EXECUTIVE SUMMARY
The epidemic of opioid addiction in the United States can threaten patient safety. Addicts may steal drugs from patients in various ways.
- Narcotics security should be assessed and improved as necessary.
- Visitation policies may be restricted for addicted patients.
- The prevalence of addiction may create an obligation to protect both addicts and other patients.
The opioid addiction epidemic is introducing a new patient safety risk to healthcare facilities: the possibility of desperate and clever opioid addicts diverting medications from patients, which could leave the provider liable for any consequences.
Healthcare providers should respond by stepping up security for controlled substances and providing increased oversight for patients receiving the opioid medications most commonly sought by addicts, experts advise.
Opioid addiction has increased rapidly in recent years, according to data provided by HHS. More people died from drug overdoses in 2014 than in any year on record, and more than six out of 10 involved an opioid. The rate of overdose deaths involving opioids, including prescription opioid pain relievers and heroin, has nearly quadrupled since 1999, and more than 165,000 people have died from prescription opioid overdoses since then. Healthcare providers dispense more than 650,000 opioid prescriptions every day and an average of 3,900 people start nonmedical use of opioids each day.
Those numbers mean that all healthcare facilities are likely to see opioid addicts in some way, says Rebecca J. Flood, MHS, LCADC, NCACII, BRI II, the CEO of New Directions for Women, an exclusively female drug and alcohol rehabilitation center in Costa Mesa, CA. Those coming in for addiction treatment are obvious, but they also will visit hospitals and other facilities for conditions not related to their addictions, and they will accompany or visit other patients.
In all of those cases, there is the risk of the addict trying to obtain pain medications, Flood says.
“Emergency rooms are flooded with addicts who have not taken care of their health and therefore develop urgent matters, or as a result of an accident, overdose, or attempted suicide,” Flood says. “They’re diagnosed with various health conditions they’ve neglected and end up on your med-surg floors. The truth is that nurses, doctors, and other healthcare professionals are not taught much about what addiction is or how to assess for it, so that puts hospitals and healthcare providers at greater risk because they don’t know and don’t understand the potential impact of dealing with addicts.”
Obligation to Protect?
The prevalence of opioid addicts could be seen as creating an obligation for healthcare providers to protect them from themselves while in the facility, and also to protect other patients who could be harmed by the addict’s drug-seeking behavior. (For more information on the legal aspects, see related story later in this issue.)
Flood points out that addicts’ behavior can be a danger not only to themselves but also to other patients, such as when a patient receiving pain medications is targeted for theft by an addict. Even when the pain medication is provided intravenously, addicts have been known to manipulate someone’s IV line to obtain the drug for themselves, says Jim Reynolds, EdD, an addiction and substance abuse counselor and professor in the College of Counseling at Argosy University in Sarasota, FL.
“I’ve met addicts who preyed on cancer patients because they are likely to be on strong painkillers. They will find an excuse to go into the home and head straight for the medicine cabinet in the bathroom or even to the bedside and steal drugs there,” Reynolds says. “I certainly can see an addict doing the same thing in a hospital, where there is so much more opportunity. Even those who are only visiting the hospital, it’s the proverbial candy shop for them.”
Flood agrees, and says this brings the possibility of harm and suffering to the patient, and a potential overdose for the addict.
“Without question, addicts will see that as an opportunity,” Flood says. “A hospital is a great place for an addict to try to get medications.”
Hospitals typically have tight regulations for controlled substances, but Flood notes those safeguards usually are focused more on medication security up to the point that the patient receives the medication. That may be inadequate in some circumstances to prevent theft by an addict.
Staff Can Also Be Addicted
Hospital staff and physicians also may be addicted and have the ability to circumvent controlled substance restrictions, Reynolds adds.
“We have seen instances of nurses and physicians, other staff, going to great lengths to obtain narcotics,” he says. “With the opioid epidemic growing as rapidly as it is, there’s no reason to think it won’t affect healthcare employees as well, and they sometimes have special access that makes it more likely they can obtain the drugs.”
Changes Might Be Needed
Flood suggests reaching out to local addiction treatment centers for help in educating physicians and staff about the prevalence of opioid addictions and the common behaviors to expect. Healthcare facilities may need to change some policies and procedures, such as ensuring that illegal narcotics are not in checked patient belongings, she says. Visitation policies are another potential area of improvement.
“If you have a patient who is identified as an addict, you might consider some form of restricted visitation because that is where drugs can get brought in that you are unaware of,” Flood says. “If the patient is on an IV, they are going to be very familiar with how to introduce that illegal narcotic without there being any evidence that would be obvious to the nurse or doctor.”
Hospitals also may need to increase the availability of naloxone, a medication used to treat opioid overdose, Flood suggests. In addition to making the drug available in the ED, hospitals should consider providing it on inpatient units and possibly even in the room of known addicts, she says.
The effectiveness of naloxone is impressive, Reynolds says.
“Administering this drug can turn around a drug addict who is experiencing a serious overdose,” he says. “In some communities it is carried by first responder, and it makes sense to have it readily available in a hospital.”
Detox Beds May Be Best
Many hospitals have drug and alcohol detox units, and when a patient is known to be an addict, Flood suggests that might be the best place for a known opioid addict even if he or she is being treated for a completely unrelated condition. The hospital could reserve a few beds for med-surg patients in the detox unit, where physicians and staff are more experienced and capable of dealing with any addiction-related issues, both clinical and behavioral.
When healthcare professionals are unfamiliar with opioid addiction, they can make poor clinical decisions, Flood notes. Even if the physician or staff member realized the patient is addicted, a prescription may be provided that is counterproductive and potentially harmful, she says. The prescription may not be for an opioid, but it might be a drug like lorazepam to treat withdrawal symptoms, which can be inappropriate and enabling for some addicts.
“The healthcare provider may dispense something to make the patient more comfortable, because that’s what healthcare professionals do. They try to stop the patient’s discomfort and suffering,” Flood says. “That might be the wrong thing to do, but you can’t blame most doctors and nurses who get maybe one hour or five hours of training in addiction treatment.”
SOURCES
- Rebecca J. Flood, MHS, LCADC, NCACII, BRI II, CEO, New Directions for Women, Costa Mesa, CA. Telephone: (949) 683-2087. Email: [email protected].
- Jim Reynolds, EdD, Professor, College of Counseling, Psychology, and Social Sciences, Argosy University, Sarasota, FL. Telephone: (800) 850-6488. Email: [email protected].
