Part I
Your patient comes into the office one week after surgery. He complains that he is not sleeping well due to pain from the surgery. When you ask what he is taking for the pain, he explains that when he went to get his prescriptions filled the pharmacist told him the drugs were opiates. He has heard about opiates on the news. He did not get the prescriptions filled because he did not want to get “hooked” on anything. This patient has no history of substance abuse.
What do you say to this patient?
What do you recommend that your patient do for his pain?
Part II
Another patient who is also post-op comes to your office with his meds. The surgeon prescribed Norco for the post-op pain. This patient explains that his stepson has a substance abuse problem. While taking the drugs for pain, the medication bottle was stored in a safe spot within his and his wife’s bedroom. Now that he has no need for the drugs, he wants you to take them because he does not want them in his house.
Are you allowed to take the drugs from the patient?
What is National Take Back Day?
What should the patient do with the drugs?
Part III
Many states are implementing programs and laws to attempt to control the opioid epidemic. Washington state, for example, has adopted laws to govern the opioid-prescribing habits of practitioners. (The laws that apply to nurse practitioners are WAC 246-840-460 to WAC 246-840-493. You can Google them if you are interested.)
One Washington state law offers nurse practitioners specific instructions for evaluating patients. Read this Washington State law and answer the following questions:
ou know how to approach a patient with chronic pain. Does the information in this law add to your knowledge?
In your opinion, should the government dictate how health care professionals practice?
Do you believe that laws such as this will have an impact on the opioid epidemic?
What are the consequences of the laws in Washington state concerning health care providers?
What are the consequences of the laws in Washington state concerning patients with chronic pain?
Sample Answer
Part I
Response to the Patient
I would make it clear to the patient that they are misinformed about the risk of addiction to opiates. The decision not to take their prescription is based on knowledge about the risk factors for addiction to opioid prescription. I would make it known to the patient that the prescription was issued by their care provider after they had made a safety analysis that involves identifying whether the patient has a likelihood of being addicted. Major risk factors for getting addicted to the prescription are a history of patient substance abuse and being diagnosed with mental health disorder (Klimas et al., 2019). The patient needs to understand that a healthcare provider has the responsibility of ensuring a safe prescription. I would let the patient know that they do not have the risk of getting addicted to opiates. I would also educate the patient on how the period of prescription increases the risk of addiction. The patient does not have the risk associated with the management of chronic pain, which increases the risk as patients with long-term use of opiates have a risk of developing tolerance to the drugs. They should therefore have nothing to worry about.
Recommendation to the Patient
First, I would let the patient know the importance of managing pain after surgery at it keeps the patient comfortable and increases the speed of recovery. The patient has a lower risk of developing complications associated with surgeries when they are able to manage pain. I would recommend the patient to get their prescription to facilitate their recovery. If the patient seems uncomfortable, I would recommend alternative medications to manage their pain. Such alternatives include Motrin, Tylenol, or Bayer. I would, however, emphasize the importance and effectiveness of the opiate’s prescription. And lack of risk factors for addiction.
Part II
Are You Allowed to take Drugs from a Patient?
As a healthcare professional am not allowed to take drugs from a patient unless the healthcare facility has a policy for drug take-back that allows the professionals to take drugs returned by patients. If the facility lacks the policy, I can only provide guidance to the patient on what to do with the unused drugs.
What is National Take Back Day
National Take-Back Day is an event held by the U.S. Drug Enforcement Administration where individuals can freely dispose of prescriptions with no questions asked, including opioids. The DEA sets up collection sites at various settings, including hospitals, retails, law enforcement facilities, or clinic pharmacies. Take-back days occur every April and October. This effort aims at promoting the disposal of unwanted and expired drugs to reduce intentional and accidental overdose.
What the Patient Should Do with the Drug
If the drug is on the FDA Flush List, the patient can flush the prescription down the toilet. If the prescription is not on the list, they can drop it off at any drug take-back location if they are available. Given that the patient has a risk of his stepson abusing the prescription, it would not be advisable for them to keep the prescription and wait for the Take Back Day and should follow instructions for disposing of the medicine in the trash and home.
Part III
You Know How to Approach a Patient with Chronic Pain. Does the Information in the Law Add to Knowledge?
The information adds to knowledge, especially in areas such as undertreatment and in the continuation of ineffective treatment. The other area is the exception for end-of-life care and cancer-related pain.
Whether The Government Should Dictate How Health Care Professionals Practice
I believe that it is important that the government should have laws and policies to monitor professional practice to increase accountability and increase safe prescription. According to Phillips et al. (2017), a leaky prescription drug system increases the risk of addiction. The opioid crisis in the country has been linked to prescription patterns that resulted from a lack of monitoring and regulation. The government, however, should involve health care professionals to minimize unfavorable laws and policies limiting the practice.
Whether the Laws such the Washington Law will have an Impact on Opioid Epidemic
Lawson prescriptions will have an impact on the opioid epidemic, although it may not fully solve the problem. Based on the evidence, the prevalence of OUD associated with prescription is estimated to be less than 3% (Nadeau, Wu, & Lawhern, 2021). Other factors such as social, economic, and psychological factors are involved and play a significant role. Prescriptions only reduce the risk factors, especially for patients who are already exposed to substance abuse.
Consequences of the Laws in Washington State Concerning Health Care Providers
Healthcare providers need to formalize and upgrade their knowledge of all existing regulations to ensure that they do not face legal consequences. Legal consequences for the providers include malpractice liability, criminal conviction, and medical board disciplinary actions. Licenses may also be revoked.
Consequences of the Laws in Washington State Concerning Patients with Chronic Pain
Patients with chronic pain may benefit from improved care. The law highlights what constitutes inappropriate care. The law champions the application of up-to-date treatment modalities and knowledge to improve the quality of life for the patients and reduce mortality and morbidity (Washington State Legislature, n.d).
