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Clinical nurses have an ethical duty to treat pain in all patients. However, many nurses struggle with treating acute pain in patients with history of opioid abuse. Evidence-based ethical interventions for treatment of acute pain among persions with a history of opioid abuse are presented.
According to the Centers for Disease Control and Pre - vention (CDC, 2017), opioids were responsible for over 42,000 American deaths in 2016; 40% of those deaths were linked to use of opioids prescribed by healthcare providers rather than illicitly used. Prescription opioids, such as hydrocodone (Vicodin®), morphine, or hydromorphone (Dilaudid®), often are used to treat moderate or severe pain that is acute or chronic. The CDC indicated illicit opioids, such as heroin and some forms of fentanyl, are used commonly after addiction to prescribed opioids has developed or for an immediate euph oric experience.
In the past decade, use of prescription opioids for treatment of chronic pain has increased markedly, without evidence supporting the practice (CDC, 2017). As prescriptions for opioids have risen, the concurrent use of illicit heroin has grown as well. Rollins (2016) reported an increase in heroin users from 373,000 to 914,000 from 2007 to 2014. Patients are believed to turn to heroin for its availability and relatively low price. The combination of prescribed and illicit opioid use and overdose has brought the United States to an opioid abuse epidemic that significantly impacts health care (CDC, 2017).
Caring for patients with opioid addiction has become challenging for healthcare providers. According to Weiss and colleagues (2017), the number of opioid-related inpatient hospitalizations nationally increased 64.1% between 2005 and 2014. These include admissions with one or more of the following: a patient with an established opioid addiction who may need acute pain management after an elective procedure or other event, a patient experiencing complications from illicit opioid drug use (e.g., endocar ditis, systemic infection, bowel obstruction, psychiatric alterations), or a patient experiencing opioid withdrawal or overdose (Meyer et al., 2014). The average length of stay for patients admitted with an opioid-related condition is 6 days, representing a 2- day increase from general inpatients (Gupta et al., 2018). With this increase in opioid-related visits, many state and federal agencies have had to adjust to a rise in treatment...