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Recovering Health Care Professional Support Forum

Ohio is at the epicenter of the opioid epidemic. One of the things we discussed during our last meeting of the OSANA Wellness/Peer Assistance Committee was

informing our membership about this epidemic. We also developed the following consensus statement of the opioid epidemic: Both the AANA and OSANA have well developed programs and resources for clinicians with addiction that have been in place for over 20 years.

We believe that this is a disease and deserves medical attention and intervention. OSANA has formed an Opioid Task Force under the Wellness/Peer Assistance Committee. We are partnering with community stakeholders including the State Attorney General’s office,the OIPP, the PDAAG, the HCHC, the U.C. College of Nursing, and others to help combat this epidemic. We will provide leadership, guidance, resources, and education.

Some of the facts:

• Drug overdose (OD) deaths in Ohio increased 18.3%
• from 2013 to 2014 (Rudd,Aleshire, Zibbell, & Gladden, 2016).
•  People who misuse opioids are 40 times more likely to become dependent on heroin (CDC, 2016).
•  Heroin abuse is increasing in women, particularly
• those with private insurance coverage and higher
• income levels (CDC, 2016). This is affecting our maternal patients.
• • Many overdose deaths now involved the combination of fentanyl and heroin or even just
• fentanyl (this fentanyl is manufactured illegally-this is not the product of drug diversion)
•  2013: 84 fentanyl overdose deaths in Ohio
•  2014: 503 fentanyl overdose deaths in Ohio
•  2015: 1155 fentanyl overdose deaths in Ohio
• Overdose deaths involving synthetic opioids, including fentanyl, increased 80% from 2013 to 2014.
• The CDC is providing grant money for counties to purchase Narcan®
• Narcan® can be purchased without a prescription and is available at more than 900 Ohio pharmacies in 79 counties
• 2013: Ohio EMS personnel administered naloxone 2,575 times.
• 2014: Ohio EMS personnel administered naloxone 16,608 times
• 2015: Ohio EMS personnel administered naloxone 19,782 times
• The Hamilton County Coroner, Dr. Samarco, has informed us that in addition to carfentanil, two other powerful synthetic opioids have surfaced in Hamilton, County, Ohio where Cincinnati is located. U.S. patents on opioids that have never been manufactured have been obtained and synthesized in China and then shipped to the U.S.
• November 17, 2016: SAMHSA announced Nps and PAs can prescribe buprenorphine for up to 30 patients beginning early 2017 after completing 24 hours of required training.

Ohio Agencies

OSANA is working with a variety of Ohio agencies to combat the opioid epidemic, including the Ohio Injury Prevention Partnership (OIPP) with the State Attorney General’s Office,the Prescription Drug Abuse Action Group (PDAAG), and the Hamilton County Heroin Coalition (HCHC). Some of the objectives of the various Ohio agencies are to obtain grants for programs such

as naloxone distribution & the collection of real-time data on emergency department overdose admissions; to develop and deliver patient education programs and treatment resources for addiction (this includes standardizing ED protocols & follow up visits to EMS treated overdoses); increase access to medication assisted treatment (MAT), establish physician education, and to promote clean needle exchange programs. Currently, there is little coordination

between agencies. Many communities are facing the same challenges and our goal is to try to bring everyone together in concerted efforts and to share knowledge.

Education

Jack Stem and Jennifer Lanzillotta partnered to provide addiction education to all freshman nursing students at the U.C. College of Nursing. This initial

program was well-received and it is going to be extended to other undergraduate and eventually graduate students. We also have DNP students whose projects will involve working with the HCHC.

Screening Our Patients

We have been asked for screening tools to help identify patients who are abusing opioids. There are no screening tools for predicting which opioid naïve

patients may develop an opiate addiction. Here are some of the screening tools:

For maternal patients the 4 P’s have been suggested:

•  Have you used during this pregnancy?

•  Have you used in the past?

• Does your partner use?

•  Were either of your parents addicted to drugs or

Alcohol?

Here is a list of other tools that can be used:

• Opioid risk tool

•  SOAPP®-R

• COMM (Current Opioid Misuse Measure)

•  DIRE (Diagnosis, Intractability, Risk, Efficacy)

• PADT (Pain Assessment & Documentation Tool

•  CAGE-AID

•  ABC

The OSANA wellness committee and the OSANA Opioid Task Force firmly believe CRNA’s need to be involved with all community stakeholders that are working to combat the opioid epidemic. We can provide innovative strategies and we are prepared to provide leadership, guidance, and education. CRNAs can and should be part of the professional pain management teams to plan and

implement acute and chronic pain management for patients with unique problems such as those on Vivitrol or Suboxone.

Jennifer Lanzillotta, PhDc; MSN, CRNA