Opioid Epidemic

1. The Impact of the Clinical Practice Problem on the Patients and the Organization

            Opioid remains the first-line treatment for adults’ post-surgical pain management. As the prevalence of chronic pain increases, marked by the escalating health care costs, an opioid prevalent with adverse effects has rocketed. However, in the midst of all these, the U.S. is faced with an opioid crisis. The rate of opioid overdose in the country has tripled since 1999 (Hedberg et al., 2019). The most regularly prescribed opioids, such as hydrocodone and oxycodone, also constitute the most common opioids causing overdose deaths. In 2019 alone, about 50,000 people in the U.S. died from opioid-related overdoses, including prescription pain relievers and synthetic opioids such as fentanyl. The Centers for Disease Control and Prevention estimates that prescription opioid misuse costs the U.S. about $78.5 billion annually (Alho et al., 2020).

Experts are arguing for alternative treatments, including psychotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), and acupuncture for adults’ post-surgical noncancerous pain management compared to opioids, to reduce pain and the prevalence of opioid dependence and the associated overdoses, which is a leading cause of deaths in the U.S. Evidence suggests that patients under long-term opioid use are at high risk of developing opioid overdose and opioid use disorder, and several other adverse outcomes such as cardiovascular events (Phillips, Ford, & Bonnie, 2017). Physicians continue to prescribe opioids for chronic non-cancer pain management, sometimes in high doses, due to the incorrect belief that the risk of developing addiction and opioid use disorder is low.

1. PICO Components
2. Patient/Population/Problem (P): Post-surgical adult patients with chronic non-cancer pain
3. Intervention (I): Alternative treatments, including psychotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), and acupuncture
4. Comparison (C): Opiate treatment
5. Outcome (O): Reduced pain and the prevalence of opioid dependence and the associated overdoses.
6. Evidence-based question

Post-surgical adult patients with chronic non-cancer pain are alternative treatments, including psychotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), and acupuncture, compared to an opiate, effective in reducing pain and the prevalence of opioid dependence and the associated overdoses?

• A Research-Based Article That Answers EBP Question From Part A2

Research-based article: “Phillips, J. K., Ford, M. A., & Bonnie, R. J. (2017). Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. National Academies Press (U.S.), Washington (D.C.). DOI: 10.17226/24781.”

1. Background of the Article

Phillips, Ford, and Bonnie (2017), in their article, explore ways the healthcare systems can adopt to balance the benefits and risks of opioid prescription. According to the authors, drug overdose in the U.S. is exacerbated primarily by overdoses linked to opioids and is currently the prominent cause of unintentional injury death. The prevailing opioid epidemic in the U.S. falls at the intersection of two public health problems: minimizing the burden of suffering from chronic pain and managing the increasing toll of adverse health effects from prescription opioids (Phillips, Ford, & Bonnie, 2017). Chronic pain and opioid overdose, and opioid use disorders are complex problems that impact millions of Americans, resulting in untold disabilities and even death.

The article state that the real challenges of under-treatment and underdiagnosis of pain are a valid concern in most healthcare systems. However, it would be a mistake to suppose the greater use of opioids would ameliorate these glitches. Opioids have long been used for post-surgical and post-procedural pain management (Phillips, Ford, & Bonnie, 2017). However, available research evidence refutes the long-term utilization of opioids for managing chronic non-cancer pains. Alternative treatments, including psychotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), and acupuncture, are suggested for chronic pain management to reduce the prevalence of prescription opioid overdose and related deaths in the United States.

Psychotherapy, including cognitive-behavioral therapy (CBT), has shown effectiveness in managing pain independently or combined with medication methods. CBT uses a bio-psychosocial approach in managing chronic pain, targeting maladaptive cognitive and behavioral reactions to pain and the environmental and social contingencies that modify the responses to pain. Besides, NSAIDs such as naproxen, celecoxib are also used to treat pain. The NSAIDs treat both inflammation and pain. Inflammation is the primary contributing factor for neck and back pain, so eliminating inflammation helps alleviate pain. However, as with other medications, NSAIDs also have side effects, and their effectiveness reduces for the patients who take them continuously for several weeks or months (Phillips, Ford, & Bonnie, 2017). Acupuncture has also become a common treatment method for pain, and its efficacy in chronic pain management generates a mixed outcome accordion to systematic reviews (Kaye et al. 2018). Some study finds acupuncture superior while others find it less effective.

• Research Methodology

The article adopted a systematic review of alternative treatments literature for post-surgical pain, concentrating primarily on psychotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), and acupuncture. The researchers adopted data from the most recent literature on the effects of long-term opioids for chronic pain management, and available alternative pain treatment methods were explored.

• Level Of Evidence Using JHNEBP Model

The level of evidence falls under Level III of the JHNEBP model. It entails a systematic review of randomized control trials long with non-experimental and quasi-experimental studies with meta-analysis.

• How The Researcher Analyzed The Data In The Article

The research method comprises of systematic and meta-analysis, which begins by formulating study questions. The researchers then collect and summarize empirical evidence that answers the research question. Statistical methods, which include the use of SPSS, were adopted to summarize the studies’ results.

• Ethical Considerations Of The Research-Based Article

No ethical consideration. The research is primarily based on a systematic review of published studies. Systemic reviews rely on or collect sensitive, personal, or confidential information from the research subject, requiring protection. Systematic review relies on publicly accessible publications as evidence, and the researchers are seldom needed to seek institutional ethics approval to conduct the study.

• The quality rating of the article: High Quality

• Conclusions Of The Research-Based Article

The authors deduce that psychotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), and acupuncture embody a potent alternative treatment for chronic pain and can help to reduce opioid dependence and related overdose, which is a common problem in the U.S. While non-opioid alternative treatments for chronic pain have their risks and indications, some can be as effective as an opioid in reducing pain when used appropriately, and should be considered.

• A Non-Research Article From A Peer-Reviewed Journal That Helps To EBP Question From Part A2
• Background of the Article

Wolters Kluwer Health (2018) explores the need to replace prescription opioids with exercise and other alternative therapies, including yoga, stress reduction, laughter, and even spiritual pain management activities. The article asserts that despite the increasing awareness of the risk of opioids in managing low back and various other forms of pain, the prescription opioid overtreatment epidemic is still rampant in the U.S. and seems to spread overseas. However, there is still no global consensus or standards on stopping the wave of opioid overuse and related deaths. Study shows that approximately, a third of the American population lives with chronic pain, and the majority rely on a prescription opioid for treatment. But there is an increasing consensus among pain experts that low-tech approaches focused on lifestyle changes, including regular exercise, yoga activities, stress reduction therapies, and other non-pharmacological methods, can be as effective as an opioid in pain management applied appropriately (Kluwer Health 2018). These treatment approaches can be more expensive and less convenient compared to a bottle of opioid pills. Nevertheless, pain experts maintain that they save money in the long-run, help patients get off opioid addiction, and improve their quality of life in general (Carroll, Green, & Noonan, 2019).

• Type Of Evidence

The article draws evidence from clinical practice guidelines on alternative safer non-opioid treatment methods for chronic pain. The report includes recommendations intended to improve patient care, in this case, recommending safer non-opioid treatment for chronic pain, informed by systematic reviews of evidence and evaluation of harms and benefits of both opioid and other alternative treatment methods. This article’s type of evidence to fall under clinical practice guideline.

• Level of evidence using the JHNEBP model: Level I. Level of evidence grounded on clinical practice guidelines based on a systematic review of randomized controlled trials of good quality.
• Quality Rating Of The Non-Research-Based Article Based On JHNEBP model: High Quality
• Author’s Recommendations

The author recommends implementing opioid prescribing guidelines, ensuring that physicians only prescribe an opioid to correct indications in limited doses, where non-opioid treatment is not practical, and advise the patients on safer prescription use. Such practice could help minimize opioid misuse and overdose and related deaths. Most importantly, the authors argue for non-opioid treatment options, particularly non-pharmacological therapies such as regular exercise, yoga, and stress reduction techniques for chronic pain (Kluwer Health 2018). These alternative options may be expensive and less convenient than a bottle of opiate pills but can significantly save money in the long-run, helping reduce the rising opioid overdoes and related deaths.

• A Practice Change That Addresses EBP Question

Addressing the opioid crisis in the United States requires a focus on improving patient safety and care and enhancing the population health by emphasizing the following areas: a) Aligning and improving financing incentives to ensure improved access to evidence-based opioid use disorder treatment. Reinforcing Medicaid and expanding the cover to adults in non-expansion states is essential in addressing the opioid epidemic; b) improving accessing to non-opioid therapy; c) protecting the society by reducing the number of opioid pills in circulation or accessible through prescription guidelines and safe storage; d) using data to inform policy evaluation to optimize outcomes (Hedberg et al. 2019). If effectively implemented, these approaches can reduce opioid overdoes and related adverse effects, including deaths.

1. Involve Three Key Stakeholders In Supporting The Practice Change

Key stakeholders include healthcare providers, government, and the public. Formulating and circulating recommended practice guidelines to concerned government institutions and healthcare facilities and discussing the recommended practice change with relevant personnel in those institutions is one way of engaging stakeholders in the two levels. As for the public, it is essential to distribute leaflets for practice guidelines to people who visit healthcare facilities. Educating people on the adverse effects of opioid overdose through widely accessed communication broadcasts such as T.V. and social media is also essential.

• Barrier In Implementing The Practice

The high cost of health care: High cost is a barrier, making it a challenge for the wider population to access quality care, including evidence-based opioid prescription as recommended.

• One Strategy To Overcome The Barrier

The best approach to overcome such barriers as the high cost of care is to lobby for healthcare policymakers’ support, including legislatures to support the recommendations. 

• One Outcome To Measure Recommended Change

A reduction in prescription opioid overdose and related deaths among the targeted population by 40% in one year will suggest the recommendations’ effectiveness.

References

Alho, H., Dematteis, M., Lembo, D., Maremmani, I., Roncero, C., & Somaini, L. (2020). Opioid-related deaths in Europe: strategies for a comprehensive approach to address a major public health concern. International Journal of Drug Policy, 76, 102616.

Carroll, J., Green, T., & Noonan, R. (2019). Evidence-based strategies for preventing opioid overdose: what’s working in the United States? Washington, DC: Centers for Disease Control and Prevention National Center for Injury Prevention and Control; 2018.

Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., & Woolf, A. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 391(10137), 2368-2383.

Hedberg, K., Bui, L. T., Livingston, C., Shields, L. M., & Van Otterloo, J. (2019). Integrating public health and health care strategies to address the opioid epidemic: the Oregon Health Authority’s Opioid Initiative. Journal of Public Health Management and Practice, 25(3), 214-220.

Kaye, A. D., Cornett, E. M., Hart, B., Patil, S., Pham, A., Spalitta, M., & Mancuso, K. F. (2018). Novel pharmacological nonopioid therapies in chronic pain. Current pain and headache reports. Springer, 22(4), 1-14.

Phillips, J. K., Ford, M. A., & Bonnie, R. J. (2017). Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. National Academies Press (U.S.), Washington (D.C.). DOI: 10.17226/24781

Wolters Kluwer Health (2018). Replacing Opioids With Exercise, Alternative Therapies, Yoga, Stress Reduction, Spiritual Activities, and Laughter, The Back Letter Journal: February 2018 – Volume 33 – Issue 2 – p 15-21 doi: 10.1097/01.BACK.0000530270.64244.49