Healthcare Policy Concern: The Opioid Crisis

The opioid crisis facing the nation is one of monumental proportions. It is a ruthless, swift, and unforgiving killer of men, women, and adolescents. Opioid addiction-related deaths take the lives of thousands of victims each year, with numbers rising uncontrollably as prescription pain killers become more and more accessible not only on the black market, but also through healthcare prescribers. In this paper, a definition of healthcare policy and its implication on the nursing profession will be presented. A definition of the role of the advanced practice nurse in policy advocacy will be identified. A specific healthcare policy concern will be selected, and a discussion of an identified solution to the concern will be presented. Identification of an elected official will be presented, and a conclusion provided. Scholarly support will be provided for all sections of this paper.

Overview of Healthcare Policy

Healthcare policy provides the consensus and framework within which healthcare and public health systems can operate. Health policy, in general, refers to decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a population. Nursing, as a profession, has a significant power to impact healthcare policy. Through policy involvement, nurses have the power to influence practice standards, assure quality of care, and shape future policies. Furthermore, as Fatchett, Clark, and Taylor (2014) state, understanding and becoming involved in the policymaking process is a valuable skill to learn and a challenge to which all nurses should aspire. When it comes to the issue of advocacy, nurses have historically played a key role in advocacy and service for all members of the community, including those who are traditionally underserved by other providers or the health system. A great part of nursing’s reputation is mirrored in the nursing profession’s willingness to provide health services to underserved populations. Throughout our history, nurses like Dorothea Dix, Clara Barton, and Susie Taylor have demonstrated the power of nursing advocacy even in times of great personal risk. Today, there is still great need for this level of nursing advocacy, and advanced practice nurses have the responsibility to provide the level of leadership and advocacy needed to reach all patient populations and to figure out better ways to serve them. Indeed, the role of the advanced practice nurse is that of community leader, patient advocate, and provider of care. Nurse practitioners have the ability to change healthcare policy on the local, state, and even federal level by becoming involved in issues that affect the nursing profession, such as opioid addiction, as well as those issues important for patient care.

Identification of Health Policy Concern

Opioid-related deaths as well as opioid dependency are an epidemic affecting the lives of thousands of Americans each year. According to Cox and Naegle (2019), opioid use killed 70,000 Americans in the year 2017 alone, which is a number equal to seven Parkland shootings per day, a September 11th attack every three days or more than all those lost in the recent Gulf and Afghanistan wars combined. Furthermore, opioid related deaths exceed those from breast cancer, auto accidents, and guns. Unfortunately, the misuse and abuse of opioids affect all socioeconomic groups, genders, races, and ethnic groups in the US, and even expecting mothers make up a large portion of the opioid-consuming community. Astonishingly sad is the fact that every 25 minutes, an infant afflicted with abstinence syndrome is born in the US. The frequency of opioid deaths is the highest in the 45-to-54-year-old population and the elderly, and it is predicted that in 2019, over 2 million Americans will be afflicted by opioid us. Opioid overdoses are not isolated cases in certain communities, and approximately 41% occur in urban counties, 26% in the suburbs, 18% in small metropolitan areas, and 15% in rural communities.

Native Americans are also disproportionally affected by overdose deaths as are African Americans in Illinois, Wisconsin, Missouri, Minnesota, West Virginia, and Washington, DC, among other places. Unfortunately, opioid addiction, use, and abuse have a devastating impact on all communities as well as all population groups. Opioid addiction is a monster that devours many without discrimination. The scientific community has recognized opioid addiction as a physical and mental health disorder. Unfortunately, those recovering from addiction to opioids continue to face public scorn. People with substance abuse disorders often report feeling alone and misunderstood, leading to emotional distress, guilt, and depression. Relief from these emotions becomes almost as necessary as relief from pain or withdrawal symptoms, causing many to self-medicate and unfortunately repeat the cycle. Morland (2019) further explains that stigmatizing patients with a history of substance abuse is also common among healthcare professionals, including nurses, and may lead to poor communication, diminished rehabilitation, and inadequate therapeutic outcomes. A lack of knowledge, education, and training regarding addiction etiology and treatment propagates this stigma. The overall impact of the opioid crisis on American lives is so staggering that according to the Centers for Disease Control and Prevention, or CDC, the national life expectancy has declined for the second year in a row since 2016.

Description of Identified Solution to Healthcare Policy Concern

One solution to combatting the devastating opioid crisis would be to develop a new, nurse-driven pain assessment scale prior to opioid administration. The proposed policy would empower nurses to use their nursing judgement and assess patients’ pain level prior to administering an opioid and allow nurses to offer different pain-relieving treatments such as non-opioid analgesics, cold or hot compresses, muscle relaxants, etc. This policy may sound like something already in place as part the nursing process, but the difference would be a system-wide pain scale that would empower nurses to refuse opioid administration to patients not meeting the requirements of the new pain scale. This new pain scale would need to be concise, detailed, flexible and able to be individually tailored to each patient. Some criteria included in the new pain scale would be procedure performed, length of hospital stay, patient co-morbidities, hemodynamic stability, recovery prognosis, patients’ willingness to participate in prescribed treatments, mobility issues and social and family support, among others. A nurse may refuse opioid administration, for example, to a mobile, young patient who is demanding morphine intravenous every 3 hours or Percocet every six hours. This particular patient was admitted for an infected finger after undergoing incision and drainage, and who is expected to be discharged in the morning. The patient is hemodynamically stable, awake, alert and oriented, in no apparent distress, playing on his smart phone and ambulating in the hallways. Under the new proposed policy, a nurse may offer alternate means of pain relief, such as tramadol, acetaminophen, cold compress to the affected area, elevation of extremity, etc. The astute nurse would be aware that intravenous morphine or a prescription for Percocet for 3 months after discharge places the young patient at high risk for dependency.

If the new policy is implemented, the positive outcome would be one less person going home with unnecessary opioid prescriptions or being administered habit-forming intravenous narcotics during hospitalization. These actions would prevent a possible addiction to opioids in a young patient who was previously opioid-naïve and at high risk for addiction. Furthermore, by implementing this new policy, a reduction in overall cases of opioid dependency would be achievable in the local community by targeting the vulnerable. In order for the new policy to be successful, we must foster open communication with local community leaders and must provide education regarding opioid dependence to the local community. One change needed in the local community to foster acceptance and policy implementation would be to understand the severity of the opioid crisis and to support the healthcare professionals as well as local leaders in the fight against addiction and prevention. An understanding must be reached amongst patients seeking medical care that narcotics will no longer be freely dispensed or prescribed upon request, as in the past. Educational campaigns such as commercials, flyers, public school education as well as other venues would be targeted during the educational campaign on opioid crisis.

A way to measure positive outcomes after policy implementation would be a reduction in opioid-related deaths and hospitalizations due to overdoses in the community. In 2018, Broward County, Florida, implemented an opioid action plan in order to reduce substance abuse and its devastating consequences. Sadly, the Florida Medical Examiners Commission reports that during 2016 alone, heroin deaths increased 31% statewide and 125% in Broward County compared to 2015. Furthermore, the number of opioid-related overdose deaths last year also increased 266% locally in Broward County. The opioid action plan was developed to facilitate the process of information collection via available local community resources, and the addition of a partnership with local healthcare professionals involved with the new proposed policy would be a great addition in the fight against opioid abuse. This partnership will be able to measure decreases in unnecessary opioid prescriptions, number of new addiction cases, number of overdose-induced hospitalizations, and number of reductions in opioid - related deaths.

In order for the new policy to work, certain changes need to happen within the local community. First and foremost, it is up to the providers of care to recognize and understand their contributions to the present crisis. As members of the local community, nurse practitioners and physicians need to realize the devastating effects of overprescribing habit-forming, opioid-based analgesics to patients who don’t necessarily need strong pain killers. The simplicity of not prescribing opioid analgesics clashes with the local community’s demands for pain relief and with the unfortunate, healthcare-driven past policies encouraging pain - seeking behavior. The healthcare field created pain as the fifth vital sign, and throughout the years, it has encouraged patients to demand relief for any discomfort or pain felt. Years ago, new nurses were taught the mantra of pain being whatever the patient said it was, and it needed to be accepted at face value. Today, in order to combat the monster created in the form of opioid addiction, healthcare providers must closely work with the local community in order to re-educate its members of the dangers of long-term opioid use, as well as the devastating effects of prescription drug abuse. The local community needs to come to an understanding that drug-seeking behavior will no longer be tolerated and coming to a local emergency room seeking opioids will be scrutinized and evaluated thoroughly by a trained provider prior to any opioid administration.

In order to foster the new policy implementation several changes would need to occur in the targeted population group. As discussed earlier, the opioid epidemic knows no boundaries, it ravages both the young and the old, the rich and the poor. Opioid addiction threatens both men and women, all religious and ethnic backgrounds, and reaches, with its unescapable tentacles, children and adolescents from every family background. Indeed, changing the population’s culture regarding opioid use is the toughest of the fights against narcotics. The entire base of cultural awareness would need to shift and drift away from not only the ease of procuring opioid-based analgesics, such as through prescriptions, but also from the ease of illegally procuring such analgesics. Unfortunately, the illegal opioid market is consumed with Percocet, Fentanyl, FLACCA, and many other highly addictive, dangerous drugs. The fight against drug-seeking behavior is a long and tough one, but with community education, community awareness campaigns, and teaming up with local leaders, it is possible to fight for innocent lives lost every year.

A measurable, positive outcome to the new policy would be a decrease in opioid-based deaths in Broward County, as well as fewer overdose-induced hospitalizations and fewer re-admission cases. A positive change could also be measure using local state policies that were initiated by the National Governors Association, certain state legislatures, and state agencies, using the Prescription Drug Monitoring Program, which monitor state specific prescribing practices.

As we fight to reduce the opioid crisis in our local community, certain challenges arise when implementing the proposed policy. One challenge would be the public’s fear of underreporting of legitimate, true pain to the healthcare providers, assuming that their request would be scrutinized and rejected. Healthcare providers, such as nurse practitioners, must be vigilant of their patients’ fears and concerns when seeking pain relief. Not all cases are equal, and the properly trained nurse practitioner would be able to differentiate a patient with chronic or acute changes in health status from those simply seeking pain medications. Another challenge that may arise after policy implementation would be to under-prescribe opioids to chronically or acutely ill patients in need of pain relief. This, again, can be combated by properly training and educating healthcare providers in the identification, assessment, and prescribing of those patients in need of pain relief.

Identification of Elected Official

In lieu of the devastating effects the opioid crisis has on our local community, the help of the highest-elected official is necessary. Mayor Frank Ortiz has served the local Broward County community of Pembroke Pines since 1977, and has been the highest ranking, locally unopposed, re-elected official since 2004. Mayor Ortiz was selected in the fight against the devastating opioid crisis because he has a proven record of helping the local community with their concerns. In the 2018 State of the City Address, Mayor Ortiz stated that the opioid epidemic has no boundaries, no age limits, no race or nationality exclusions and no socio-economic status. Mayor Ortiz further stated that only by coming together and openly discussing, sharing and learning we can make a difference in our communities, and by working together we can put an end to the deadly opioid epidemic in Broward County.

Conclusion

The devastation that opioid addictions and opioid related deaths bring to not only my local community, but every community in the United States, has awakened a great, compassionate, dedicated, unfaltering drive to combat this crisis. The proposed solution to the opioid crisis would have positive outcomes in my local community and could dramatically reduce opioid-related deaths, addiction numbers, as well as overdose-related hospitalizations. A partnership with local community leaders, and the support of Mayor Frank Ortiz can be an effective vehicle and serve as a liaison between healthcare providers and the targeted population.

References

1. Broward County Opiate Action Plan. (2018). Retrieved from http://www.drugfreebroward.org/wp-content/uploads/2018/03/Opiate-Action-Plan-2018.pdf
2. Broward mayor Ortiz hosts opioid epidemic town hall meeting. (2018) Retrieved from https://www.ppines.com/DocumentCenter/View/5452/Broward-Mayor-Hosts-Opioid-Epidemic-Town-Hall-Meeting-August-24-002?bidId=
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