The opioid oxymoron
Opioids are known for their powerful pharmacokinetics for pain relief, but are now well recognized for their overuse and abuse through prescriptions provided by healthcare providers. This has created a medical oxymoron: well-meaning pain management as a valued, caring practice for successful recovery from both medical problems and surgical procedures, juxtaposed by the alarming growth of opioids' prescriptive footprint. Data show that, in 2012 alone, 259 million prescriptions were written—enough for every American adult to have a bottle of pills (www.cdc.gov/vitalsigns/opioid-prescribing/).
The medical and lay press are now replete with reporting on the use and abuse of opioid drugs, and deaths from opioid prescription misuse is well known to medical providers. The list of tragic, untimely deaths of celebrities who succumbed to prescription drugs lengthens, including the lost talents of Cory Monteith (31 years old), Heath Ledger (28 years old), Elvis Presley (42 years old), Michael Jackson (50 years old), Whitney Houston (48 years old), Anna Nicole Smith (40 years old). Every time we write an opioid prescription, we potentially place an adolescent at risk for abuse and an untimely death.
Outlawing 'doc shopping'
Numerous medical and advanced practice nursing organizations support the use of legislative initiatives to reduce opioid prescribing, and legislatures have listened and passed bills. In 2012, New York required prescribers to check the state’s prescription monitoring program before prescribing painkillers and, in 2013, saw a 75% drop in patients who were seeing multiple prescribers to obtain the same drugs, placing them at risk for overdoses (www.cdc.gov/vitalsigns/opioid-prescribing/).
The screening imperative
Prescribing of opioids for pain management to adolescents has become a major concern as discussed by Dr. Bass in the article “Opioids: A pediatric epidemic.” Dr. Bass provides powerful statistics on the ready availability of opioids for use by adolescents—often as close within reach as the household medicine cabinet. Screening with substance abuse tools is highly recommended by Dr. Bass and should be a routine part of NP practice. NPs need to take the opportunity to probe at every well and episodic visit with older school-aged children and adolescents to capture the important data that places a particular child at risk for substance abuse.
Once identifying a patient as an at-risk or substance-abusing adolescent, the NP can do a brief office-based intervention and make a referral for treatment. NPs should take an active role in altering the opioid oxymoron by using a valid assessment pain tool, prescribing nonnarcotic pain medication first, and employing other known, effective, pain management strategies before considering a prescription for opioids.