One of the fastest growing drug-related problems in the United States is the overuse and distribution of prescription narcotics (MMWR Morb Mortal Wkly Rep. 2012;61:10-13). Much of this avoidable epidemic appears to stem from the emergency department. Narcotic abusers tend to have unwarranted emergency department visits that influence our nation’s increasing health care costs and dependency. How do we fix the problem? Providers need to unite and follow a linear continuum of set criteria that directly focus on standardized screening, guidelines, and limits.
The U.S. Department of Health and Human Services (DHHS) initiated a public health surveillance system, the Drug Abuse Warning Network (DAWN), in 1974 and updated it in 2010. DAWN monitors narcotic-related visits to emergency departments (DHHS, http://www.samhsa.gov/data/2k12/DAWN2k10/DAWN2k10-Trend-Tables.htm). If a patient presents to the emergency department and the provider suspects narcotic abuse, DAWN allows the provider to access a database that displays all the narcotic prescriptions that the patient has filled within the United States. DAWN appears to be the solution to this epidemic, but providers continue to prescribe narcotics.
The Washington State Hospital Association drafted strict guidelines for emergency department medical providers to follow. If one state can draft simple guidelines, then why can’t the entire nation develop and implement a universal plan?
One reason that there is no consensus is patient satisfaction. Because our health care system is driven by patient satisfaction scores, providers feel almost obligated to give patients what they want, despite how providers morally and ethically feel and DAWN’s results. Patients continue to sign into the emergency department for narcotic medication refills. If a provider opts to not fill the prescription, the patient will give poor satisfaction scores, resulting in the possibility of no reimbursement. Patients will seek narcotics in the easiest, fastest, and most accessible way possible, and that is within our nation’s emergency departments.
Providers need accurate and appropriate information on standardized screening of all individuals who visit the emergency department for narcotic pain relievers. National guidelines need to be implemented that address dispensing and duration of the narcotic, strict avoidance of long-acting opioids dispensed and prescribed in the emergency department, and universal screening and tracking of all emergency department visits and clinics. If all emergency departments would follow universal guidelines, it would have a huge impact on patient outcomes and dependency and significantly lower health care costs.
Narcotic dependency is prevalent in our youth today. In 2009, 69,236 U.S. adolescents were admitted to the emergency department for medical emergencies related to narcotic dependency (www.samhsa.gov/data/2k12/DAWN_Short_Report_038/DAWN_Short_Report_038_Narcotics_2012.pdf). This is why we as health care professionals must take a stand and voice our concerns to Congress. DAWN is just one piece of the puzzle. We will never be able to completely eliminate narcotic dependency. However, educating patients and providers, changing our methods, engaging in our moral and ethical values, and developing a universal standard can steer this nation’s narcotic dependency on the right path.
Jessica Dare Evans, MSN, CEN, ARNP, NP-C, is a nurse practitioner with Lake Mary Medical Consulting in Palatka, Fla.