First, Do No Harm: Marshaling Clinician Leadership to Counter the Opioid Epidemic (2017)
Chapter: What Are Primary Clinician Opportunities to Counter the Opioid Epidemic and Its Consequences?
| Mention nonpharmacologic options | ++ | ++ | ++ | ++ | ++ | |
| RECOMMENDATIONS ON TREATMENT OF OPIOID USE DISORDER | ||||||
| Use of medications | ++ | + | ++ | + | ++ | |
| Referral to specialty care | + | + | ++ | |||
| EDUCATION RECOMMENDATIONS | ||||||
| Improve prescriber education | ++ | ++ | ++ | ++ | ++ | ++ |
| Improve patient education | ++ | ++ | ++ | ++ | ++ | |
SOURCES: a = AMA, 2017; b = AAMC, 2017; c = FSMB, 2017; d = Dowell et al., 2016; e = FDA, 2017a; f = VA/DoD, 2017.
NOTES: ++ = yes or recommended; + = positive; +/- = equivocal; - = evidence lacking.
WHAT ARE PRIMARY CLINICIAN OPPORTUNITIES TO COUNTER THE EPIDEMIC AND ITS CONSEQUENCES?
Just as primum non nocere is the foundation for clinician action, it primarily serves as obligatory prelude to the primary duty, deinde benefacere (then, do some good). The opportunities are abundant. Approximately 5 million clinicians are actively delivering patient care in communities throughout the nation. The largest group is nurses, and the most referenced in the context of clinician engagement in pain management are physicians (there are 950,000 licensed physicians) and nurse practitioners (about 220,000). But the pool of skilled and dedicated health professionals providing capacity and leadership to health initiatives in pain management and opioid crisis mitigation also includes dentists, psychologists, pharmacists, physician assistants, registered nurses, physical therapists, podiatrists, occupational therapists, dental hygienists, paramedical assistants, emergency medical technicians, and social workers, as well as others who assist them.
All are important to successfully countering the opioid epidemic, whether through caring for persons prescribed opioid medications, providing assistance to those who need it, or rallying community action. In carrying out their respective daily roles, as well as through their community activities, each clinician—and their other colleagues in the health professions—has access to numerous frontline and supportive opportunities to help turn the tide, including:
- Using a team-based approach to care, especially important in substance use disorders
- Emphasizing that substance use disorders are treatable chronic neurologic conditions, requiring the sustained, multifaceted approach typical of managing any chronic disease
- Precautionary prescribing that accounts for individual risk factors and social circumstances
- Counseling of patients and caregivers regarding secure storage and proper disposal of unused opioids
- Prescription Drug Monitoring Program (PDMP) cross-checking to identify unsafe drug use behaviors
- Systematic followup by the care team for signs of opioid misuse or opioid use disorder
- Co-prescribing naloxone to patients at risk of overdose
- Facilitating use of medication (e.g., buprenorphine/naloxone), as indicated, for opioid use disorder, including obtaining training and authority for MAT
- Referral for treatment assistance, as indicated, including follow-up with the referral team
- Community engagement to promote the availability of necessary substance use disorder treatment resources
Optimal management of opioid use disorder is facilitated through effective coordination as a team. Although the role of individual team members will vary, each clinician involved in the care of people who are prescribed opioids bears responsibility to ensure optimal pain management and safety of their patients. Similarly, they have an opportunity to promote awareness and stewardship in the performance of each component of the system.
