Identification of the Issue and the Ethical Position
The prescription of opiates by healthcare providers in the United States has recently become an issue. The painkiller abuse has led to around 500,000 emergency cases and hospital visits yearly (Bohnert et al., 2018). More than 10,000 Americans die annually due to overdose of opioids (Bohnert et al., 2018). More than 12 million Americans are admitted to hospitals due to recreational use of opiates (Bohnert et al., 2018). These figures are alarming since the healthcare providers contribute to patient addiction and the availability of opioids.
The dilemma’s existence can be attributed to healthcare provides, who swear to relieve pain and suffering. However, in their efforts to amend that, they have found themselves the main perpetrators. Most pain complaints, however slight they are, are managed by opiates. The administration of painkiller drugs is continuing despite the enormous risks associated with it. Occasionally, complaints of poorly managed pain reach the institutions’ management, who insist on allowing the nurses to prescribe opiates.
How the Scenario Might Develop and Impact the Nurse
Due to the availability of opioids that have lasting effects, nurses have a role in weighing the benefits and the risks of prescribing them. They should be aware that patients have an understanding that pain cannot be eased by simple tests and physical examinations and therefore necessitates opioid discomfort management. Thus, the nursing staff is in an uncomfortable position of acting against the patient’s informed demands.
Headache, dental pain, and backache are the most common emergency department (ED) patients’ claims because they know the pain’s etiology cannot be confirmed. Nurse practitioners can be impacted in the prescription of opiates without assessment, which leads to addiction. Nurses should also understand that even patients with legitimate discomfort tend to exaggerate their pain due to pseudoaddiction or anxiety. Some of them do it for iatrogenic reasons, and many nurses care for clients who claim to experience the highest level of pain. Clinicians should seek more non-opiate pain relief measures and advocate for them.
Defense of the Position: Legal, Ethical, and Professional Evidence
Several attempts have been made to address the situation and halt the practice. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) initiated a project of assessing pain and how to manage it (Bohnert et al., 2018). Uncontrollable pain (10/10 according to the scale) was seen as a public health problem (Bohnert et al., 2018). It was declared to have psychological, physiological, and financial effects on the client and society (Bohnert et al., 2018). Pain management was later recognized as a right for patients (Bohnert et al., 2018). The commission published a standard requiring every client’s initial pain assessment, which became the fifth vital sign (Bohnert et al., 2018). Altogether, the issue’s legal side has been gradually covered.
The above measures were commendable towards the management of pain, but the providers’ responses were misled as they rushed to meet the criteria. The institutions would manage the pain of 4/10 by prescribing opioids in the emergency room. Nutritionists would bring their stable and functional arthritis patients to the ED for 5/10 pain management. The described practices have eventually contributed to opioid addiction in the US (Bohnert et al., 2018). Immediately after the standard’s implementation, the pharmaceutical industry started issuing opioids containing oxycontin with long-lasting effects to provide prolonged pain relief. They were marketed to rural areas where health providers had less knowledge on pain management. The oxycontin later caused more people to become addicted (Bohnert et al., 2018). US Food and Drug Administration (FDA) summoned the oxycontin manufacturer for misguiding the healthcare providers to overlook the addictive effects of the drug, and while the manufacturer pleaded guilty, the drug is still being used today (Bohnert et al., 2018). Altogether, the evidence is conflicting, suggesting that the situation remains unresolved in the targeted spheres.
Strategies and Solutions of Addressing the Issue
Web-based prescription monitoring programs (PMP) enable healthcare providers to understand who else is prescribing drugs to the patients seen by them. Thus, the legislation now exists in 48 states, and although it is time-consuming and needs extra security and ethical implications, the initiative can curb unnecessary prescription of opiates (Pozgar, 2019). Once a patient exhibits aberrant behavior, such as frequent ED visits, their healthcare providers should investigate. In the electronic records, one should be able to document “substance abuse,” “drug shopping,” “addiction,” and other terms. Caregivers should ensure that the medication is safe by partnering with the ailing party. On the other hand, clients will avoid polypharmacy by agreeing to consult a single healthcare provider and a pharmacist and refrain from taking medications that can lead to addiction. In turn, health professionals must screen patients for substance abuse and provide options for interventions to manage pain, for example, physical therapy, which reduces overreliance on opiates and consequently prevents addiction. Overall, PMP, health records, and monopharmacy coupled with responsible care administration may resolve the issue.
Other Ethical Issues Connected with Opioid Use
Patients with a history of drug-seeking behavior tend to refuse a complete physical examination and blood sampling and ignore medical advice. Convincing them is challenging, and some healthcare providers feel helpless because they have the tools to assist the patient but cannot apply them. Determining how much pain the patient experiences without cooperation from their side is also difficult. It should also be assessed based on the patient’s feelings and not only numerical scores (Butts & Rich, 2019). Another prominent issue is healthcare costs, which may be unmanageable by the customer due to their state, so the medical staff may have to abandon them. Although those dilemmas seem approachable if the patient changes, the reality is that health providers bear most of the responsibility.
Bohnert, A., Guy, G. P., Jr, & Losby, J. L. (2018). Opioid prescribing in the United States before and after the Centers for Disease Control and Prevention’s 2016 Opioid Guideline. Annals of Internal Medicine, 169(6), 367–375.
Butts, J., & Rich, K. (2019). Nursing Ethics (4th ed.). Jones & Bartlett Learning.
Pozgar, G. (2019). Legal and ethical issues for health professionals (4th ed.). Jones & Bartlett Learning.