Preventing Opioid Misuse and Potential Abuse: The Nurse's Role in Education

Purpose: Prescription drug misuse and abuse is the intentional or unintentional use of medication without a prescription, in a way other than prescribed, or for the experience or feeling it causes. (SAMHSA, 2013).  In 2013, 15.3 million people ages 12 or older used prescription drugs non-medically with pain relievers (1.9 million).  As many as 12.5% of new illegal drug users began with prescription pain relievers (SAMHSA, 2013).  Prescription drug abuse and misuse has been steadily increasing over the past three decades in the United States.  Opioid analgesic sales increased nearly four-fold between 1999 and 2010, coinciding with a nearly four-fold increase in opioid overdose deaths and substance abuse treatment admissions during the same time period. Prescription drug abuse-related emergency department visits and treatment admissions have risen significantly in recent years (CDC,2011).In a call to action, the CDC, 2013 has recommended that healthcare providers follow evidence based guidelines for safe and effective use of opioids prescriptions.  Nurses play a vital role in providing education for proper use of opioids.  Data recently released by the National Center for Health Statistics show opioid drug overdose deaths increased for the 11th consecutive year in 2010.  In recent years, prescription drug use has claimed more lives than heroin and cocaine combined (Jones, Mack, & Paulozzi, 2013).  The incidence of increased opioid use is not limited to the United States but also Canada, which has seen an increase in opioid use in recent years and, as of 2011, was the second largest per capita consumer of prescription opioids after the United States (2013).  The International Narcotics Control Board reported that Canadians’ use of prescription opioids increased by 203% between 2000 and 2010 (2011).  The Youth Smoking Survey revealed that nationally, 5.9% of Canadian adolescents reported the use of prescription drugs in the past year to get high (Currie &Wild, 2012).  Deaths related to prescription opioids doubled in Ontario, from 13.7 deaths per million in 1991 to 27.2 per million in 2004 (Fischer & Argento, 2012).  Nurses play a key role in providing this patient education at the point of care when the patient first receives the opioid prescription.  However it has been hypothesized that nurses lack sufficient knowledge of opioids to provide patients with all the information they need to safely care for themselves. This descriptive study was designed to explore nurses’ knowledge of opioids.

Methods: Nurses in two large urban east coast medical centers in the United States were invited to participate in the study.  One hundred and thirty three nurses completed the survey in its entirety.  Registered nurses’ knowledge of and attitudes about opioid use were assessed using a 48-item web based questionnaire sent via email.  Frequencies were computed for all items on the questionnaire.  Data were analyzed using Chi-square for all questions that fewer than 50% of participants answered correctly.

Results: The results of this study identify that there is a pain management knowledge gap among nurses caring for patients who are receiving opioid analgesics. This gap includes patient assessment; pharmacologic management, use of adjuvant medications; risks of addiction; risks of respiratory depression; and disposal and storage of opioid analgesics. Twenty-five percent of the nurses answered 50% of the survey questions correctly. Demographic variables such as experience working as a nurse or length of time as a nurse, in addition to educational level, did not influence how nurses performed on the questionnaire.  However, nurses who received education on opioids as a separate class of medication answered a higher percentage of questions on the survey correctly than those who did not receive education on opioids.

Conclusion: The results of this study reveal a knowledge gap and nurses’ lack of sufficient information about opioids that may affect their ability to provide effective medication instructions to their patients.   The findings from this study informed the development of an opioid discharge medication class to help nurses in their awareness of the scope of the problem and to offer evidenced based guidelines for safe use of opioids in the home.