Analysis of Substance Abuse Cases

1. Badler, Charlotte,B.S.N., R.N. (2017). Confronting the opioid epidemic in ambulatory care: Preparing for overdose emergencies.AAACN Viewpoint,39(6), 4-8

This article, written by Charlotte Badler, RN, talks about the benefits of ambulatory care practices or walk-in clinics equipping themselves with Narcan, also known by the generic name of naloxone. Narcan is used as an antidote for substance overdose, such as opioids and illegal street drugs. There is no bias toward this article, as it is backed up by evidence-based practice that lately has been used more often in clinical settings, due to the increase in opioid overdose across the world.

The example used in this article clearly shows that Narcan can be used in any setting to save someone's life if it's given in a timely manner. In this case, QSEN (Quality and Safety Education for Nurses) practice demonstrates that if Narcan nasal spray is used, versus the injections, medical staff is protecting themselves by avoiding needle sticks and therefore heightening their exposure to getting infected with diseases such as Hepatitis B and C or HIV (Human Immunodeficiency Virus). The nasal spray works just like its counterpart IM (intramuscular) injection.  It should be available in any health setting, to include small clinics, because a person might not have enough time to be taken to a big hospital as it might be far. The article is intended for general knowledge of staff working in smaller clinics. There's a possibility of them not being sure about their using this medication, because they might not be fully informed of its pros and cons.  Not only can they raise awareness and bring it up with their site managers for the possibility of having this life-saving medication on hand; but they're also advocating for the patient that might walk into their clinic after overdosing and needing their help to save their life. There is the conception that if a person with an overdose walks into a medical clinic, they are more likely to be saved, as staff would initiate life-saving measure and/or have Narcan available for such emergencies.

2. Hashmi, A. M., Han, J. Y., French-Rosas, L., Jabbar, Q., Burhan, A. K., & Shah, A. A. (2018).  Benzodiazepine use and abuse.Psychiatric Annals,48(8), 360-365

This article focuses on the increasing abuse of benzodiazepines in the last 8 years. The number of visits to the emergency room have increased by approximately 139%. The article, written by several Medical Doctors and Professor Assistants that specialize in Psychiatry and Behavioral Sciences, explains while Benzodiazepines are effective in treating anxiety disorders, they are highly addictive and can cause death if abused. Their uses range from status epilepticus, anxiety disorders, panic disorders, and alcohol withdrawal. These medications have side effects in common, ranging from fatigue, drowsiness, and lethargy to slurred speech and euphoria. The article also points out that women are prescribed these medications more often than men and abuse is more likely in countries where these medications are not tightly controlled, making it easier to obtain them.

While the focus is to treat the abuse of this medication, this has to be done carefully, as abruptly stopping benzodiazepines can cause withdrawal symptoms to worsen or to affect the patient in a negative way, such as seizures and paranoia.  QSEN focuses on minimizing harm to the patient when there in avoidance in worsening the symptoms of withdrawal, but at the same time treating the overdose. The article showed no bias, as this is focused on evidence-based practice and on-gong research. The awareness and education of the abuse of this line of medications can help save a person's life, due to family and/or caregivers knowing the overdose symptoms of patients taking these medications.

3. Hawk, K., & Gail D'Onofrio. (2018). Emergency department screening and interventions for substance use disorders.Addiction Science & Clinical Practice, 13

In the last couple of decades, screening and identification of patients with substance abuse disorders has been more common. The authors of this article, Kathryn Hawk and Gail O'Onofrio, focused on the evidence that patient identification, rehabilitation referral, and help in overcoming their substance abuse disorder. The screening of these patients can be done by asking a single question or by using one of the tools mentioned in the article. The tools for alcohol are: AUDIT-C, CAGE (Cut down, annoyed, guilty, eye-opener), and NIAAA (National Institute on Alcohol Abuse and Alcoholism). There is also one for substance use: DAST (Drug Abuse Screening Test), and the single question NIDA which asks if in the past year the patient has used illicit drugs or prescription medication for other than a medical reason.

Statistics used in this article showed that physicians having this type of discussion with identified patients has a positive impact, as it can get them to reflect on their current situation. This can gear them towards wanting more information or a referral to for treatment. While not all of the patients will complete the treatment, the chances of them doing it is higher than if they were ignored when they need this help. QSEN practice shows that this intervening in the emergency department can help the patient with making a healthy lifestyle change. This is a good practice to get into, not only for seasoned staff, but for new staff as well. This might help more than a couple of patients make changes in their life that they may otherwise not make alone.

4. Melville, N. A. (2016, November 18). Landmark Surgeon General Report Tackles Addiction

This website focuses on a report by Nancy Melville, on the General Surgeon's point of view on substance abuse. United States General Surgeon Vivek Murthy, MD, has called the nation to assess and come up with a plan to tackle the chronic disease of our times: addiction. There was a suggestion to treat patients with non-opioid medications, if at all possible, to lessen the chances of addiction. This article is biased, as it is true that we all need to work together in helping tackle addiction, whether it's by educating ourselves or by reporting it, or by helping the person that wants referral to get help in overcoming their addiction.

While this report was in 2016, I think it would be a good to have an updated report on this topic with Dr. Murthy, as it's likely that new medications, strategies, and research have emerged since then. QSEN in this topic shows that education, teamwork, and solution, due to the suggestion of the nation and communities to work together to come up with a plan and/or ideas to tackle addiction.

5. Payette, M. J., MD, MBA. (2017, January 05). Physical Manifestations of 9 Drugs of Abuse

This website is very informative. It's rather up-to-date, within the last year, and focuses on signs and symptoms caused by various types of drugs. It talks about alcohol intoxication, cirrhosis, heroin, cocaine, injectable steroids, marijuana, and methamphetamines. As well as harsher drugs like, Krokodil, bath salts, Levamisole in cocaine, and Kratom. It also mentions that while there is a 439% increase of heroin-related deaths in the United States from 1999-2014, there is also a big response that has taken place. For example, there is an increase in access to reversal agents for drug overdose, like naloxone and Suboxone. Also, there is safe-injection sites across the nation, where a heroin-addict can go in there and safely use heroin, as these centers are supervised. This constitutes as providing a safe place for the patient as they have the help available to them should they overdose on heroin while at the center. This is good resource to educate a person on what happens to the body with drug use.

6. R, G. W., John, D. G., Mei, L. L., & Dan Quan. (2018). Advanced management of opioid overdose in the emergency department. Emergency Medicine Reports, 39(6)

This article focuses on the signs and symptoms and treatment for opioid overdose patients in the emergency department. The three symptoms that are most commonly seen in these patients are respiratory depression, miosis, and alteration in mental status. The article lists the most common medication that is used for overdose, naloxone. It also lists the two types naloxone formulations available to take home. There is the injectable but requires assembly and use of needles, Evzio (it's Narcan manufactured by another company) is intranasal spray, which is used by spraying it into the patient's nose. Emergency department providers have seen the rise of addiction, as they see more and more of these patients in their department. The article mentions that emergency department providers can help with this by implementing safety when they prescribe opioids to manage acute pain, also by being knowledgeable in managing an emergency when a patient presents in their department with respiratory depression. They also need to be knowledgeable in the use of Narcan to be able to safely use it to manage an overdose. QSEN is shown in this situation, because the patient's safety is implemented, staff work together in teamwork and collaboration to save the patient's life, patient centered care is implemented through evidence-based practice.

7. Sorrell, J. M. (2017). Substance use disorders in long-term care settings: A crisis of care for older adults.Journal of Psychosocial Nursing & Mental Health Services, 55(1)

This article, written by Jeanne M. Sorrell, PhD, RN, FAAN, focuses on a population that has a high percentage of addiction to opioids, illicit drugs, and alcohol. It can be shocking to some, as the elderly are often seen as grandparents, na??ve when it comes to newer drugs, and at the same time experienced to say no to this epidemic. But the truth is that it's an issue that is overlooked because it's not expected from them, just as like it's not always intentionally that they start abusing these substances. As the article mentions, they sometimes become addicted due to having a deficit in cognitive reasoning, due to them not hearing well when the provider is explaining the directions to taking their medications. It can also mean that they are not quick to understand terms used by the provider. And the most common one, they are embarrassed to ask questions about it, as they don't want to be a bother or they assume that 'Doctor knows best.

There is also mention in the article that many of the elderly have abused drugs since they were younger, but now it's not noticeable, as they are better at hiding it. It is a biased, as it is true that many providers might not pay much attention to this population when it comes to drug abuse or misuse because it's not common. Many elder may be reluctant to attend any type of rehabilitation program for this, as they most likely see it as I have lived this long with this and I will die soon anyway. Also, like the article mentions, there are not many studies out there when it comes to the elderly and drug abuse or drug misuse. In the article it was mentioned that a patient passed away a couple of days after leaving the nursing home where he was a patient for rehabilitation. The patient was given increasing amounts of opioids and not offered substance abuse treatment, even though his family brought up the topic with staff about the amount of opioids he was taking. This situation is a perfect example that if staff had been educated in opioids abuse, then referrals would have been made to help him with this addiction, and maybe he would be alive today. In this case, QSEN did failed to be met, as the team of nurses and providers could have worked together as a team to make referrals for substance abuse counseling, they did not keep the patient from neglect, as he was discharged and abruptly stopping the medications.

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