Author: Brooke Trainum

Last week, Senator Claire McCaskill’s (D-Mo) office released a report finding that over the last six years, enough opioids were shipped into the state of Missouri to give every resident 260 pills. While that is a snapshot of just one state, combine that news with the latest report from the Centers for Disease Control and Prevention (CDC) that the number of overdose deaths involving fentanyl and similar drugs nearly doubled between the last half of 2016 and the first half of 2017, and it becomes clear that the opioid crisis is still destroying the lives of individuals, families, and communities in epic proportions.

These reports follow a new CDC alert to public health and health care professionals about the increased availability of illicit synthetic opioids, the second update to the health advisory since October 2015. As the crisis continues to transform, health care providers, government agencies and Congress are also changing their tactics to fight this epidemic.

Over the past few weeks of extensive negotiations, the House of Representatives wrapped up multiple proposed opioid crisis bills into one large package, the SUPPORT for Patients and Communities Act (H.R. 6). This iteration of the bill would grant Nurse Practitioners and Physician Assistants permanent authority to prescribe Medication-Assisted Treatment (MAT) while the other three Advanced Practice Registered Nurse (APRN) professions (Certified Nurse-Midwives, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists) would have authorization for five years. The SUPPORT for Patients and Communities Act would also require a study of the efficacy of providing MAT by all providers, including physicians. H.R. 6 will now move to the Senate where there has been concern over the CBO estimated cost of $395 million over a 10-year period. Given the important role that treatment has in solving this epidemic, ANA does not believe this cost should impede the passing of this bill and increase access to life saving treatment to those suffering from substance use disorders.

Medication-Assisted Treatment has been shown to be the most effective form of treatment for opioid use disorders. The National Institute on Drug Abuse states that combined with behavioral therapy, effective MAT programs for opioid addiction decrease overdose deaths resulting in cost savings, reduce transmissions of HIV and hepatitis C related to IV drug use, and mitigate associated criminal activity. Along with APRNs providing MAT services, all nurses with their roles as direct care givers, care coordinators, educators, and patient advocates play a pivotal role in solving this crisis by helping patients and their families understand the risks and benefits of pain treatment options.

ANA will continue to work with Congress, federal agencies, and our partners in the Nursing Community to fight to expand the nurse’s role in solving the opioid crisis. We urge everyone to now call their Senators in support of Senate bill S.2317 (Addiction Treatment Access Improvement Act of 2018) and ensure that they include it in any opioid package that is passed.

Congress, government agencies, foundations, communities, and health care providers have been developing and implementing policies to turn the tide on the opioid epidemic for years. Nurses are on the frontline and in the trenches treating chronic pain, substance misuse, and mental health issues. Many health related policies and regulations are still ineffective in fixing the opioid epidemic, but we do know that using a criminal justice route to solve a public health problem will not succeed in its intent. But just this week, President Trump called for the death penalty, also known as capital punishment, for “certain drug dealers” in order to curb the opioid epidemic.

The American Nurses Association (ANA) opposes both capital punishment and nurse participation in capital punishment. Capital punishment and penalizing those convicted of certain classes of crimes by killing them violates the most basic human right, the right to life and liberty. The ethical standards of the profession obligates nurses to protect human rights and practice with respect for the inherent dignity, worth, and unique attributes of every. Instead ANA advocates  for increasing access to Complementary Alternative Medicine (CAM) and Medication-Assisted Treatment (MAT), access to mental health services, and patient centered education.

The Trump administrations plan also includes a federally backed ad campaign to prevent non-prescribed opioid use. Education needs to extend past prevention measure to include safe use, storage, and disposal. Proper disposal of unused pills ensures that fewer opioids reach unintended persons and markets, and in turn, less misuse of narcotics.

Health care providers, public health officials, and law enforcement need to work together to implement proven policies that help all individuals and communities. Instead of taking a criminal justice path, such as the failed drug policies of the “just say no” campaign, which history has shown to perpetuate public health issues, officials need to take an interdisciplinary approach to address the underlying health, economic, social, and educational causes of drug use in both urban and rural communities. ANA is actively advocating for nurses through advising federal agencies, supporting federal legislation, and connecting members with their representatives to ensure the voices of nurses are heard.

Nurses see firsthand the devastating effects of the opioid crisis on their patients, communities, and perhaps even themselves or their families. ANA members have been forthcoming in their stories about access, treatment, and the pain they have dealt with each and every day working to fight this crisis. That’s why many are cheering the Trump administration’s work on the crisis, with the First Lady leading the administrative efforts for declaring it a national emergency, as nurses team with emergency responders, policymakers, law enforcement, and other stakeholders in the fight to turn the tide on the devastating effects of opioid abuse in local communities.

The statistics are sobering: 64,000 Americans lost their lives to drug misuse in 2016. The number of people misusing prescription opioids in 2015 is even more alarming, 12.5 million people. There is hope—however, a comprehensive approach is needed from the ground level all the way up through state and federal governments in order to address the crisis. ANA supports nurses who are facing this crisis head on through targeted continuing education, support of federal legislation that supports nurses to practice to the full extent of their training and education, and supporting/advocating for policies that allow APRNs to prescribe medication assisted therapy, which has proven effective in stemming substance use disorder.

Within the walls of Congress, there are currently over a hundred of bills aimed at addressing varying aspects of the opioid crisis. Two in particular are at top of ANAs priorities for opioid legislation. In the Senate ANA has signed on to support is Combating the Opioid Epidemic Act, introduced by Bob Casey (D-PA) and Ed Markey (D-MA). In the House, Reps. Paul Tonko (D-NY) and Ben Ray Luján (D-NM) introduced H.R. 3692, the Addiction Treatment Access Improvement Act with support from ANA and our nursing partners. The latter bill aims to build on the Comprehensive Addiction and Recovery Act in order to allow clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists to practice to the full extent of their training and education in prescribing buprenorphine.

Buprenorphine, however, is just one piece of the puzzle in treating opioid dependency. As with all medications used in Medication Assisted Therapies (MAT), it is just one part of a comprehensive treatment plan that includes addressing the underlying issues through counseling and participation in social support programs. Nurses play a primary role in comprehensive treatment plans and will continue to be integral in treating the most vulnerable populations throughout the country. ANA urges you to continue to voice your support in this fight by contacting your representatives and asking them to support H.R. 3692.