My Nursing Specialty: Oncology Nursing

As opioid dependency and overdoses in the U.S. continue to rise, Chamberlain University Doctor of Nursing Practice (DNP) graduate Linda Young, DNP, APRN-BC, has set out to find answers. Alongside John P. Fulton, PhD, clinical assistant professor of behavioral and social sciences at Brown University, Dr. Young recently published an article suggesting a credible link between the increased prescribing of opioids and increased opioid addiction. Within the article, Drs. Young and Fulton summarize a pilot program that they designed and launched, aimed at monitoring opioid prescriptions. The two are making an impact on this global health crisis at the local level.

Drs. Young and Fulton spoke with us about the steps they are taking to combat the opioid crisis in Rhode Island.

How did the pilot program get started?

“For the program, [our] team designed and piloted an evidence-based quality-improvement project in four urgent care clinics in Rhode Island,” stated Dr. Young. “Their results found that by implementing guidelines, and tapping into the resources of Rhode Island’s Prescription Drug Monitoring Program database (PDMP), you can limit the amount of opioid prescriptions—or at least monitor it.”

What did you find was key in combating the crisis?

“Healthcare provider awareness and education is key,” shared Dr. Fulton. “Implementing goal setting and monitoring assessments for patients and using referral practices is also vital. For this reason, the Rhode Island Department of Health, among many other public health agencies, recommends adoption of a protocol called Screening Brief Intervention and Referral to Treatment, or simply SBIRT.”

How does “SBIRT” work?

“It’s recommended that healthcare providers consider screening all patients annually or upon entry into a practice to assess potential risk for substance abuse,” explains Dr. Young. “Tools such as the Opioid Risk Tool (ORT), the Drug and Alcohol Screening Test 10 (DAST 10) and several others are available from the Substance Abuse and Mental Health Services Administration.”

Why is the opioid crisis so difficult to combat?

“The opioid crisis in the United States is difficult to combat for several reasons,” said Dr. Fulton. “Firstly, opioids treat pain, and pain is ubiquitous and hard to quantify. In our society, we expect to be pain free. Secondly, opioids are ubiquitous! They are sitting in millions of homes across the U.S. Thus, the misuse of opioids is far too easy. Thirdly, opioids are also over-prescribed because providers were sold on the effectiveness—and safety—of a number of prescribed opioid formulations for the treatment of pain. They are also over-prescribed because providers are never sure how many doses patients will need to be pain-free after surgery, injury, etc. Finally, opioids are over-prescribed because patients with chronic pain develop a tolerance for opioids, which require higher dosages over time.

Lastly, opioids are highly addictive. Opioid addiction, on average, requires lengthy and complex treatment (medical, psychological, social), which is costly and interruptive of life. The latter conflicts with treatment, competes with it and frequently frustrates it.”

What are next steps for combating the crisis?

“Because the opioid problem is so complex, it requires complex, ‘all hands on deck,’ coordinated solutions,” said Dr. Fulton. “I believe this is best addressed in grassroots, community efforts, because aspects of the problem differ from place to place, as do access to treatment assets. The first step in a community effort is to assess the problem. This includes confirming that the community understands the opioid problem, and that they understand its scope and what forces control it. We must also organize and dedicate ourselves to a long-term, year-after-year effort. The opioid crisis did not arise overnight, but took years to develop. And it will take years to resolve.”

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