Identification and Management of Prescription Opioid Abuse in Hospitalized Patients

Abstract

Prescribing of opioids for acute and chronic pain has increased; so has the incidence of abuse of these medications. Patients in the hospital may have hyperalgesia, tolerance, and dependence on opioids which can complicate their overall treatment. Some patients have opioid addiction from prescription opioids as well as heroin with aberrant medicine taking behaviors. Managing these patients takes special knowledge and skills from the whole team. It is important to identify patient concerns and barriers to treatment and work as a team to treat the pain with pharmacological, nonpharmacological, and behavioral techniques to help keep the patient safe and comfortable during their hospitalization. A nonjudgmental attitude and problem-solving approach are necessary for medical (pain) and psychosocial issues. Recommendations for safe prescribing of opioids to the addicted patient at discharge are included.

Nurses' Perceptions of Caring for Childbearing Women who Misuse Opioids

“…Prior research has also demonstrated the many challenges associated with proper pain management of patients with histories of opioid abuse (Jewell et al, 2011). Pain as the fi fth vital sign has placed emphasis on prevention and treatment of pain by often scheduling pain medication treatment around the clock rather than offering a more individualized approach.…”

“…Nurses' perceptions related to caring for patients who misuse opioids can infl uence patient care decision making and overall quality of nursing care provided (Jewell, Tomlinson, & Weaver, 2011;Monks, Topping, & Newell, 2013;Wilson, 2009). With the rise in the number of pregnant women misusing opioids, obstetric nurses need the skills and knowledge to adequately provide them quality nursing care.…”

Ethical Considerations in Use of Injectable Opioid Agonist Treatment in Pregnancy

“…Hearing statements such as “It helps me calm down” or “It helps me sleep at night” can provide an opportunity for exploring whether more appropriate medication, such as a nonbenzodiazepine sedative, may be indicated, and this can reduce the overall dose of opioids. This is an opportunity to educate the patient about different reasons for requesting a medication, and asking for appropriate medication for the type of symptom she experiences 9 . Monitoring activities of daily living can give an indication of the effect of the iOAT.…”

“…This is an opportunity to educate the patient about different reasons for requesting a medication, and asking for appropriate medication for the type of symptom she experiences. 9 Monitoring activities of daily living can give an indication of the effect of the iOAT. Increased functioning in self-care (bathing herself, getting up to the bathroom with appropriate assistance, agreeing to work with the nurse, etc) is a desired and objective outcome.…”