Describe the indications of chronic opioid therapy (COT) and standards for initiating as well as maintaining COT?
The current opioid crisis causes significant concerns regarding the initiation of chronic opioid therapy (COT) and its maintenance. The need for using COT in pain management increases dramatically, while even small dosage of opioids may lead to addiction. The indicators for using COT involve non-cancer management of chronic pain occurred as a result of disease or injury (Waszak & Fennimore, 2017). For instance, specific fibromyalgia, back pain, or headache may be noted as the cases for COT prescription. The critically meaningful enhancement in a patient’s condition signals the effectiveness of the above treatment and prescribes further maintenance. The patients with COT should be subjected to continuous monitoring and receive relevant education.
There are several standards and evidence-based practical guidelines elaborated especially for nurse practitioners (NPs). Chesney and Duderstadt (2017) pinpoint that NPs who possess a full practice authority (FPA) may provide schedule II controlled substances for patients with opioid addiction. In many states though, the prescription of the above medications should be controlled by a physician in order to prevent malpractice. A patient should receive all prescriptions from one physician and pharmacy, thus avoiding any misunderstanding or errors related to treatment and maintenance processes. Jukiewicz, Alhofaian, Thompson, and Gary (2017) emphasize that none of the states require prescription drug monitoring programs to be utilized in practice. Instead, the prescribers are expected to focus on the best evidence-based practices to decide with regard to a particular patient. The fact that different states and even hospitals may have their own guidelines may cause inconsistency in schedule and dosage (Jukiewicz et al., 2017). Nevertheless, it is essential to specify that federal guidelines such as the Centers for Disease Control and Substance Abuse and Mental Health Services Administration provide relevant clinical assessment tools and typology of outcomes.
What are ways to stratify or even minimize patient risk of opioid addiction
The current evidence presents several ways to stratify and minimize patient risk of opioid addiction, among which one may enumerate utilization of primary care providers, patient-centered delivery of opioid pain therapy, continuous monitoring, education, and consistent consideration of laws, guidelines, and policies.
The review of the recent research studies reveals that insufficient attention is paid to the role of primary care providers in terms of COT. According to Jenkinson and Ravert (2013), there is a lack of programs and the number of nurses, who are unable to prescribe schedule III medications due to the fact that they do not have FPA. In this regard, the mentioned authors argue that a primary care setting is the most appropriate environment for opiate addiction stratification and minimization. Attentiveness and sensitivity with which primary care providers should treat patients would lead to their improved satisfaction as well as better health outcomes.
The patient-centered delivery of opioid pain therapy is another option to address opiate addiction. As stated by Waszak and Fennimore (2017), education for a patient and his or her family is essential to equip them with knowledge and skills in order to combat opiate addiction and minimize the risks for its development. The consideration of on a patient’s values, views, preferences, and any other critical peculiarities would provide more focused and specific care. More to the point, continuous monitoring along with staff education composes an integral part of stratifying and minimizing opioid addiction risks. Since today’s rapidly changing environment presents new challenges and opportunities in the field of patient care and opiate pain treatment, staff education should be timely and relevant. Ultimately, by consistently aligning laws, guidelines, and policies with the practical initiatives, it is possible to achieve the reduction in opioid addiction resulted from non-cancer pain management.
References
Chesney, M. L., & Duderstadt, K. G. (2017). States’ progress toward nurse practitioner full practice authority: Contemporary challenges and strategies. Journal of Pediatric Healthcare, 31(6), 724-728. Web.
Jenkinson, J., & Ravert, P. (2013). Underutilization of primary care providers in treating opiate addiction. The Journal for Nurse Practitioners, 9(8), 516-522. Web.
Jukiewicz, D. A., Alhofaian, A., Thompson, Z., & Gary, F. A. (2017). Reviewing opioid use, monitoring, and legislature: Nursing perspectives. International Journal of Nursing Sciences, 4(4), 430-436. Web.
Waszak, D. L., & Fennimore, L. A. (2017). Achieving the Institute of Medicine’s 6 aims for quality in the midst of the opioid crisis: Considerations for the emergency department. Journal of Emergency Nursing, 43(6), 512-518. Web.