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Analysis of Position Papers for Vulnerable Populations

Learner’s Name

Capella University, School of Nursing and Health Sciences

NURS-FPX6026: Biopsychosocial Concepts for Advanced Nursing

Practice II Faculty’s Name

Month, XX, XXXX

Analysis of Position Papers for Vulnerable Populations

As a group, veterans present a complicated, vulnerable population for the health care

industry. Reports show that more than half of the U.S. Department of Veterans Affairs’ primary

care patients state that they have pain, several of whom report chronic pain. Patients suffering

from chronic pain often have higher levels of medical utilization, more disability claims,

diminished productivity at work, and a poorer quality of life compared to patients who do not

suffer from chronic pain. Further, it has been observed that the latter present with higher rates of

alcohol and substance use disorders (Lovejoy, et al., 2016).

The need for pain management was advocated and discussed in the 1980s and 1990s.

Groups such as the WHO took a stand on how to address pain as a health care issue, particularly

with reference to how cancer and cancer treatment affects patient lives. It was argued that it is

unethical for any patient to be dying in pain, even if the treatment hastens death. This mandate

was initially meant for cancer patients with chronic pain; however, over time, it has been

extended to include chronic noncancer pain as well (Sullivan & Howe, 2013). One of the

treatments recommended at the time was using opioids to manage pain. However, studies have

since confirmed that a significant link exists between prescription opioid treatment and opioid

addiction (Compton et al., 2016; Kolodny et al., 2015; Volkow & McLellan, 2016). Veterans as

a population are particularly vulnerable in this situation given that many of them deal with both

physiological pain and psychological issues including post-traumatic stress disorder and

substance abuse disorder (Sullivan & Howe, 2013). It is then necessary to look for a solution

that allows veterans dealing with pain to manage it effectively and, further, to regulate and

control the use of opioids to minimize the risk of addiction as well as the potentially dangerous

side effects of opioid use.

Pain Relief Management and the Opioid Crisis Position

The guidelines issued by the WHO and the Declaration of Montreal issued by the

International Association for the Study of Pain state that if patients suffer from chronic pain, it is

unethical to let them remain in pain (Sullivan & Howe, 2013). However, there is a line that

separates the management of pain and the abuse of medication. Studies have shown that opioids

do provide significant pain relief in modest doses over a short period of treatment. However, the

long-term efficacy of opioids for pain relief management has not been proven to be clinically

significant (Sehgal et al., 2013).

The management of pain to improve quality of life and the possibility of medication

abuse and addiction are two sides of the opioid issue. The position that the American Academy

of Neurology takes on the issue reiterates earlier studies that show that the efficacy of opioid

medication might not extend to a long-term prescription of opioids. The current state of opioid

prescription practices has been associated with significant morbidity and high rates of mortality

(Franklin, 2014). On a similar note, The American Osteopathic Academy of Addiction Medicine

(n.d.) issued a public policy statement on the use of naloxone, an opioid antagonist that blocks

opioid receptor activation and, through this, reverses opioid overdoses by preventing or reversing

respiratory arrest.

The American Society of Addiction Medicine (2016) also suggests a similar course of

action in terms of educating individuals on the use of naloxone. It also encourages those close to

the individual experiencing an opioid overdose to educate themselves on how to detect the onset

of an overdose. The same association presents the rising statistics associated with prescription

opioids and the necessity of raising awareness about the dangers associated with opioids and

educating people on the treatment of an opioid overdose. The American Society of Addiction

Medicine recommends co-prescribing naloxone with opioids for people who might be at risk of

overdose and educating both the patient and those close to the patient on how to properly use a

naloxone kit.

Evaluation of Ethical Pain Management versus the Possibility of Addiction

The above papers focus on ensuring that the public and individuals prescribed opioids are

made aware of the dangers associated with the use of opioids. The addictive properties of opioids

and the epidemic of opioid overdoses that has spread over the past few decades are indicators of

the severity of the situation (Kolodny et al., 2015). The other side of the argument is that opioid

treatment is a necessity for many in chronic pain. In Sullivan and Howe’s 2013 study on opioid

therapy for chronic pain, the authors recount the history of the opioid crisis. The shift toward the

use of opioids in the treatment of pain was marked by the WHO issuance of guidelines for the

use of opioids in the context of pain relief for cancer patients in 1985 and 1996. This was

eventually extended to noncancer pain as well. The underlying logic at work was that chronic

noncancer pain could be debilitating to the same extent as cancer pain over longer periods of

time and with greater rates of prevalence.

There are two aspects to the counterargument presented by supporters of opioid

treatment. The first is that pain as a symptom or consequence of injury or illness can lead to

inferior quality of life, resulting in psychological difficulties and even impeding recovery

(Manjiani, et al., 2014). The second aspect is that opioid treatment potentially provides a long-

term solution for chronic pain. This claim is made largely as an extension of the efficacy that

can be seen in short-term studies of opioid treatment (Franklin, 2014).

However, as there exists very little evidence on the long-term efficacy of opioid

treatment, it becomes problematic that opioid treatment is already in practice to relieve chronic

noncancer pain. In the American Academy of Neurology’s position paper on the use of opioids

for chronic noncancer pain, Franklin (2014) analyzes both the rise of opioids as a treatment as

well as the epidemic of addiction and overdose that came about as a result of the advocacy for

opioid treatment. Aside from the dangers of addiction that individuals face, Franklin also

addresses the significant side effects that opioids present when taken over long durations,

including opioid-induced hyperalgesia, immunosuppression, infertility, and hypogonadism.

Newhouse states that opioid drugs were prescribed to over 400,000 veterans for pain

relief, which correlates to approximately 1.7 million opioid prescriptions (as cited in Snow &

Wynn, 2018). The effort to manage the chronic pain that veterans face, however, presents with

its own unique set of complications, particularly because of how widespread the use of opioid

treatment has become. Baser et al. state that veterans are approximately seven times more likely

to abuse opioids than civilians (as cited in Snow & Wynn, 2018). Further, opioids are more

likely to be prescribed to individuals who have a history of substance abuse and mental health

issues, and this would result in unfavorable or harmful outcomes such as drug abuse or opioid

overdose (Howe & Sullivan, 2014). When considering this with the prevalence of psychological

issues and chronic physiological pain that many veterans present with, it becomes apparent that

long-term treatment with opioids for veterans is not advisable.

Interprofessional Team Role

Kissin found that 35% of veterans who were admitted to Tuscaloosa Veterans Affairs

Medical Center’s acute inpatient psychiatric unit presented with severe post-traumatic stress

disorder symptoms, coupled with issues such as suicidal ideation and mood disturbances. Kissin

also found that 25% of these veterans had an underlying case of opioid use disorder (as cited in

Snow & Wynn, 2018). To treat veterans such as these who are comorbid with chronic pain and

behavioral issues, it is necessary to integrate the psychological and the psychiatric into the model

of care to sufficiently address the overall health of the patient (Snow & Wynn, 2018). Such a

model would require physicians, psychologists, and psychiatrists to simultaneously address the

needs of the patient. One of the issues they might encounter is managing the patient’s

prescriptions. Denenberg et al. note that opioids are contraindicated for patients with substance-

abuse issues (as cited in Snow & Wynn, 2018); physicians and mental health specialists would

have to come to some resolution to mediate the patient’s need for pain relief and the patient’s

potential for abuse of his or her medication.

Weiss et al. (2014) note that individuals who present with post-traumatic stress disorder

and substance abuse disorder are likely to use opioids to relieve negative emotional states, aid

sleep, or relieve pain. Crowley et al. (2017) suggest that behavioral health should be taken into

consideration while evaluating the overall health of the individual. The purpose of opioid

treatment is to improve the patient’s quality of life with respect to the reduction of pain.

Therefore, there should be a simultaneous push toward counseling to address the overall health

of the individual and not solely focus on pain. This would involve coordination between

counselors and physicians who specialize in pain management to effectively improve the quality

of life for these patients.

Conclusion

The management of chronic pain with long-term opioid treatment involves significant

risk and does not have clinically significant evidence to support its use. Veterans present a

complicated population because many of them deal with mental health issues such as post-

traumatic stress disorder and substance abuse disorder as well as chronic pain. An analysis of

policies of various institutions and position papers on the use of opioids for pain management

brings into focus the severity of the opioid crisis. Most position papers take the stance that long-

term opioid treatment would not be advisable given the lack of evidence to support it. Further,

the abundance of public policy statements that advocate educating individuals on the use of

naloxone, an opioid antagonist, indicates the severity of the crisis in the present context. One

effective response to the existing crisis might be to simultaneously provide counseling along

with opioid treatment to address the individual’s overall health. The comorbidity of behavioral

issues and chronic pain in veterans indicates that they are a particularly vulnerable population,

with a high risk of addiction and prescription drug misuse. Therefore, to provide efficient,

holistic care, it is necessary to evaluate the efficacy of long-term opioid treatment and the

guidelines associated with it.

References American Society of Addiction Medicine. (2016). Use of naloxone for the prevention of opioid

overdose deaths. https://asam.org/advocacy/find-a- policy-statement/view-policy-

statement/public-policy-statements/2014/08/28/use-of- naloxone-for-the-prevention-of-

drug-overdose-deaths

Compton, W. M., Jones, C. M., & Baldwin, G. T. (2016). Relationship between nonmedical

prescription-opioid use and heroin use. The New England Journal of Medicine, 374(2),

154–163. http://floridahealth.gov/statistics-and-data/e-forcse/news-

reports/_documents/NEJM-opioid-heroin-use.pdf

Crowley, R., Kirschner, N., Dunn, A. S., & Bornstein, S. S. (2017). Health and public policy to

facilitate effective prevention and treatment of substance use disorders involving illicit

and prescription drugs: An American College of Physicians position paper. Annals of

Internal Medicine, 166(10), 733–736. http://dx.doi.org/10.7326/M16-2953

Franklin, G. M. (2014). Opioids for chronic noncancer pain: A position paper of the American

Academy of Neurology. Neurology, 83(14), 1277–1284. Retrieved from

https://doi.org/10.1212/WNL.0000000000000839

Howe, C. Q., & Sullivan, M. D. (2014). The missing ‘P’ in pain management: How the current

opioid epidemic highlights the need for psychiatric services in chronic pain care. General

Hospital Psychiatry, 36(1), 99–104. https://doi.org/10.1016/j.genhosppsych.2013.10.003

Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., &

Alexander, G. C. (2015). The prescription opioid and heroin crisis: A public health

approach to an epidemic of addiction. Annual Review of Public Health, 36(1), 559–574.

https://doi.org/10.1146/annurev-publhealth-031914-122957

http://floridahealth.gov/statistics-and-data/e-forcse/news-

http://dx.doi.org/10.7326/M16-2953

Lovejoy, T. I., Dobscha, S. K., Turk, D. C., Weimer, M. B., & Morasco, B. J. (2016). Correlates

of prescription opioid therapy in veterans with chronic pain and history of substance use

disorder. Journal of Rehabilitation Research and Development, 53(1), 25–36.

http://dx.doi.org/10.1682/JRRD.2014.10.0230

Manjiani, D., Paul, D. B., Kunnumpurath, S., Kaye, A. D., & Vadivelu, N. (2014). Availability

and utilization of opioids for pain management: Global issues. Ochsner Journal, 14(2),

208–215.

http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocvie

w%2F1541487990%3Faccountid%3D27965

Sehgal, N., Colson, J., & Smith, H. S. (2013). Chronic pain treatment with opioid analgesics:

Benefits versus harms of long-term therapy. Expert Review of Neurotherapeutics, 13(11),

1201–1220. http://dx.doi.org/10.1586/14737175.2013.846517

Snow, R., & Wynn, S. T. (2018). Managing opioid use disorder and co-occurring posttraumatic

stress disorder among veterans. Journal of Psychosocial Nursing and Mental Health

Services, 56(6), 36–42. http://dx.doi.org/10.3928/02793695-20180212-03

Sullivan, M. D., & Howe, C. Q. (2013). Opioid therapy for chronic pain in the US: Promises and

perils. Pain, 154(Suppl 1), S94–100. https://ncbi.nlm.nih.gov/pmc/articles/PMC4204477/

The American Osteopathic Academy of Addiction Medicine. (n.d.). Naloxone public policy

statement: The use of naloxone for the prevention of opioid overdose deaths.

https://c.ymcdn.com/sites/www.aoaam.org/resource/resmgr/Docs/AOAAM_NALOXON

E_POLICY_2015.pdf

http://dx.doi.org/10.1682/JRRD.2014.10.0230

http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocvie

http://dx.doi.org/10.1586/14737175.2013.846517

http://dx.doi.org/10.3928/02793695-20180212-03

http://www.aoaam.org/resource/resmgr/Docs/AOAAM_NALOXON

Volkow, N. D., & McLellan, A. T. (2016). Opioid abuse in chronic pain — misconceptions and

mitigation strategies. The New England Journal of Medicine, 374(13), 1253–1263.

http://pcpr.pitt.edu/wp-content/uploads/2018/01/Volkow-McLellan- 2016.pdf

Weiss, R. D., Potter, J. S., Griffin, M. L., McHugh, R. K., Haller, D., Jacobs, P., Rosen, K. D.

(2014). Reasons for opioid use among patients with dependence on prescription opioids:

The role of chronic pain. Journal of Substance Abuse Treatment, 47(2), 140–145.

http://doi.org/10.1016/j.jsat.2014.03.004

http://pcpr.pitt.edu/wp-content/uploads/2018/01/Volkow-McLellan-

http://doi.org/10.1016/j.jsat.2014.03.004

Pain Relief Management and the Opioid Crisis Position
Evaluation of Ethical Pain Management versus the Possibility of Addiction
Conclusion