By Melinda Young
While the world focused on the COVID-19 pandemic, another crisis — the opioid epidemic — continued to unfold, taking hundreds of thousands of lives.1
Hospital discharge is an opportunity for case managers and other providers to help prevent patients from becoming victims of opioid overdoses.
The opioid crisis worsened during the COVID-19 pandemic, says Selena A. Gilles, DNP, ANP-BC, CNEcl, FNYAM, an associate dean of the undergraduate program, clinical associate professor, and affiliate faculty at the Hartford Institute for Geriatric Nursing (HIGN) at New York University Rory Meyers College of Nursing.
In 2020, there were 2,062 overdose fatalities in New York City, making 2020 the deadliest year on record for the city and the United States.2
“What we saw during COVID was a lot more people being isolated,” Gilles says. “The mental impact of dealing with COVID and the pandemic and social isolation and financial issues that come with COVID can increase the risk of people dying from an opioid overdose.”
Recognize the Signs
Healthcare professionals who rarely work with a population that abuses substances may not be aware of the risks opioid addiction poses. “Substance use can impact anyone for various reasons,” Gilles says. “Someone may use substances because of difficulty sleeping, or not having their pain under control, or because they just want to try it, or they want to get high, or they’re using substances as a coping mechanism.”
Case managers may see patients with substance use issues, or who could develop substance use problems, and they are unaware this is a possibility. As a nurse educator who works with patients in pain management, Gilles says better education about substance use in training for nurses and other healthcare professionals is needed.
“There are so many things we can do to educate our healthcare providers about the risk of using substances so they can educate patients on preventing addiction and on preventing death from using substances,” she says.
Train to Prevent Overdoses
Case managers and nurses need to understand addiction is a medical condition. They can help patients dealing with substance use issues, Gilles says. For example, the New York State Department of Health offers a program in which organizations can become overdose prevention training centers. A state law allows people who are not medical professionals to administer naloxone to reverse an opioid overdose. The prevention program gives naloxone to registered opioid overdose programs.2,3
Overdose prevention training centers save lives, and can be located in the communities hardest hit by the opioid epidemic. “We can provide education for nurses and other healthcare professionals, teachers, and anyone in the community who wants training on how to prevent an overdose,” Gilles says.
Overdose prevention training centers can teach both professional healthcare staff and laypeople how to use naloxone and to have it on hand. “We teach signs and symptoms of overdose and how to treat it. Any person can do this,” Gilles adds. “A case manager can [become] a trainer to recognize an overdose and prevent opioid deaths.”
The program began in 2018 and has trained hundreds of people from different backgrounds, including nursing students, security guards, and nightclub employees. They receive a naloxone kit with two doses of the medication, gloves, and a mouth shield for CPR.
Training also is about teaching patients that substance use is a disease, and it is not easy to quit when someone is physically dependent on the drug.
Case managers and nurses can teach patients with substance use disorder that their tolerance levels will decrease while they are hospitalized and unable to obtain the same levels of the substance as they had been using.
“Your tolerance goes down, and when they leave the hospital, they can’t use the same amount they did previously because their tolerance has decreased,” Gilles explains. “This education can prevent overdoses.”
Patients also need to know the dangers of using any drug they obtain outside a pharmacy or medical office. One of the biggest culprits in opioid overdose is fentanyl, which is mixed into other street drugs, such as cocaine.
“It’s much more potent than cocaine or heroin,” Gilles notes. “You have people who may be getting drugs off the street and may be buying a pill to help them sleep, and it has fentanyl in it, which can cause them to overdose.”
Fentanyl contains 50 to 100 times the strength of morphine and 30 to 50 times the strength of heroin. If someone takes fentanyl — knowingly or not — and uses it with alcohol or other medications, they are increasing the risk of an overdose.
“Your body is not getting enough oxygen, and this can happen in a matter of minutes,” Gilles says. “We teach people to recognize the signs and symptoms of what an overdose may be, and we give them a naloxone kit to keep in their car or at home.” If someone administers naloxone to someone who is not overdosing, the medication will not harm them, she adds.
Hospitals can help prevent overdoses through simple community outreach measures, such as opioid overdose education. They can distribute plastic cards with important information about overdoses, and they can provide training on a mannequin for using naloxone, spraying it in the nostrils.
“Usually when someone is overdosing, it’s likely they are not breathing, so you can give them this nasal spray because it will absorb the medication,” Gilles adds.
Case managers and nurses can teach postoperative and chronic pain patients how to prevent an overdose and what to do if one occurs. “You can prescribe them naloxone and teach them how to use it in the event something happens,” Gilles says. “Case managers can send people home with a naloxone kit if they get an opioid prescription.”
Some of these steps could become commonplace, but the stigma of opioid abuse is a barrier. “Providers may be cautious about asking about naloxone, or they may be cautious about offering it to patients,” Gilles says. “It should be more common, and it’s up to us to do this education.”
At New York University, educators presented an interprofessional simulation of an opioid overdose. Nursing students had to care for a patient at risk for opioid overdose and misuse. “Any education of healthcare professionals is something we need to put in our curriculum because this is a public health emergency,” Gilles says.
Federal agencies have developed harm reduction tactics and have encouraged state, local, and tribal governments to build capacity to deal with the epidemic.
These prevention actions are necessary:
- Educating providers and the healthcare system;
- Partnering with public safety, teaching law enforcement and fire departments how to prevent overdoses;
- Empowering people who use substances to make safe choices, such as needle exchange programs and staying in safe opioid consumption sites;
- Teaching staff how to prevent overdose.
“Everyone plays a part here,” Gilles says.
REFERENCES
- Gilles S. Opioid overdose harm prevention: The role of the nurse in patient education. Nurs Clin North Am 2022;57:477-488.
- Harocopos A, Gibson BE, Saha N, et al. First 2 months of operation at first publicly recognized overdose prevention centers in US. JAMA Netw Open 2022;5:e2222149.
- New York State Department of Health. New York State’s Opioid Overdose Prevention Program. Revised November 2022.
While the world focused on the COVID-19 pandemic, another crisis — the opioid epidemic — continued to unfold, taking hundreds of thousands of lives. Hospital discharge is an opportunity for case managers and other providers to help prevent patients from becoming victims of opioid overdoses.
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