Registed Nurses' Association of Ontario

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Spotting the red flags

Nurses have a crucial role to play when treating people who may be vulnerable to addiction to a drug like OxyContin

Thirty-two year old Elizabeth* suffered from chronic back pain for years before going to her family doctor in desperation. She wanted the pain to stop. She was prescribed Percocet and then OxyContin. Elizabeth immediately felt relief – and almost invigorated. She was able to work 12 hour shifts comfortably as an aid at an institutional kitchen.

In time, she developed a tolerance to the drug, and began using more than what she was prescribed to experience the same relief. She began asking a friend for medications after being warned by her doctor that she was requesting refills too soon. Her friend started to charge her for the pills and she was spending money she didn’t have. She felt guilty and overwhelmed. She was embarrassed to tell her doctor but finally did, and was referred to Kingston’s Street Health Centre (SHC).

Carol Lynch, a nurse practitioner who works at SHC, performed the initial evaluation on Elizabeth. Once Lynch started to “peel the onion layers,” she discovered Elizabeth had a history of depression and trauma. “She had a lot of red flags to start an opioid,” recalls Lynch. The RN, whose main roles at the centre include providing primary care and support to the methadone physician (checking patients’ histories, doing physical examinations), helped Elizabeth manage her chronic pain and helped her deal with addiction and withdrawal symptoms.

Lynch gave Elizabeth a list of treatment options. Elizabeth chose methadone. Lynch relies on RNAO’s BPG, Supporting Clients on Methadone Maintenance Treatment, which provides nurses with up-to-date information about MMT.

One way nurses can ensure patients are being properly prescribed opioids is to look for those telltale “red flags” a patient may present with – such as  traumatic events or mental health disorders –  that could make them vulnerable to a possible drug addiction, says Lynch. The best way to do this, Lynch says, is to use assessment tools such as the opioid risk scale, a patient form that determines a client’s propensity to addiction. She adds: “(People who are susceptible to addiction)…need good assessments.”

Research indicates clients with post traumatic stress disorder are at higher risk for addiction, Lynch says. “Pain is very complicated, and when a client experiences both physical and emotional pain, it can be difficult to treat,” she says. Using universal precautions for pain management, including urine toxicology screenings and a good follow-up, is the best way to care for pain, says Lynch.

Also key is developing a strong, therapeutic rapport with the patient, and “maintaining a respectful relationship and not (minimizing the effects of a client’s) pain.”

* Not the person's real name.