University Report: Opioid Abuse in Healthcare - Analysis

This report comprehensively addresses the issue of opioid abuse in healthcare within the United States. It begins by outlining the scope of the opioid crisis, including the alarming statistics on overdose deaths and the economic burden associated with misuse. The report then explores the significance of opioid abuse, its impact on public health, and current healthcare practices implemented to combat the crisis, such as prescription drug monitoring programs and medication-assisted treatment. A thorough literature review is conducted, analyzing research articles and non-research articles related to opioid abuse, and a PICO question is formulated to guide the analysis. The report proposes a recommended practice change, advocating for increased education on opioids to reduce abuse, along with a detailed implementation process involving physicians, nurses, and specialized clinics. The report also identifies potential barriers and strategies to overcome them. Finally, the report includes an evidence matrix summarizing the reviewed literature and concludes with an overview of the opioid abuse crisis.

Running Head: OPIOID ABUSE IN HEALTHCARE
OPIOID ABUSE IN HEALTHCARE
Name of the student
Name of the University
Author Note

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OPIOID ABUSE IN HEALTHCARE
Table of Contents
Opioid abuse in the US..............................................................................................................3
Significance of opioid abuse......................................................................................................3
Current healthcare practices.......................................................................................................4
Impact of opioid abuse...............................................................................................................4
Literature review........................................................................................................................5
Research article 1...................................................................................................................6
Improving Patient Knowledge and Safe Use of Opioids: A Randomized Controlled Trial
............................................................................................................................................6
Research article 2...................................................................................................................6
Prescription opioid use, misuse, and use disorders in US adults: 2015 National Survey
on Drug Use and Health.....................................................................................................6
Non-research article 1............................................................................................................7
Preventing an Opioid Overdose.........................................................................................7
Non-research article 2............................................................................................................7
The Opioid Epidemic and Its Impact on the Health Care System.....................................7
PICO question............................................................................................................................7
Recommended practice change..................................................................................................7
The process to implement the practice change..........................................................................8
Evidence Matrix.........................................................................................................................9
Authors.......................................................................................................................................9
Journal Name.............................................................................................................................9

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Year of Publication....................................................................................................................9
Research Design.........................................................................................................................9
Sample Size................................................................................................................................9
Outcome/Variables Measured....................................................................................................9
Quality (A, B, C)........................................................................................................................9
Results/Author’s Suggested Conclusions..................................................................................9
Bibliography.............................................................................................................................12

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OPIOID ABUSE IN HEALTHCARE
Opioid abuse in the US.
Data from 2018 shows that about 128 people in the United States die from opioids
overdose every day. Opioid abuse and addiction, including prescription pain relievers, heroin,
and synthetic opioids such as fentanyl, is a severe national crisis that adversely impacts on the
social, and economic wellbeing as well as the public health. According to the Centers for
Disease Control and Prevention (CDC), the total “economic burden” of prescription opioid
misuse in the US is estimated at $78.5 billion per annum, which encompasses the healthcare
costs, productivity loss, treatment for addiction, and criminal justice association. During the
late 90s, pharmacological companies convinced the medical community that prescribing
opioid medication will not lead to any addiction crisis, and hence healthcare professionals
started to prescribe opioids tremendously as a common pain reliever. This afterwards headed
to the rampant misuse of these prescriptions far before their adverse effects were even
identified, which significantly contributed to the rise in opioid overdose rates. Data from
2017 suggests that more than 47,000 Americans were deceased due to an opioid overdose. In
the same year, about 1.7 million people were estimated to be the victims of substance use
disorders connected to prescription opioids in the US.
Significance of opioid abuse
The growing abuse of prescription opioids has led to a severe public health concern
with shocking consequences such as increased rates of opioid exploitation and associated
overdoses, as well as the intensifying prevalence of neonatal abstinence syndrome caused by
opioid abuse in pregnancy. Frequent injection drug use has also added to the spread of
damaging infectious diseases such as HIV and hepatitis C, significantly. Throughout the
history of medicine, it has been observed that scientific approaches are a critical part of
solving a public health crisis of this severity (Kolodny et al., 2015).

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OPIOID ABUSE IN HEALTHCARE
Current healthcare practices
In an attempt to tackle the opioid epidemic in the US, the following practices are
currently implemented through different modes:
 Prescription Drug Monitoring Programs (PDMPs)
 Including naloxone in the drug overdose toolkit
 Medication-Assisted Treatment (MAT) combined with behavioural therapy
The National Institutes of Health (NIH) is an initiative of HHS, which is working as the
nation’s prominent medical research organization towards resolving the opioid crisis through
the discovery of novel and enhanced ways to avert opioid misuse, treat disorders associated
with opioid use, and relieve pain. NIH has collectively taken action with pharmaceuticals and
academic research centres to initiate discussions and establish plans through which reliable,
active, and non-addictive pain management strategies can be facilitated. The need for
innovative medicinal therapies and cutting-edge technologies in the treatment of opioid use
disorders has been identified in this collaboration. HEAL (Helping to End Addiction Long-
term) Initiative has also been launched as a rigorous trans agency effort to amplify the
implementations and actions regarding mitigation of the nationwide opioid crisis.
Impact of opioid abuse
The growing burden of opioid abuse has created a devastating impact on the nation’s
overall public wellbeing. Consequences of the widespread opioid misuse consist of higher
incidences of opioid overdoses, and an exponential rise in the occurrence of newborn
withdrawal syndrome as a result of opioid abuse during pregnancy (Compton, Boyle &
Wargo, 2015). The misuse of prescription opioids not only affects the user but also causes
harm to those nearby. For example, when a pregnant woman continues to use opioids
throughout her pregnancy, there can be adverse effects on the unborn child. Women who are

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addicted to such medications also tend to sacrifice required prenatal care due to the
possibility of their practitioner to realize their opioid addiction. Abuse of opioids also leads to
several nutritional neglects, which could potentially upset the fetus development. Parents who
are suffering from such substance abuse disorder habitually ignore their child’s health
necessities and foregoes their health deterioration concerns. Opioid misuse and addiction also
have a detrimental impact on the communities across the US by disrupting their societal
status, health, and wellbeing as well as economic welfare. The influence of this crisis on the
medical community is intense. As a result of the impending burden of the deaths and
rehabilitation for overdose and addiction, emergency system resources, which are already
taxing and on the edge of overloading, become further drained. Subsequently, without
responding to other crucial situations such as heart attacks, or strokes, first responders have to
tend to the overdose cases by stabilizing them and admitting them in the hospitals, which
occupies their time. This emptying out of resources eventually results in worrying outcomes
such as greater insurance costs to compensate for the limitations in medical resources.
Literature review
A search of the literature was conducted to identify the recent problems regarding
opioid abuse, and its associated impact and factors. The search strategy included the use of
Boolean operators to enhance search results. Keywords used for the search were opioid
abuse, the opioid epidemic in the US, chronic pain, and opioid addiction. The literature
review was done via google scholar and PubMed databases, where the inclusion criterion for
the articles was ‘not more than five years old’.

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OPIOID ABUSE IN HEALTHCARE
Research article 1
Improving Patient Knowledge and Safe Use of Opioids: A Randomized Controlled Trial
In a research article, the prevalence of discharge education regarding the safe use of
prescription opioids was studied through a randomized controlled trial. The effect of written
and spoken health literacy program on the discharged patients knowledge level was
evaluated. Educational strategies relevant to improve their knowledge were discussed. With
the help of the strategy developed in this research, appropriate interventions to address the
issues were successful in the case of a few patient aspects (McCarthy et al., 2015).
Research article 2
Prescription opioid use, misuse, and use disorders in US adults: 2015 National Survey on
Drug Use and Health
In another research article, results and findings of the “2015 National Survey on Drug
Use and Health” were discussed. This survey was conducted to evaluate the prevalence of
abuse of prescription opioids, opioid use disorders, and motivating factors for misuse within
US adults. Through this survey, it was established that the most regularly reported factor
(around 64.3%) for misuse was to get rid of physical pain. Disorders related to opioid abuse
were abundant in uninsured adults, especially in unemployed, low-income groups, or those
who had a behavioural health issue. These findings indicated the need for implementing
improved evidence based management of chronic pain disorders and adopting alternative
therapeutic tools in place of opioids (Han et al., 2017).

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Two non-research articles were also reviewed in the literature search:
Non-research article 1
Preventing an Opioid Overdose
An article issued by the centres for disease control and prevention (US) outlines the
basic guidelines related to opioid abuse or overuse and the indications necessary to identify
them (Cdc.gov, n.d.).
Non-research article 2
The Opioid Epidemic and Its Impact on the Health Care System
Another article illustrates the severe impact of opioid misuse on the healthcare
systems in the US. It describes the financial burden caused by this epidemic and lays down
strategies to be adopted by hospitals and institutes to approach this crisis effectively (Kasarla,
2017).
PICO question
From the literature review, a PICO question was developed- ‘Among patients, does
education on opioids lower the problem of opioid abuse as compared to no education?’
 Patient/population- Chronic pain patients, opioid addicts
 Intervention- strategies that can be implemented to increase the efficacy of education
and treatments to reduce the abuse of prescribed opioid use
 Comparison- with those who have not received education on opioid lowering
 Outcomes- in terms of function, quality of life, therapy efficacy
Recommended practice change
The five research articles support that opioid education lowers opioid abuse. An
effective way to decrease the burden of opioid abuse and addiction is to decrease the use of

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prescribed opioids gradually by imparting knowledge to the practising physicians who are the
prescribers and making them aware of the proliferation of non-opioid analgesics usage in the
management of chronic pain disorders. Education and adequate training regarding the
reduction strategies of routine opioid medications must be facilitated to the practitioners to
provide them sound knowledge about the crisis build-up, correlated risks, and encouraging
them about the substitute therapies available (Davis & Carr, 2016). Implementing an
educational strategy on the patients who are users of prescription opioids, a change can be
initiated in the safe practice of opioids. By using health literacy programs on patients who are
discharged from hospitals with opioids prescribed to them, an improvement can be obtained
through enhancing their knowledge (McCarthy et al., 2015). Methadone maintenance
treatment (MMT) is an effective therapeutic strategy through which opioid substitution
treatment can be achieved. Due to lack of awareness and prevalence of stigma regarding the
efficacy of MMT, many patients are reluctant to undergo this therapy. Hence, increasing their
education about MMT to reduce stigma around it is a necessary step (Woo et al., 2017). A
substantial way to optimize the addiction care in hospitalized in-patients is to link them with
additional outpatient addiction diagnostic centres post-discharge which ensures that they are
complying to the treatment procedures via assistance from caregivers (Trowbridge et al.,
2017). Combining medication-assisted treatments for opioid addiction disorders with
cognitive behavioural therapy and psychosocial support to the patients is a significant method
in improving their quality of life and higher the treatment efficacy (Dugosh et al., 2016).
The process to implement the practice change
Three critical stakeholders in the implementation of the practice change are
physicians, nurses, and specialized clinics working collectively with hospitals. Their
involvement is required to adopt strategies that could alleviate the risks linked with the
routine use of opioids in prescriptions. The physicians are directly responsible for reducing

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the usage of opioids in hospital settings for patients requiring pain management and assessing
the feasibility of administering other viable therapies. At the same time, nurses are the
medium through which the delivery of non-opioid analgesics can be ensured. Nurses can also
communicate with the patient and their families in order to make them understand the
approach being taken and educate them on the relevant health outcomes. Patients who are
habitual users of opioids frequently face withdrawal symptoms, and they are referred to the
specialized clinics for behavioural counselling, providing support to the patient’s family, and
rehabilitation for opioid addiction. Two barriers that the nurses may face are resistance from
patients and their families and unavailability of necessary training related to non-opioid
treatments. Strategies to mitigate such limitations may be the arrangement of nursing training
workshops and guide patients and their families on the adverse effects of prolonged use of
opioids and increasing their awareness of the possible alternative managements. One
indicator that can measure the outcome of administering non-opioid can be reduced addiction
and dependence on opioid drugs and improved quality of life.
Evidence Matrix
Author
s
Journal
Name
Year
of
Public
ation
Research
Design
Sample Size
Outcome/Variables
Measured
Quality
(A, B,
C)
Results/Author’s
Suggested
Conclusions
Corey S.
Davis and
Derek Carr
Drug and
alcohol
dependence 2016
Systematic
review
all laws in 50 states in the
US
characteristics of continuing
medical education regulations A
presently physicians receive
minimal education on chronic
pain management, which should
be highlighted and addressed by
governing bodies

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OPIOID ABUSE IN HEALTHCARE
P.
Trowbridg
e, Z.M.
Weinstein,
T.
Kerensky,
P. Roy, D.
Regan, J.
H. Samet,
& A. Y.
Walley
Journal of
substance
abuse
treatment
2017
Original
research
337 consultations
Impact of linking in-patient
addiction care with post-discharge
additional addiction care
B
Such linkage can be leveraged
as a significant treatment
method
Dugosh,
K.,
Abraham,
A.,
Seymour,
B.,
McLoyd,
K., Chalk,
M., &
Festinger,
D.
Journal of
addiction
medicine
2016
Systematic
review
27 articles
Prevalence of the psychosocial
interventions in medication
treatment of opioid disorders
A
Further research is required to
identify the specific
interventions that provide the
best results when combined
with medication therapy
Danielle
M.
McCarthy,
Michael S.
Wolf,
Ryan
McConnell
, Jill Sears,
Allison
Chevrier,
Eric
Ahlstrom,
Kirsten G.
Engel,
Kenzie A.
Cameron,
James G.
Adams, &
D. Mark
Courtney
Academic
emergency
medicine
2015
Prospective
randomized
control trial
274 patients
Effect of a dual-mode educational
program on patient knowledge
A
The strategy enhanced several
aspects of the patients and made
them abstain from driving while
on opioid medication.
Woo,
Julia,
Anuja
Bhalerao,
Monica
Substance
abuse:
research and
2017 Qualitative
research
18 participants To evaluate the current
perspective of patients of MMT
and the stigma around this
B Stigma is a significant concern
existing in MMT patients,
which affects their quality of
life and recovery process.
Continuing education and

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OPIOID ABUSE IN HEALTHCARE
Bawor,
Meha
Bhatt,
Brittany
Dennis,
Natalia
Mouravska
, Laura
Zielinski,
& Zainab
Samaan
treatment
treatment
awareness drives are essential
to reduce stigma.
Full links of the articles in evidence matrix-
1. http://stoprxabuseinga.org/wp-content/uploads/2016/06/Physician-continuing-
education-to-reduce-opiod-misuse-abuse-and-overdose-05-2016.pdf
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795974/
3. https://onlinelibrary.wiley.com/doi/pdf/10.1111/acem.12600
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035788/
5. https://journals.sagepub.com/doi/pdf/10.1177/1178221816685087

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OPIOID ABUSE IN HEALTHCARE
Bibliography
Cdc.gov. Retrieved 5 April 2020, from
https://www.cdc.gov/drugoverdose/pdf/patients/Preventing-an-Opioid-Overdose-Tip-
Card-a.pdf
Compton, W. M., Boyle, M., & Wargo, E. (2015). Prescription opioid abuse: problems and
responses. Preventive medicine, 80, 5-9.
Davis, C. S., & Carr, D. (2016). Physician continuing education to reduce opioid misuse,
abuse, and overdose: Many opportunities, few requirements. Drug and alcohol
dependence, 163, 100-107.
Dugosh, K., Abraham, A., Seymour, B., McLoyd, K., Chalk, M., & Festinger, D. (2016). A
systematic review on the use of psychosocial interventions in conjunction with
medications for the treatment of opioid addiction. Journal of addiction medicine,
10(2), 91.
Han, B., Compton, W. M., Blanco, C., Crane, E., Lee, J., & Jones, C. M. (2017). Prescription
opioid use, misuse, and use disorders in US adults: 2015 National Survey on Drug
Use and Health. Annals of internal medicine, 167(5), 293-301.
Kasarla, M. (2017). The Opioid Epidemic and Its Impact on the Health Care System. The
Hospitalist, 24.
Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., &
Alexander, G. C. (2015). The prescription opioid and heroin crisis: a public health
approach to an epidemic of addiction. Annual review of public health, 36, 559-574.

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OPIOID ABUSE IN HEALTHCARE
McCarthy, D. M., Wolf, M. S., McConnell, R., Sears, J., Chevrier, A., Ahlstrom, E., ... &
Mark Courtney, D. (2015). Improving patient knowledge and safe use of opioids: a
randomized controlled trial. Academic emergency medicine, 22(3), 331-339.
Trowbridge, P., Weinstein, Z. M., Kerensky, T., Roy, P., Regan, D., Samet, J. H., & Walley,
A. Y. (2017). Addiction consultation services–Linking hospitalized patients to
outpatient addiction treatment. Journal of substance abuse treatment, 79, 1-5.
Volkow, N. D., & McLellan, A. T. (2016). Opioid Abuse in Chronic Pain—Misconceptions
and Mitigation Strategies. N Engl J Med, 374, 1253-63.
Woo, J., Bhalerao, A., Bawor, M., Bhatt, M., Dennis, B., Mouravska, N., ... & Samaan, Z.
(2017). “Don’t judge a book by its cover”: a qualitative study of methadone patients’
experiences of stigma. Substance abuse: research and treatment, 11,
1178221816685087.