MSN-Ed, BSN, RN
When you hear the word “methadone,” what comes to mind? If you are honest, your thoughts are likely not entirely positive. This is part of the stigma associated with opioid use disorders. (OUD).
According to a report by the U.S. Department of Health and Human Services (HHS), 1.6 million people in the U.S. have misused prescription pain relievers for the first time, and more than 70,000 people died from a drug overdose in 2019 alone. The HHS declared the problem a “crisis,” and in 2017, declared it a public health emergency. Although drug overdoses occur for reasons other than misused opioid pain relievers, nurses have reason to be concerned.
Opioid use disorder (OUD), previously termed “opioid abuse” or “opioid dependence,” is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a “problematic pattern of opioid use leading to clinically significant impairment or distress.”
Some diagnostic criteria for OUD include:
A 2023 National Association of Counties report states that OUD treatment is called “Medication-Assisted Treatment” (MAT) and is often used in combination with counseling and behavioral therapies. Along with methadone, the U.S. Federal Food and Drug Administration (FDA) has approved two other medications to treat OUD: buprenorphine and naltrexone. Treatment duration may vary, and treatment can continue indefinitely for some patients.
These medications may also be referred to as “Medications for Opioid Use Disorder” (MOUD). According to the National Association of Counties report, the terms are interchangeable.
However, MAT was used to highlight how these medications can “assist” other forms of therapy (for example, counseling). The term MOUD implies that these medications alone can be considered a form of therapy, as they are effective in treating OUD without other therapies, according to the report. According to the CDC, medication treatment of OUD has been associated with reduced overdose and mortality.
I was no stranger to this subject as an acute care registered nurse. I frequently cared for patients who had OUD. Although I wasn’t necessarily familiar with the terms MAT or MOUD, I knew my patients were on these particular medications to better manage their symptoms and dependency. The FDA noted the need to remove stigmas and bring awareness to OUD as a chronic disease so treatment can be facilitated and new therapies developed.
Pain management can be complicated for patients who have both OUD and chronic pain. As a result, many patients may receive assistance from outpatient pain specialists to help with pain management while at home. Nurses may have a more challenging time managing pain for hospitalized patients with OUD as they may be hesitant to administer opioids for pain relief, even if there is a physician’s order to do so. While the concern and hesitancy are genuine, OUD does not exempt someone from feeling pain. Nurses should address any safety concerns they may have with the physician.
There is a dire need to dispel a common myth about opioids. Over the years, many of my opioid-naïve patients were afraid to take opioids for post-surgical pain management because they “didn’t want to get addicted.” With proper education, I was able to get their pain under control. Patients need to know that although opioids can have adverse effects, taking them for pain does not automatically form a dependency. The treatment of pain with opioids is associated with an increased risk for OUD, mainly if they are prescribed for more than 90 days.
As discharge day approached, many of my patients needed fewer and fewer opioids. They were able to alternate opioids with non-opioid pain relievers, termed “combination therapy” – a proven pain relief strategy.
As nurses, we are patient advocates and educators. We have the power to improve healthcare. We need to be educated on OUD and MAT and how both may affect the care we give to our patients. Nurses should avoid feeding into the stigma and instead bring awareness to the problem and educate others to improve patient outcomes.
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