RESPONSE TO HEATHER

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Prior to starting the family nurse practitioner (FNP) program, I wouldn’t have guessed how often patients seek narcotic pain medication for chronic back pain.  I have sure been enlightened!  In my short time in clinical rotations as an FNP student, it seems that patients with various types of back dysfunction and/or back injury are among the patients who have the highest amount of chronic pain and are also the most likely to seek narcotic pain medication.  According to a 2016 article from the American Nurses Association, nurses and advanced practice nurses have a key role to play in helping to solve this complex problem,(American Nurses Association [ANA], 2016, p. 1).  

There is ample data showing that deaths from opioid overdose are on the rise.  The Centers for Disease Control and Prevention (CDC) share some pretty grim facts on their website about the opioid epidemic.  At first glance, it seems the problem might be improving.  In fact, the number of deaths attributed to drug overdose actually decreased by 4% from 2017 to 2018.  However, if we compare deaths from drug overdose in 2018 to the total amount of deaths related to drug overdose from 1999, we find that the number of people who died in 2018 is 4 times more than the number of people who died in 1999.  It’s hard to believe that in 11 years, the number of deaths from opioid drug overdose has quadrupled, (Opioid Overdose, 2020, para. 1).  I am sure I’m not the only one whom this epidemic has touched.  One of my friends, who is also a nurse, lost her young adult son in 2018 to a narcotic drug overdose.  He had become addicted to narcotics as a teenager and had struggled on and off with his addiction for many years.  A few months after he became a father, he lost his life to his addiction, leaving his newborn son without a father and leaving his mother without her son.  

What is the solution?  It certainly isn’t a simple one.  Complex issues demand a thoughtful and complex approach.  One of the best tools a provider has currently is to utilize an electronic database that records the history of narcotic prescriptions for patients in each state called Prescription Drug Monitoring Programs (PDMPs).  Through this centralized state-level system, providers can track prescriptions that patients are getting filled, possibly from other healthcare providers, allowing at-risk patients to have more oversight and accountability.  While this isn’t a complete solution, it is a piece of solving a larger puzzle, (Prescription Drug Monitoring Programs, 2020, paras. 1-2).  

In the event that a patient came to me with chronic back pain, I would need to further assess the patient to determine the best course of action.  What have they tried and failed?  What have they tried that has worked?  What other modalities of pain management have they been exposed to and educated on?  Do they have structural or functional abnormalities that need to be addressed to alleviate pain?  Is there a psychological component to their pain?  Have they seen a pain specialist, such as a physiatrist?  What type of pain do they have?  Do they have a history of narcotic use and/or other substance abuse?  The reality is that narcotic pain medication does not address the root cause of the pain.  In fact, it isn’t even a preferred method of treatment for certain pain etiologies.  In other words, some pain will not respond to narcotics.  

The job of the healthcare provider is to provide the correct intervention.  I also believe that means to intervene as little as possible and only as much as is necessary.  Sometimes, our intervention will be great, requiring significant support from the FNP and perhaps other specialists.  However, sometimes that isn’t at all what the patient needs.  Sometimes they need counseling.  It is our job to determine the need and to genuinely help the patient.  I am humbled by the enormity of it and am determined to do it well.