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Epidemiology of Opioid Abuse and Addiction

      Opioid addiction, such as heroin and prescription pain medication, is a growing problem in the United States and internationally. Knowledge and respect for the epidemiology of opioid abuse and addiction, its consequences, and the role of the ED prescriber and nurse in reducing the risk and sequelae of opioid abuse and addiction is critical to reduce the incidence of adverse outcomes and deaths. This article will consider briefly the historical perspectives, the epidemiology, and the causes and risk factors of opioid abuse and review select evidence-based approaches that ED providers and nurses may implement to minimize the risk of opioid abuse and addiction by reducing inappropriate prescribing of opioids, implementing stronger prescription monitoring programs, improving access to substance abuse programs, and expanding training in the recognition of overdose and access to emergency overdose treatments.
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      References

        • Aragon-Poce F
        • Martinez-Fernandez E
        • Marquez-Espinos C
        • Perez A
        • Mora R
        • Torres LM
        History of opium.
        Int Congr Ser. 2002; 1242: 19-21
        • Freedman DX
        Heroin epidemics.
        JAMA. 1973; 223: 1155
        • Hughes PH
        • Crawford GA
        A contagious disease model for researching and intervening in heroin epidemics.
        Arch Gen Psychiatry. 1972; 27: 149-155
        • Traynor K
        White house summit tackles opioid abuse.
        Am J Health Syst Pharm. 2014; 71: 1242-1243
        • Jones CM
        • Logan J
        • Gladden RM
        • Bohm MK
        Vital signs: demographic and substance use trends among heroin users—United States, 2002-2013.
        MMWR Morb Mortal Wkly Rep. 2015; 64 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6426a3.htm. Accessed September 15, 2016): 719-725
        • Centers for Disease Control and Prevention
        Data overview: injury prevention and control: prescription drug overdose.
        (Updated March 14, 2016. Accessed September 15, 2016)
        • Compton WM
        • Jones CM
        • Baldwin GT
        Relationship between nonmedical prescription-opioid use and heroin use.
        N Engl J Med. 2016; 374: 154-163
        • Mowry JB
        • Spyker DA
        • Brooks DE
        • McMillan N
        • Schauben JL
        2014 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 32nd annual report.
        Clin Toxicol. 2015; 53: 962-1147
        • Centers for Disease Control and Prevention
        CDC grand rounds: prescription drug overdoses–a U.S. epidemic.
        MMWR Morb Mortal Wkly Rep. 2010; 61 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm. Accessed September 16, 2016): 10-13
        • Tookes H
        • Diaz C
        • Li H
        • Khalid R
        • Doblecki-Lewis SA
        cost analysis of hospitalizations for infections related to injection drug use at a county safety-net hospital in Miami, Florida.
        PLoS One. 2015; 10: e0129360
        • Ronan MV
        • Herzig SJ
        Hospitalizations related to opioid abuse/dependence and associated serious infections increased sharply, 2002-12.
        Health Aff. 2016; 35: 832-837
        • National Institute on Drug Abuse
        The science of drug abuse & addiction: drugs of abuse—heroin.
        Date: 2015
        (http://www.drugabuse.gov/drugs-abuse/heroin. Updated May 2016. Accessed September 16, 2016)
        • Substance Abuse and Mental Health Services Administration
        The National Survey on Drug Use and Health (NSDUH) Report.
        (Published September 4, 2014. Accessed September 15, 2016)
        • Kuehn BM
        Driven by prescription drug abuse, heroin use increases among suburban and rural whites.
        JAMA. 2014; 312: 118
        • Nelson LS
        • Juurlink DN
        • Perone J
        Addressing the opioid epidemic.
        JAMA. 2015; 314: 1453-1454
        • Olsen Y
        The CDC guideline on opioid prescribing.
        JAMA. 2016; 315: 1577
        • Dowell D
        • Haegerich TM
        • Chou R
        CDC guideline for prescribing opioids for chronic pain—United States, 2016.
        MMWR Recomm Rep. 2016; 65: 1-49
        • Kolodny A
        • Courtwright DT
        • Hwang CS
        • et al.
        The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction.
        Annu Rev Public Health. 2015; 36: 559-574
        • Volkow ND
        • Frieden TR
        • Hyde PS
        • Cha SS
        Medication-assisted therapies—tackling the opioid-overdose epidemic.
        N Engl J Med. 2014; 370: 2063-2066
        • Murthy VH
        Letter from the surgeon general.
        (TurnTheTideRx website) (Accessed September 15, 2016)
        • Office of the Surgeon General
        Prescribing opioids for chronic pain [pocket card].
        (TurnTheTideRx website) (Accessed September 15, 2016)
        • Butler MM
        • Ancona RM
        • Beauchamp GA
        • et al.
        Emergency department prescription opioids as an initial exposure preceding addiction.
        Ann Emerg Med. 2016; 68: 202-208
        • Chesters A
        • Atkinson P
        Fascia iliaca block for pain relief from proximal femur fracture in the emergency department: a review of the literature.
        Emerg Med J. 2014; 31: e84-e87
      1. Grissa MH, Baccouche H, Boubaker H, et al. Acupuncture vs intravenous morphine in the management of acute pain in the ED [published online ahead of print July 20, 2016]. Am J Emerg Med. doi:http://dx.doi.org/10.1016/j.ajem.2016.07.028.

        • Cantrill SV
        • Brown MD
        • Carlisle RJ
        • et al.
        Clinical policy: critical issues in the prescribing of opioids for adult patients in the emergency department.
        Ann Emerg Med. 2012; 60: 499-525
        • del Portal DA
        • Healy ME
        • Satz WA
        • McNamara RM
        Impact of an opioid prescribing guideline in the acute care setting.
        J Emerg Med. 2016; 50: 21-27
        • Neven DE
        • Sabel JC
        • Howell DN
        • Carlisle RJ
        The development of the Washington State emergency department opioid prescribing guidelines.
        J Med Toxicol. 2012; 8: 353-359
        • Chu J
        • Farmer B
        • Ginsburg BY
        • et al.
        New York City emergency department discharge opioid prescribing guidelines.
        (Accessed September 15, 2016)
        • Centers for Disease Control and Prevention
        Injury prevention and control: opioid overdose: state successes.
        (Updated March 23, 2016. Accessed September 15, 2016)
        • Prescription Drug Monitoring Program Center of Excellence at Brandeis
        Mandating PDMP participation by medical providers: current status and experience in selected states.
        (Accessed April 18, 2016)
        • Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis
        Authorized requestors of PDMP data.
        (Accessed September 15, 2016)
        • Setnik B
        • Roland CL
        • Sommerville KW
        A multicenter, primary-care based, open-label study to identify behaviors related to prescription opioid misuse, abuse, and diversion in opioid-experienced patients with chronic moderate-to-severe pain.
        J Pain Res. 2015; 8: 361-373
        • Humphreys K
        An overdose antidote goes mainstream.
        Health Aff. 2015; 34: 1624-1627
      2. SBIRT article.

        • Jamison RN
        • Sheehan KA
        • Scanlan E
        • Matthews M
        • Ross EL
        Beliefs and attitudes about opioid prescribing and chronic pain management: survey of primary care providers.
        J Opioid Manag. 2014; 10: 375-382
        • Carr DB
        Patients with pain need less stigma, not more.
        Pain Med. 2016; 17: 1391-1393
        • St. Marie B
        Primary care experiences of people who live with chronic pain and receive opioids to manage pain: a qualitative methodology.
        J Am Nurse Pract. 2016; 28: 429-435
        • Dwyer K
        • Walley AY
        • Langlois BK
        • et al.
        Opioid education and nasal naloxone rescue kits in the emergency department.
        West J Emerg Med. 2015; 16: 381-384
        • Manworren RC
        • Gilson AM
        Nurses’ role in preventing prescription opioid diversion.
        Am J Nurs. 2015; 115: 34-40

      Biography

      Jonathan Green is Director of Critical Care, Good Samaritan Hospital, Suffern, NY.