Opioids: The menace in our midst

Opioids have impacted every population served by all healthcare providers in the United States. The resulting increase in deaths related to opioid abuse now spans a generation of victims: adolescents, young adults, pregnant women, adults-even older adults. By now, virtually every nurse practitioner (NP) has been exposed to the opioid scourge whether in his/her professional practice, via its documentation in the professional literature and newspapers, through social media, or, tragically and with increasing frequency, through personal loss of a relative or family friend.

Perhaps it’s time to reassess the role for NPs in caring for their individual populations confronting an opioid crisis. Ms Zimlich’s Clinical Brief in the September issue of Contemporary Pediatrics titled “Teens not being treated for opioid use disorders” spotlights the benefit of early intervention in reducing the incidence of opioid use disorders through prompt diagnosis and evidence-based treatment.

Red flags and referrals

Primary care pediatric and family NPs are in a key vantage point to spot teenagers early on who may have an opioid use disorder. In the critical care setting, acute care pediatric NPs may be literally the first to recognize the adolescent who presents in crisis. Both these time points in care are clearly too late for primary prevention strategies. Instead, primary and acute care NP pediatric providers must assume the role of patient advocate by making an immediate referral to a psychiatric mental health provider with expertise in caring for adolescents given the diagnosis of opioid use disorder. In making such a referral, primary care providers then assume the role of the medical home in caring for these adolescents. The resulting collaboration between the psychiatric provider and the NP must be seamless to ensure the best outcomes. Medication management, in particular, is crucial and should be made equally available to all who meet the criteria.

Ahead of the crisis curve

If NPs can collectively move to the forefront of the epidemic, proactively addressing the healthcare needs of the individual patient, the family, and the community at large, perhaps we can help reverse the trends in opioid use disorders. One specific strategy to accomplish this may be found in interprofessional collaboration.

Taking care to the street level

The opioid crisis is a major national issue that warrants the attention of our local, state, and national legislatures, law enforcement agencies, and the healthcare community as a whole. Most recently, as part of my Advanced Nursing Education, Health Resources and Services Administration grant, I had the pleasure of collaborating with the nursing population health expert from New York University Rory Meyers College of Nursing, Robin Toft Klar, DNSc, RN, the Deputy Assistant Chief of the Bronx Borough Command, Fire Department of New York (FDNY), and the Division Chief of FDNY Emergency Medical Services (EMS) who advocated for collaboration among first responders in the field, NPs in clinical practice, and population health experts. One resulting recommendation was to use “heat maps” generated collectively by the community-based fire departments and EMS-including paramedics-to assess the “hot spots” within individual communities. All healthcare facilities located within these areas can then become operational centers for both primary and secondary prevention programs geared to reducing the incidence of opioid use and its horrific outcomes.

Crises demand creativity

As child health advocates, NPs are called to preemptively explore such novel collaborations and other ideas if we are to blunt the opioid onslaught. And if such collaborative concepts succeed, we may well have hit upon a framework through which to tackle the next pressing public health concern.

What opioid-countering measures are being tried in your area? Reach Dr. Hallas at DrHallas@ubm.com