat addiction.
As part of the discharge process, nurses have an opportunity to educate individuals about naloxone kits and provide broader insight into prevention, further treatment options, and rehabilitation services that can address addiction. Nurses are there at the precise moment when patients-and their families-are receptive to potentially life-saving information about this medicine.
Pausing Before Prescribing
Nurses are also well positioned to educate colleagues and influence best practices in our emergency departments. Out of context, any given opioid prescription might not raise alarm, but with the potential for overuse and abuse so extreme, caution is now the norm.
Opioid prescriptions often continue to be a first response for treating pain, despite their risk and national guidelines recommending other solutions. The impact is compounded when patients, whether or not addicted to the medications, share them with family and friends.
The guidelines for prescribing opioids are well established-from CDC recommendations to state laws-yet not consistently followed. By learning and sharing that knowledge, nurses can directly impact opioid addiction at the source.
To help emergency nurses and providers drive change in their departments, the Emergency Nurses Association (ENA) has released its Naloxone Education Toolkit (NET), delivering clear steps for what nurses can do to help, along with the context to understand the crisis in-depth. It is a free resource for ENA members and is available for purchase by non-members for $25. Several components of the toolkit are also available to the public, including a pamphlet on how to spot and overdose and administer naloxone, a template flyer advertising the availability of naloxone kits, and a poster on how the public can assist if they witness an overdose.
The toolkit presents evidence-based approaches for educating patients and family members about opioid overdose, advises on the distribution and proper use of naloxone kits, and provides step-by-step instructions to implement custom opioid overdose prevention programs in an emergency department.
Through a series of worksheets and specific tasks, the NET presents ways for nurses to teach patients about opioid addiction signs and symptoms and information to counter myths about treatment.
The toolkit also addresses critical issues that have not yet received necessary attention, such as a need for stronger Good Samaritan laws to encourage overdose witnesses to intervene or seek assistance without fear of legal reprisal; as well as a push for hospitals to use state drug-monitoring programs and standardize tough opioid prescription guidelines.
With wide adoption, the toolkit has the potential to recruit tens of thousands of nurses into a growing national campaign. For that reason, it was showcased alongside other educational resources at ENA’s “Emergency Nursing 2016” conference in September in Los Angeles.
Even with a unified national approach, a problem as complex and devastating as opioid addiction will not be quickly defeated. However, with ongoing efforts from nurses and our colleagues throughout emergency care, perhaps the trend can be reversed – and at this stage of crisis, that would be a huge victory.