Clinical perspectives on hospitals’ role in the opioid epidemic

Abstract

Background Policymakers, legislators, and clinicians have raised concerns that hospital-based clinicians may be incentivized to inappropriately prescribe and administer opioids when addressing pain care needs of their patients, thus potentially contributing to the ongoing opioid epidemic in the United States. Given the need to involve all healthcare settings, including hospitals, in joint efforts to curb the opioid epidemic, it is essential to understand if clinicians perceive hospitals as contributors to the problem. Therefore, we examined clinical perspectives on the role of hospitals in the opioid epidemic. Methods We conducted individual semi-structured interviews with 23 clinicians from 6 different acute care hospitals that are part of a single healthcare system in the Midwestern United States. Our participants were hospitalists (N = 12), inpatient registered nurses (N = 9), and inpatient adult nurse practitioners (N = 2). In the interviews, we asked clinicians whether hospitals play a role in the opioid epidemic, and if so, how hospitals may contribute to the epidemic. We used a qualitative thematic analysis approach to analyze coded text for patterns and themes and examined potential differences in themes by respondent type using Dedoose software. Results The majority of clinicians believed hospitals contribute to the opioid epidemic. Multiple clinicians cited Center for Medicare and Medicaid Services’ (CMS) reimbursement policy and the Joint Commission’s report as drivers of inappropriate opioid prescribing in hospitals. Furthermore, numerous clinicians stated that opioids are inappropriately administered in the emergency department (ED), potentially as a mechanism to facilitate discharge and prevent re-admission. Many clinicians also described how overreliance on pre-populated pain care orders for surgical (orthopedic) patients, may be contributing to inappropriate opioid use in the hospital. Finally, clinicians suggested the following initiatives for hospitals to help address the crisis: 1) educating patients about negative consequences of using opioids long-term and setting realistic pain expectations; 2) educating medical staff about appropriate opioid prescribing practices, particularly for patients with complex chronic conditions (chronic pain; opioid use disorder (OUD)); and 3) strengthening the hospital leadership efforts to decrease inappropriate opioid use. Conclusions Our findings can inform efforts at decreasing inappropriate opioid use in hospitals.

Identifying barriers and facilitators for nurse practitioners' opioid management of chronic pain

“…Six of nine articles identified professional education as either a barrier or a facilitator for NPs' management of chronic pain (Craig-Rodriguez et al, 2017; Franklin et al, 2013; Mazurenko et al, 2020; Nikpour et al, 2021; Spitz et al, 2011; St Marie, 2016). As barriers to opioid prescription for older adults, 77% of NPs and physicians in one study identified fear of causing harm from adverse effects, and 35% identified insufficient pain management education (Spitz et al, 2011).…”

“…Along with the prescriptive authority issue, the practice environment is a significant factor affecting NPs' opioid management. Not surprisingly, NPs in specialty care settings are more likely to prescribe opioids than NPs working in primary care settings (Mazurenko et al, 2020). Given the significance of the practice context in this regard, educational enhancements and other forms of NP support should be tailored to the NP's practice environment.…”

COVID-19 health practices and attitudes in the United States: the role of trust in healthcare

“…It is well established that distrust in the pharmaceutical industry is associated with lower vaccination rates, for both adults and their children (Attwell et al 2017 ). The perceived culpability of healthcare professionals in the opioid epidemic and rising healthcare costs likely contributes to the erosion of trust in healthcare and medicine (Gale 2016 ; Mazurenko et al 2020 ); perceived financial incentives of healthcare professions to work against people’s health or best interest is an important component of medical distrust (Dana and Loewenstein 2003 ; Grande et al 2012 ; Schwei et al 2014 ; Webb Hooper et al 2022 ). Additional research is necessary to elucidate public perception of healthcare’s financial “benefit” from the pandemic and how this may have fostered distrust in COVID-19 information and mitigation efforts.…”

Redefining “Epidemic”: Nursing an end to the opioid crisis

“…To "get [patients] out the door," providers fail to collect a comprehensive medical history and form a relationship that would allow them to distinguish between the patients who are experiencing true pain from the patients who are seeking out opioids to abuse. 31 Before nurses are even licensed to provide care, they are taught to relieve suffering. Thus, nurses are presented with an ethical dilemma when tending to the needs of their patients, which may ultimately result in feelings of burnout that reduce the availability and quality of care.…”