Identifying Drug-Seeking Behavior: A Nursing Duty to Act

The United States is currently experiencing a public health crisis related to opioid abuse, much of which can be attributed to easy access to prescription pain medications. Emergency Departments are often targeted by drug-seekers because they manage acute pain, provide episodic care, have rotating staff, and frequently lack resources to address patterns of drug-seeking behavior (DSB). Presently, many emergency departments fail to adequately screen patients for potential opioid abuse and DSB. Reasons for this failure include: staff burnout, pressure for fast door-to-discharge times, expectation of good patient satisfaction scores, lack of nursing protocol for identification of DSB, and lack of nursing empowerment to escalate concerns. These barriers make it difficult for nurses to adequately address DSB when they suspect it, a cycle that promotes ongoing apathy and a sense of powerlessness among the nursing staff. If nurses are given the right tools and adequate support, emergency departments can implement practice-changes and reduce inappropriate opioid prescriptions, which will subsequently reduce the availability of opioids in the community. Rather than relying on demographics to identify patients who are at-risk for prescription opioid abuse, observing patients' behaviors in the emergency department can help to better identify drug-seekers. Using an objective screening tool to identify the presence of predictive behaviors, and utilizing a nurse-driven protocol to escalate concerns, empowers nurses to collaborate with prescribers. When patients are identified as potential drug-seekers, establishing multidisciplinary care teams and implementing individualized care plans reduces both opioid abuse and unnecessary visits to emergency departments. Ongoing screening and treatment for DSB will likely have a cumulative effect in reducing the number of drug-seekers in emergency departments, as public perceptions about the availability of opioid prescriptions gradually change. Given the huge social and public health impact of opioid abuse in the United States, and the professional duty of nurses to care for both individuals and populations, it is imperative that evidence-based practice be implemented to reduce the availability of prescription opioids to individuals who would be harmed by them. Emergency departments are uniquely positioned to begin this effort.