Constance Hall’s 16-year-old daughter suffered from chronic migraine headaches that left her in excruciating pain, essentially all day every day.

When the pain became too much and Hall brought her daughter to the emergency room, she had a leg up on other parents in her situation. You see, Hall is a nurse. When the hospital care team recommended opioids to treat her daughter’s pain, Hall began to ask hard questions. She pushed for alternatives that could work. Eventually, they landed on a non-opioid medication that effectively managed her daughter’s pain.

“No one in the hospital offered up alternatives to opioids until I pressed the issue, and no one shared the potential negative impact of my daughter taking opioids,” recalls Hall, EdD, MSN, RN, faculty chair in the graduate nursing program at Capella University. “That was such a traumatic and painful experience for me. As a nurse, I know we can do better.”

Unfortunately, too many people don’t have Hall’s medical background and don’t know the right questions to ask and when to push for alternatives to opioids to treat pain. Hall says they shouldn’t have to, if nurses step up to advocate for them.

“Nurses are really a first line of defense in the opioid crisis,” Hall explains. “We are often the first ones to connect with patients. We are the first person to identify any medication needs they have, and whether opioids might be the right choice. We are also the ones to recognize the triggers patients may have that put them at risk for addiction.”

The risk for addiction is huge. Consider this: On average, 130 Americans die every day from an opioid overdose.

To help combat the opioid addiction crisis in America, Hall offers the following four suggestions for nurses to act as a first line of defense:

  1. Educate patients on what opioids are and what they can do – Often, when medications are being recommended to treat pain, patients may not recognize them as opioids, Hall says. She adds that it is incumbent upon nurses to inform patients about what drugs are being recommended and the potential ramifications of taking them.

    “Nurses need to very clearly and plainly let a patient know when a drug is an opioid, and say that word,” Hall says. “Nurses need to ensure that the patient knows that opioids can be addictive and that there is an opioid crisis in America. The point is not to scare them, as opioids can be the right choice, but patients need to be fully informed about what they are getting into. They need to be aware of the potential addiction that can come with taking opioids.”

    Hall adds that nurses also need to educate patients on what to do with medications like opioids when they are not needed anymore, and how to dispose of them.

    “Opioids are not like antibiotics,” Hall explains. “You don’t necessarily keep taking them until they are gone, particularly if you don’t need them anymore to treat pain. That’s a hugely important thing to understand. You don’t just keep taking them because there are pills in the bottle. That’s dangerous. A nurse needs to explain that clearly.”

  2. Advocate for other medication options – While opioids are effective in treating pain and can be the right choice, there are often other medication options that pose less of an addiction risk, Hall says. Nurses need to advocate on behalf of patients to explore those alternative options, particularly when a patient would be at heightened risk for an opioid addiction.  “Nurses need to ensure that patients know that there are often non-opioid medications that can treat pain,” Hall says. “Patients need to know it’s not only OK, but is encouraged, to ask their doctor or prescriber about alternative options. Most patients don’t bring this up on their own, so nurses need to be their advocates in doing so. Most doctors or medication prescribers are very open and receptive to those conversations.”

  3. Explore holistic treatments and lifestyle changes – Medication is just part of the puzzle in treating pain, Hall says. She encourages nurses to explore holistic treatments and lifestyle changes with their patients, not in replacement for traditional medications, but as a complement to them. “There are almost always lifestyle changes and holistic treatments that can complement medicine to help patients heal,” Hall says. “Nurses need to have conversations with their patients about their lifestyles. Talk about nutrition and exercise. Talk about sleep habits and stress levels. Explore distraction techniques for pain such as meditation and deep breathing exercises. Maybe acupuncture could help. Don’t leave anything on the table that could bring them relief.”

  4. Raise your voice in your organization if the above is not happening – No nurse is an island. It takes an entire care team acting in the best interest of the patient to ensure the right medications are being prescribed to the right people, and that those people are fully informed. If a nurse believes that opioids are being over-prescribed, or that patients are not being adequately informed of the risks and alternative options, that nurse must raise their voice. “As nurses, we have an obligation to do this,” Hall says. “We have a mandate to act on behalf of the best interests of our patients at all times. If an organization, or the doctors and nurses working there, are not acting in accordance with what is in patients’ best interests, nurses must feel empowered to speak up. It’s not only the right thing to do, it is an obligation. The opioid crisis we are facing requires all of us to do everything we can to combat it.”

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