Two people die of an opioid overdose nearly every day in Washington state. Though heroin and synthetic fentanyl overdoses have increased in number, deaths due to opiates prescribed by providers remain the leading cause of unintentional overdose deaths. While the number of prescriptions for narcotics is decreasing in Washington, the number of deaths is not.
Nurses have a role to play in reducing opioid deaths in Washington. Here are some things you can do.
- Enroll in and use the Prescription Monitoring Program (PMP) http://www.wapmp.org/practitioner/pharmacist/
As of July 2017, 33 percent of ARNPs were enrolled, leading physicians in percentage enrolled, but behind Physician’s Assistants and Osteopathic Physicians. When seeing patients in clinical practice, check the PMP before any and every prescription for a controlled substance is written. If done every time for every patient, we are not targeting any individual. Nurses can be enrolled as delegates to simplify the process in clinic.
- Become waivered with the DEA to prescribe buprenorphine. http://wsna.to/AANP-OpioidCE
One year after waivers became available, 137 Washington state ARNPs are now registered with the Drug Enforcement Agency as buprenorphine prescribers. Becoming waivered requires 24 hours of continuing education provided free through the American Association of Nurse Practitioners and the American Society of Addiction Medicine. The training is free, but your time is not. Request additional time from your employer to complete the one-time training. Use a low threshold for patients to access buprenorphine, even if a patient continues using other drugs or alcohol, buprenorphine aids the patient in continued positive behavior change. Assist patients to find a source for substance use disorder treatment with “no wrong door,” including primary care, behavioral health or chemical dependency treatment. Be aware of housing and social services that can support a patient’s efforts to become opioid free.
- Prevent opioid dependence to begin with by careful opiate prescribing.
Exposure to a first dose of opioids increases the risk of recurrent use. Recognize that acute pain can be quickly addressed with non-opiate options. Chronic non-cancer pain requires a multimodality approach to learn means of functioning and adapting using nonpharmacologic methods to maintain a higher quality of life.
- Follow the recommendations of the Agency Medical Director’s Guidelines for safe prescribing.
If you are a prescriber, refer to the guidelines. If you support prescribers, make sure they are aware of and follow these guidelines. The guidelines answer questions regarding challenging situations, including how to address the acute pain needs of a chronic pain sufferer. Support alternatives to opioid prescribing for chronic pain management including non-opiate medications, exercise, yoga, counseling and complementary medicine.
- Be aware of the new Health Care Authority guidelines
HCA restricts opioid prescribing to 18 tablets, a 3-day supply for patients 20 and under and 42 tablets, a 7-day supply, for patients over 20.
- Provide naloxone, a short-term antidote for opioid overdose, to all patients receiving opioid prescriptions and to family members who express concerns about relatives with substance use disorders.
Be sure they know how and when to use naloxone. All Safeway and Albertsons pharmacies in Washington now have naloxone available directly from pharmacists. Pharmacies stock Narcan Nasal Spray, and patients can acquire it after a 15-20 minute pharmacy consultation. A prescription permits insurance coverage. At increased risk of overdose are persons who have had a period of abstinence; someone leaving a rehabilitation or detox facility, jail, prison or after a hospitalization. That person’s tolerance will have decreased and if they resume opioid intake at the level they did before the period of abstinence they are at increased risk for overdose.
- Support efforts for public and private insurers to cover the costs of substance use disorder treatment.
Medicare pays for some services and not others. Similarly, Apple Health programs are inconsistent on what treatments for what diagnoses are covered, exposing patients to prohibitive costs.
- Psychiatric ARNPs have a special role to play in providing Cognitive Behavioral Therapy or Dialectic Behavioral Therapy as a means of addressing chronic pain.
The Washington State Department of Labor & Industries now pays ARNPs 100% of allowable charges for providing therapy to injured workers and assisting in their return to work.
- Learn the location of your nearest needle exchange program.
You can find it on the NASEN directory (https://nasen.org/directory/wa/). Provide the information to patients.
- Keep local and state legislators informed and ask for their support. Tell you lawmakers about effective, evidence-based substance use disorder treatment options and ask them to support and fund these services in our communities.
- Participate in the University of Washington Telepain conferences.
Submit information on a patient problem and experts will provide feedback and suggestions for care. Observe and earn continuing education credits.