Health care policy. Advocating for Pain Assessment before Opioids Prescription.

Advocating for Pain Assessment before Opioids Prescription
Pibi Jean Bouda
University of Missouri in Saint Louis.
Abstract
The opioid crisis is a national epidemic in the United States of America. While opioids are medically prescribed to control pain, misuse of opioids has been prevalent. As a result, many Americans have died and others have been incarcerated due to crimes committed while using opioids. The existing policy has not been effective in addressing the opioid crisis. There is, therefore, a need to initiate a new policy that requires a pain assessment for every patient before an opioid prescription. This paper examines the benefits and limitations of the new policy against the existing policy in the State of Missouri. It also compares the proposed policy with an alternative policy of non-opioids prescriptions. Through this examination, the paper clearly demonstrates that the proposed policy is an effective approach to the opioid crisis.
Advocating for Pain Assessment before Opioids Prescription
Policy Statement
“The opioids crisis is a national problem in the United States. Many approaches are being put in place to reduce the severity of the problem. Initiating a policy that requires a pain assessment for all patients before an opioid prescription can significantly impact the opioids crisis in the USA. The stakeholders involved include legislators, practitioners, and pharmacists.”
Introduction
The opioid crisis is a national problem in the United States of America (USA). Opioids, commonly called “pain killers” are medications prescribed to control pain in various medical situations such as cancers, fractures, and post-surgical conditions. When misused, opioids have a chance of causing addiction with severe consequences. The consequences of opioid addiction include mental health problems, kidney diseases, cardiovascular diseases, and even death. Opioids overuse is also a cause of criminality. The addictive opioids include not only various prescribed pain relievers but also other drugs such as heroin and synthetic fentanyl. In the USA, the misuse of opioids has reached a critical level, so that the term “opioids crisis” is now used. Opioids addiction affects people of all socioeconomic statuses. A recent review of Missouri’s opioid crisis, published in 2017, revealed that about 2.9 million persons living in the USA were non-medical users of opioid pain relievers, which was categorized as opioid use disorder (Lewis, et al., 2017). Also, a report by the Center for Behavioral Health Statistics and Quality (2015) revealed that over 50,000 people died in the USA due to drug overdose, with most people being middle-aged and young. The National Institute on Drug Abuse (NIDA)(2020) revealed that in 2018, over 67,300 people died from a drug overdose in the USA, which indicates there is a rise in the percentage of people dying as a result of opioid use in America.
To combat the problem of opioids crisis, policies requiring pain assessment before prescribing opioids are being considered. Before exploring the feasibility of such a policy, consider the following points: the consequences of opioids addiction, the perspectives of the stakeholders and the limit of current policies.
The Opioids Crisis and its Consequences
The addiction to opioids claims 128 lives in the USA every day, creating an economic burden of 78.5 billion dollars every year (NIDA, 2020). This economic burden is a result of the high cost of healthcare, which is associated with treating addiction, as well as incarceration due to opioid use. Also, many opioid users are rendered unproductive. Other than causing death among American citizens, the opioid crisis has also been linked to an increase in crime rates within the country. According to NIDA (2019), approximately 65% of the inmates in the USA have substance use disorders.
Besides these data at a nationwide level, opioids addiction negatively affects communities in both urban and rural regions in the state of Missouri, regardless of age, gender, or race. In 2018, 1,132 people died as a result of opioid overdose, while 8,073 people visited the emergency department (ED) in the state of Missouri (Missouri Department of Health & Senior Services (DHSS), 2020). Opioids addiction also affects the health of the future generation. In 2018, 490 infants were diagnosed with Neonatal Abstinence Syndrome (NAS) in 1,711 potential neonatal exposures (DHSS, 2020). NAS occurs when a mother exposes an infant to an addictive substance in utero or passes the substance to her infant through breast milk or placenta. The infant will then experience some withdrawal symptoms from this substance, causing some physical manifestations (Wachman, Schiff, & Silverstein, 2018).
Besides the socio-economic consequences, the opioids crisis also affects the practitioners. They are sometimes accused of mis-prescribing pain killers to patients who do not need it. For instance, a doctor in East Saint Louis was sentenced to more than three years in prison for wrongfully prescribing some pain killers to some women. One of the women was a registered nurse who lost her nursing license for being involved in many accidents while under the influence of prescription drugs (Associate Press, 2018). These examples highlight how deep and wide the problem of opioids addiction is for the general public, the patients and the practitioners.
Role of APRNs in Opioids Crisis and Policy Making
Opioids crisis affects Advanced Practice Registered Nurses (APRN) in many ways. APRNs are trained to assess, educate, and suggest a plan of care for patients. Prescribing medications can be part of the plan of care. In the role of prescribers, the APRNs care for patients who have legitimate pain and need some pain relievers. In contrast, APRNs see patients who are addicted to opioid medications. Manipulation techniques are often used by this population to satisfy their addiction demands. As a result, practitioners are under investigation because they are considered the main sources of opioids prescription in the USA (Barth, Guille, McCauley, & Brady, 2017). APRNs must be able to balance the legitimate need for opioids, and the risk of addiction. A policy requiring a mandatory pain assessment before opioids prescription will protect the practitioners from misusing the prescription authority to satisfy displaced demands.
In addition to the clinical role APRNs play in the fight against opioids crisis, they can initiate positive change in policies to promote the health of the community. Through advocacy and lobbying, APRNs influence the decision-making process. For the issue at hand, APRNs would advocate for the institution of a policy requiring a pain assessment by an independent entity before any pain killer prescription.
Current Policy Overseeing Opioid Use in the State of Missouri and their Limits
The response to the present opioids crisis in America varies substantially. Many attempts are made to solve the opioids crisis. In the state of Missouri, the opioid crisis is handled by many measures. For instance, Naloxone can be dispensed by pharmacists without a prescription. Also, the state has established an overdose response team in St. Louis to reduce deaths associated with opioids use (DHSS, 2020). Mo Healthnet developed recommendations for best clinical practices related to opioid prescriptions. It suggests following the CDC 2016 Guidelines for Prescribing Opioids for Chronic Pain and having appropriate pain indication for opioids. These guidelines fall short in preventing opioids addiction because they are only at the state of suggestions without any coercive measure if violated by a practitioner. The failure of the guidelines is also explained by the fact that in many cases, the practitioner prescribing the pain medication is at the same time the one who decides about the need for a pain killer for a patient.
In the state of Missouri, the DHSS, in partnership with the Centers for Disease Control and Prevention (CDC) and different departments in the state government, among others, are involved in finding solutions to the crisis. In 2018, Missouri Governor Mike Parson signed a law aiming to minimize opioids addiction with new regulations based on prevention, education, and treatment. A program called “comprehensive, integrated, innovative approach” involving different departments in the state of Missouri is also put in place. This program supports initiatives aimed at providing treatment and training opportunities to organizations and individuals, as well as reducing the harm associated with opioids (DHSS, 2020).
Despite these efforts, one in every three individuals in Missouri is still a victim of opioid overdose, either directly or indirectly (DHSS, 2020). A careful analysis of the existing measures indicates that they are too vague and do not focus on the mis-prescription of opioids, which is the major cause of the epidemic. A new policy requiring a mandatory pain assessment by an independent pain management specialist is necessary.
The New Policy to Manage the Opioid Crisis in the State of Missouri: Criteria and Alternatives
The opioids crisis in the state of Missouri requires new interventions to eradicate the problem. The preexisting measures failed to put an end to opioids addiction. A new approach requiring a pain assessment for all patients before any pain killer is given is being suggested. This policy, if put in place will have positive impacts in the fight against opioids addiction. Such a policy will involve stakeholders like practitioners, pain management specialists, pharmacists, and elected officials. The pain management specialists will rely on multidimensional pain assessment scales to assess the patient. Such tools are effective because they not only assess the intensity and nature of the pain, but also the effect of pain on the patient’s brain activity. Also, it helps in improving pain outcomes (Petti, et al., 2018). The multidimensional pain assessment scales will ensure that patients receive effective pain killers, thus improving the quality and outcomes of care.
This approach of ensuring that a pain assessment is performed before prescribing any pain killer will also ensure that practitioners meet their moral obligation of relieving pain and suffering of patients. When pain is assessed, the practitioners can ensure that they minimize the negative outcomes and maximize the positive outcomes of the pain killers prescribed. This is in line with utilitarianism, which is a moral theory that promotes decisions that maximize benefits and minimize harm (Robinson, 2016). For instance, when the pain management specialist determines that the pain is not severe, the patient receives non-opioid pain killers. These pain killers eliminate the harm caused by opioid addiction while relieving the pain the patient is experiencing. Also, if the patient has to receive an opioid prescription, the practitioner can take precautions to minimize the risk of addiction and maximize the benefits, which in this case are improved pain outcomes. The flow chart below explains the steps to be followed in opioid prescriptions.
Flowchart: Suggested interventions for pain assessment and opioid prescription guidelines
An alternative to the mandatory pain assessment before the prescription is to start the medicated pain management by non-addictive pain medications such as Tylenol, ibuprofen, acetaminophen, or baclofen. In daily practice, many practitione...