By the end of this topic, the student should be able to:
Opioids are used primarily for their analgesic (pain-relieving) effects for moderate to severe acute pain from a variety of causes.
Opioids are frequently used to treat chronic cancer pain. Opioids are also used in opioid replacement therapy in the form of buprenorphine or methadone.
The use of opioids for reasons other than the treatment of pain as managed by a prescriber is sometimes called non-medical use; however, this description is misleading.
Opioid users have complex, interprofessional needs. In order to understand these needs, we will explore the role of several professions when it comes to opioid users.
Almost every social worker who is involved in clinical or community work will engage with a person experiencing a substance use disorder or a family that has a member who is.
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Listed below are some of the positions social workers are involved in related to opioid use practice.
Depending upon the setting, a social worker may screen an individual for opioid use and/or assess the individual.
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The following are recommendations by CASN for registered nurses and nurse practitioners on how to address the opioid crisis in Canada (CASN, 2017).
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The primary roles of the pharmacists with respect to opioids are drug dispensing, client care, and opioid stewardship.
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Community pharmacists are the gatekeepers of prescription opioids. They interact with the client and/or caregiver on a regular basis, are easy to access, and are the resource for over-the-counter medication inquiries. Pharmacists address the opioid crisis in Canada by doing the following:
Pharmacists are in an ideal position to monitor for adverse events and client progress. Pharmacists must ensure that opioid prescriptions are appropriate and dispense the correct product. In addition, pharmacists can:
Pharmacists must communicate with clients about opioid use to maximize benefits and minimize the risk of adverse effects, including the possibility of tolerance, dependence, and addiction. They are in a position to:
Since 2016, pharmacists have also been directly engaged with harm reduction, dispensing naloxone to medical and non-medical opioid users and their supports. They may also have more time to dedicate to client education and follow-up. Pharmacists also maintain the dispensing records for opioids (as well as other medications).
To optimize health outcomes, team-based health care approaches that facilitate interprofessional collaboration are being recognized as effective interventions for opioid misuse and treatment.
Randomized control trials have shown improved client outcomes when the interprofessional team members collaborate in multi-modal care planning with the individual and their family. Referred to as collaborative care (CC), this model of care involves a number of health professionals working with a person who uses drugs to comprehensively address issues related with opioid use.
Evidence suggests that by using the collaborative care approach, treatment outcomes can be significantly improved.
Comprehensive addiction evaluation and individualized treatment plans should be supported over usual primary care. Treatment can include behavioural therapy (such as addiction treatment counselling, cognitive behavioural therapy, or motivational interviewing), medications, cultural interventions, or a combination of approaches.
In the United States, different professions are implementing initiatives that can help to address the opioid crisis. These initiatives are outlined below.
Regis University Rueckert-Hartman College for Health Professions (RHCHP). Represented opioid panel health care professions and associated professional association opioid initiatives.
Profession | Professional Association Initiatives/Guidelines |
---|---|
Counseling | Behavioral Health emphasizes the use of supportive psychotherapy, behavioral strategies, and medication-assisted treatment to address opioid dependence and addiction. Comprehensive, whole-person therapies are designed to help the patient understand the triggers for opioid misuse, develop strategies to effectively address underlying etiologies, and incorporate healthy relationships and community in recovery. |
Nursing | The American Nurses Association (ANA) is focusing nursing efforts on assessing, diagnosing, and managing patients with addiction through the expansion of medication-assisted treatment, training opioid prescribers, increasing the awareness of prescription drug monitoring programs, increasing access to Naloxone, and in the development of abuse-deterrent formulations. |
Occupational Therapy | Occupational therapy (OT) practice in pain management focuses on biopsychosocial approaches to address occupational functioning, activity promotion, and self-management. The American Occupational Therapy Association (AOTA) promotes consumer guidelines for managing chronic pain and provides educational fact sheets on OT’s role in pain rehabilitation and substance abuse. As part of the U.S. Surgeon General’s call to action to fight opioid abuse, AOTA and state OT associations are working to develop solutions to address the opioid crisis. |
Pharmacy | The American Pharmacists Association® has an Opioid Center designed to closely monitor, respond, and inform their membership about opioid use, abuse, and misuse. Housed within the practice section of the website, the opioid center provides tools and guidelines, clinical and patient resources, as well as state and federal resources. The American Society of Health-System Pharmacists has a series of policy positions related to stewardship of drugs with potential for abuse, controlled substance diversion and patient access, naloxone availability, prescription drug abuse, and pain management. Also, they provide a formal statement regarding the role of pharmacist’s in substance abuse prevention, education, and assistance. |
Physical Therapy | The American Physical Therapy Association (APTA) is educating consumers about the benefits of physical therapy as a safer alternative to opioids in their #ChoosePT campaign (moveforwardPT.com). The APTA’s Position Paper outlines what the profession is doing to identify their role in pain management based on the Centers for Disease Control and Prevention (CDC’s) recommendations to move towards nonpharmacologic alternatives. |
Adapted from Brooks et al. (2017)
Described as both a tool and a process, intersectoral collaboration is defined as
“A recognized relationship between part or parts of the health sector with part or parts of another sector which has been formed to take action on an issue to achieve health outcomes ... in a way that is more effective, efficient or sustainable than could be achieved by the health sector acting alone”
In Waterloo Region, Ontario, the Waterloo Region Integrated Drugs Strategy partnered with Region of Waterloo Public Health and Emergency Services to develop an opioid response plan. For more information, visit Enhancing Harm Reduction Services in Waterloo Region (PDF).
In Alberta, the Alberta Addiction and Mental Health Provincial Clinical Network was formed to ensure front-line clinical staff were involved with client safety and quality initiatives in meaningful and productive ways. One outcome was a multidisciplinary and multidepartment working group that addressed the screening and assessment of concurrent disorders. For details, visit 2017-2020 Transformational Roadmap. Addiction and Mental Health Strategic Clinical Network (PDF).
Stewardship is defined as the responsible management of resources (Saskatchewan Health Authority, 2020). Interventions should be responsible in ensuring the appropriate use of opioids.
Opioid stewardship is described as coordinated interventions designed to improve, monitor, and evaluate the use of opioids to support and protect human health (ISMP Canada, 2020).
Now that you have reviewed this content, consider the following:
What are the primary roles of nurses in opioid use management?
What are the primary roles of pharmacists in opioid use management?
What are the primary roles of social workers in opioid use management?
How can we improve interprofessional care in opioid use management?
Refer to the roles as described above and interprofessional considerations provided.
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