By Jeni Miller
Regardless of whether they know it, many case managers are faced with patients and clients each day who are struggling with opioid use disorder (OUD). As rates of OUD continue to increase, it is essential for case managers to hone their skills of confidently recognizing and addressing the disorder. The prescribing of opioids may have been (and still may be) for good reason, but the consequences have presented severe challenges.
“[Opioid use] stems from prescribing practices dating back to the late 1980s to the early 1990s when the medical profession believed we were inadequately addressing the needs of acute and chronic pain,” explains Rebecca Perez, MSN, RN, CCM, senior manager of education and strategic partnerships with Parthenon Management Group. “Pharmaceutical companies that manufactured opiate medications assured prescribers that these medications were safe, and addiction was unlikely.”
Unfortunately, addiction was anything but unlikely.
Perez describes how “those challenged with OUD are not the stereotypical drug addict. They are injured veterans returned from multiple tours in the Middle East, individuals with medical conditions that result in chronic pain, or pregnant mothers who suffered from chronic pain before getting pregnant. All who believed they were receiving treatment for their respective conditions and now are told that they should not be taking these medications.”
The result, says Perez, is the use, misuse, and abuse of opiates. The problem is escalating as deaths from overdose reach “epidemic proportions.” The stigma of drug abuse has hindered access to treatment for OUD — all while individuals struggling with it find other ways to control their pain and fill the void.
“Many of those with dependence on opiates who have found themselves now without their prescriptions seek illicit forms of opiates like fentanyl, or other illegal drugs mixed with fentanyl, increasing the overdose rate,” said Perez.
What factors should case managers consider as they seek to support their patients struggling with OUD? What should they know regarding the “assessment, care planning process, and intervention development to address opioid use disorder?” For Perez, “assessing the patient’s history is vital.” Three aspects of the patient’s history should be considered.
First, “Knowing what precipitated the use of opiates is very important,” Perez explains. “Most often, the patient suffered a traumatic injury or has a condition resulting in chronic pain. The cause of the pain needs to be understood so that alternatives to pain management can be facilitated.”
As the case manager develops a care plan for their patient, also should consider a second piece of the patient’s history: potential drug or alcohol misuse or abuse. This history, according to Perez, “leaves an individual vulnerable to other addictions.”
Finally, a history of mental illness or behavioral disorders can affect the use or misuse of substances.
“If mental or behavioral conditions are poorly managed, individuals may attempt to self-medicate to improve or stabilize mood,” Perez notes.
In addition to the patient’s history, assessment for social challenges may be “just as crucial,” according to Perez.
“Social barriers prevent individuals from accessing needed care,” she adds. “Knowing these potential risks helps develop a more targeted care plan with interventions tailored to the individual.”
Due to the all-encompassing nature of their role, case managers play an integral part in helping patients access treatment options. Case managers should continue educating themselves about opioid use and its effect on their patients and community. “Case managers are life-long learners,” Perez explains. “They need to stay on the cutting edge of how best practices evolve. Providing resources on how and where to guide patients to treatment is one of the most critical interventions.”
“Until just a few years ago, medication-assisted treatment [MAT] for OUD was not included as first-line treatment, and treatment was not always easy to find or access,” she continues. “Mental health treatment, in general, has not been a priority in our healthcare system. However, with epidemic rates of overdose, OUD has become a priority, and treatment — primarily MAT — has become best practice and more readily accessible.”
To help case managers access reliable and timely information, the Case Management Society of America created its Opioid Use Disorder Guide Case Management Guide to provide resources for assessment and care planning specifically for this condition. The guide is available at: https://cmsa.org/opioid-use-disorder-case-management-guide/.