Abstract
James, father of two young children, injures his back on a construction site, and after back surgery and 6 months of rehabilitation, he is desperately in pain each time he tries to decrease his pain medication. Danny arrived home after knee surgery to find many of his buddies waiting to party. After a few hours of drinking, Danny’s friends, laughing and joking, post videos on Facebook of Danny snoring loudly. With opiates and alcohol on board, those were the last sounds Danny made. Fifteen-year-old Sondra began using her mother’s pain medication to cope with the abuse and violence in their family. When she was placed in foster care, there was no longer a source for those pills. Nauseated and shaking at school, Sondra met another student who said he could take care of those shakes. Sondra began using heroin. These are but a few examples of the many ways opiates are affecting the health of our citizens and communities. Accidental deaths from opiates have more than doubled in the past 14 years (Levi, Segal, & Martin, 2015). More than half of young people who inject heroin report starting with prescription opiates (National Institute on Drug Abuse, 2016).
The White House summarized the current epidemic of prescription opiate and heroin use across the nation in a release stating, “Prescription drug abuse and heroin use have taken a heartbreaking toll on too many Americans and their families, while straining law enforcement and treatment programs” (The White House Statements & Releases, 2015). The cost of this epidemic, both in human lives and suffering and economic costs, is well documented and staggering.
As the largest segment of the health care workforce (Health Resources and Services Administration, 2010), nurses touch the lives of more patients than any other group in health care. With the nursing process forming the basis for all of nurses’ interactions with patients (American Nurses Association, 2016), we have many opportunities to assess, prevent, educate, and influence our patients’ lives in any setting. In our patient interactions we see, hear, and notice things that translate into opportunities for us to educate and address each person in a holistic way. That is why the Institute of Medicine Future of Nursing (2010) report recommends that nurses lead efforts to transform health care. This is especially powerful in the context of the current opioid misuse and heroin epidemic.
Approximately 2.3 million U.S. citizens aged 12 and older have opioid use disorder, and most states have higher rates of need for treatment than capacity to treat (Jones, Campopiano, Baldwin, & McCance-Katz, 2015). In this context, educating health professionals and encouraging them to apply best-treatment practices is critical to improve the health of the nation. Because nurses have frequent and regular contact with patients in numerous settings and levels of care, they are ideally suited to provide effective opiate interventions. Nurses have been described as the “backbone” of the Opioid Treatment Program system of care (Kub, 2010), yet nurses may lack essential education in substance use disorders in general (Kane, 2012), and in the risks of opioid addiction specifically (Costello & Thompson, 2015).
Last October, the American Psychiatric Nurses Association (APNA) announced its participation in a White House effort to address the ongoing epidemic of prescription drug abuse and heroin use across the nation. With the participation of organizations from both the public and private sectors, the effort seeks to stem the epidemic by training health care providers, improving access to treatment, and raising awareness of the risks of prescription drug misuse. One of the key commitments is to “reach more than 4 million health care providers with awareness messaging on opioid abuse, appropriate prescribing practices, and actions providers can take to be a part of the solution in the next two years” (The White House Statements & Releases, 2015).
John F. Kennedy once said, “Leadership and learning are indispensable to each other.” The expertise of psychiatric-mental health nurses gives us an opportunity to lead the movement from an old treatment paradigm that focuses on treating the disorder to one that emphasizes prevention and early recognition. We lead through education that has the opportunity to reach our colleagues throughout nursing. APNA has therefore committed to develop, provide, and disseminate educational interventions focusing on prevention and early identification of opioid use disorder. To do so, we will draw on the APNA Addiction Council’s national network of experts in mental illness and substance use disorders. Under the leadership of Matthew Tierney, PMHNP-BC, ANP-BC, a task force will develop three free educational webinars. The first webinar will be developed for registered nurses in all settings, the second for psychiatric-mental health nurses, and the third for psychiatric-mental health advanced practice nurses.
All three of these webinars will have the same underlying message: a holistic patient-centered message of hope and empowerment for nurses. With education outlining the most current and accurate information and evidence-based approaches, nurses can lead a shift in care as they screen, address, treat, and improve the health of those with or at risk for opioid use disorders. The webinars will cover epidemiology, assessment and screening tools for opioid use and risk, evidence-based treatments (both nonmedicinal and medication assisted), safe practice guidelines (prescription drug monitoring and toxicology), and overall context. In this way, psychiatric-mental health nurses can bring nursing together to lead in influencing this national epidemic.
Look for an announcement from APNA about these webinars soon. In the meantime, I would like to extend special thanks to Carolyn Baird, Susan Caverly, Mary Kastner, Laura Leahy, Rick Pessagno, and Matt Tierney for their collaboration on these webinars. They are great examples of psychiatric-mental health nurses using their expertise and leadership to impact a national health crisis. I would like to thank the Board of Directors for their vision and foresight in funding this education. I am honored to be a member of an organization that supports the critical role that our members play each day to address substance use and addiction in our communities.