A Delicate Balance: Pain Management and Opioid Use Disorder

Promoting Clinician Awareness About Opioids

Opioid abuse has been a major public health concern and is a daily topic in both professional and lay media. Nurses are central to pain management across diseases and settings, and advanced practice nurses increasingly are involved in prescribing and monitoring of opioids. A recent report^[1] from the National Academies of Sciences, Engineering and Medicine summarizes the current status of the opioid epidemic, with important implications for all healthcare professionals, including nurses.

This report was commissioned by the US Food and Drug Administration (FDA) to develop plans for responding to the opioid epidemic. The data within the report confirm that drug overdose is now the leading cause of death from unintentional injury in the United States. Other key findings in the report include:

From 1999 to 2011, the number of annual deaths from prescription opioid overdoses nearly tripled.
From 2011-2015, the number of annual deaths from illicit opioids nearly tripled. (These are related in part to use that began with a prescribed opioid.)
As of 2015, two million Americans aged 12 or older had an opioid use disorder.

The report discusses strategies for reducing the opioid epidemic, including restricting opioid supply, influencing prescribing practices, reducing public demand, and harm-reduction programs. But it also addresses the important issue of balance in opioid policy, because millions of Americans live with painful, chronic illnesses and are severely affected by barriers to opioid access.

Viewpoint

Nurses have been strong advocates for care of patients in pain, including those with acute, chronic, or terminal illnesses. Over the past 40 years, nurses have contributed significantly to improved pain assessment, development of pain clinics and services, and advancing pharmacologic management of pain. These very significant strides are now threatened by the opioid epidemic as the critical problem of this drug abuse is creating increasing barriers to appropriate management of pain.

Reading this informative report is an important reminder of the complexity of this major public health concern. The suggested strategies require the efforts of manufacturers/pharmaceutical companies, government agencies, law enforcement, and healthcare professionals across many disciplines.

Nurses must be knowledgeable about society's concerns and the extent of the opioid epidemic. In the same way that nurses have strongly advocated for pain relief for patients, we need to be well-informed advocates for solutions to this complex problem.

Cite this: Betty R. Ferrell. A Delicate Balance: Pain Management and Opioid Use Disorder - Medscape - Oct 10, 2017.

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