A common scenario: It’s 3:00pm on a Tuesday and you are discharging a patient from the acute care unit/emergency room/ambulatory surgical unit. You go over their discharge instructions to make sure they understand their recovery process and limitations after discharge. You then hand them a prescription for a narcotic pain killer. They look you in the eye and state “I’m a little bit nervous to take these at home. I don’t want to become addicted!”
Most nurses have been in this situation before. With national headlines appearing daily regarding prescription drug abuse and the many deaths it is causing every day, it’s natural that patients may worry about falling into this trap. The truth is that hundreds of thousands of patients use prescription opioids every year without falling victim to abuse or addiction; but what is the best way to address a patient’s fears? Education is the key in this situation, and presenting them with the following facts may help ease their mind:
There is a difference between opioid tolerance and addiction.
When used appropriately, a patient may over time develop a tolerance to opiate medications. This is more common in treatment of chronic pain, but can also occur with acute pain related to a slowly resolving health issue. A tolerance means that a person may require increased dosage to effectively manage pain, because the body has become tolerant to their current dosage. If a patient has a condition causing chronic pain, the reality is that the patient may need to be on a standing regimen of opiate medication, and over time will develop a tolerance requiring increase in dosage. This is not the same as addiction. Addiction occurs when a person’s entire life becomes focused around obtaining the drug, and the patient will go to any length to secure more medication. The following video visualizes the development of opioid tolerance.
Patients without a history of substance abuse are far less likely to become addicted to opioids.
Addiction is not a medical condition, but rather a pattern of behavior, as mentioned above. If a patient admits to a history of substance abuse and has fears about taking prescription opioids, they may require an extra layer of support and follow-up care to make sure their pain is being managed in the most optimal way with the least risk of relapse. This could involve the support of a social worker to follow up at home, a home health nurse, or even additional follow-up visits with the physician prescribing the opioid.
If a patient goes home and takes a medication appropriately, as prescribed, they will not become addicted.
Even if the medication regimen continues for weeks or months for ongoing pain, once the health issue is resolved and the pain level decreases, the patient can usually be weaned off the opioid slowly without experiencing any effects of withdrawal.
One of the best ways to prevent addiction is to recognize signs that indicate it may be developing.
These signs include a craving for the medication, seeing several different doctors to obtain the amount of medication desired, and feeling the need to be dishonest about the use of opioid medication when speaking with family members and medical professionals. If any of these start to occur, seek the help of a professional. Check the following video to learn all the signs of a developing addiction.
Be mindful of the side effects and contraindications when taking opioid medications.
Patients who are fearful of addiction are often also fearful that it can cause death. The side effects of opioids can indeed be serious and even deadly at times. One of the biggest causes of death for those taking opioids is when they are consumed in conjunction with alcoholic beverages. Alcohol, which is a depressant, interacts negatively with opioids by increasing the side effect of respiratory depression, causing death for some patients.
Armed with the facts, you will be better prepared to effectively answer your patient’s questions and provide them a sense of comfort as they prepare to go home and manage their own pain with opiate medication.