Nancy Lawton

Nancy Lawton, MN, ARNP, FNP
President, ARNPs United of Washington State

Two people die of an opioid overdose nearly every day in Washington state. Though heroin and synthetic fentanyl overdoses have increased in number, deaths due to opiates prescribed by providers remain the leading cause of uninten­tional overdose deaths. While the number of prescrip­tions for narcotics is decreasing in Washington, the number of deaths is not.

Nurses have a role to play in reducing opioid deaths in Washington. Here are some things you can do.

  • Enroll in and use the Prescrip­tion Monitoring Program (PMP) http://​www​.wapmp​.org/​p​r​a​c​t​i​t​i​o​n​e​r​/​p​harmacist/
    As of July 2017, 33 percent of ARNPs were enrolled, leading physi­cians in percentage enrolled, but behind Physician’s Assis­tants and Osteo­pathic Physi­cians. When seeing patients in clinical practice, check the PMP before any and every prescrip­tion for a controlled substance is written. If done every time for every patient, we are not targeting any individual. Nurses can be enrolled as delegates to simplify the process in clinic.
  • Become waivered with the DEA to prescribe buprenor­phine. http://​wsna​.to/​A​A​N​P-OpioidCE
    One year after waivers became avail­able, 137 Washington state ARNPs are now regis­tered with the Drug Enforce­ment Agency as buprenor­phine prescribers. Becoming waivered requires 24 hours of contin­uing educa­tion provided free through the American Associ­a­tion of Nurse Practi­tioners and the American Society of Addic­tion Medicine. The training is free, but your time is not. Request additional time from your employer to complete the one-time training. Use a low threshold for patients to access buprenor­phine, even if a patient continues using other drugs or alcohol, buprenor­phine aids the patient in continued positive behavior change. Assist patients to find a source for substance use disorder treat­ment with no wrong door,” including primary care, behav­ioral health or chemical depen­dency treat­ment. Be aware of housing and social services that can support a patient’s efforts to become opioid free.
  • Prevent opioid depen­dence to begin with by careful opiate prescribing.
    Exposure to a first dose of opioids increases the risk of recur­rent use. Recog­nize that acute pain can be quickly addressed with non-opiate options. Chronic non-cancer pain requires a multi­modality approach to learn means of functioning and adapting using nonphar­ma­co­logic methods to maintain a higher quality of life.
  • Follow the recom­men­da­tions of the Agency Medical Director’s Guide­lines for safe prescribing.
    http://​wsna​.to/​A​M​D​-​O​p​i​o​i​d​Guidelines
    If you are a prescriber, refer to the guide­lines. If you support prescribers, make sure they are aware of and follow these guide­lines. The guide­lines answer questions regarding challenging situa­tions, including how to address the acute pain needs of a chronic pain sufferer. Support alter­na­tives to opioid prescribing for chronic pain manage­ment including non-opiate medica­tions, exercise, yoga, counseling and comple­men­tary medicine.
  • Be aware of the new Health Care Authority guide­lines http://​wsna​.to/​H​C​A​-​O​p​i​o​i​d​Guidelines
    HCA restricts opioid prescribing to 18 tablets, a 3‑day supply for patients 20 and under and 42 tablets, a 7‑day supply, for patients over 20.
  • Provide naloxone, a short-term antidote for opioid overdose, to all patients receiving opioid prescrip­tions and to family members who express concerns about relatives with substance use disor­ders.
    Be sure they know how and when to use naloxone. All Safeway and Albert­sons pharma­cies in Washington now have naloxone avail­able directly from pharma­cists. Pharma­cies stock Narcan Nasal Spray, and patients can acquire it after a 15 – 20 minute pharmacy consul­ta­tion. A prescrip­tion permits insur­ance coverage. At increased risk of overdose are persons who have had a period of absti­nence; someone leaving a rehabil­i­ta­tion or detox facility, jail, prison or after a hospi­tal­iza­tion. That person’s toler­ance will have decreased and if they resume opioid intake at the level they did before the period of absti­nence they are at increased risk for overdose.
  • Support efforts for public and private insurers to cover the costs of substance use disorder treat­ment.
    Medicare pays for some services and not others. Similarly, Apple Health programs are incon­sis­tent on what treat­ments for what diagnoses are covered, exposing patients to prohib­i­tive costs.
  • Psychi­atric ARNPs have a special role to play in providing Cogni­tive Behav­ioral Therapy or Dialectic Behav­ioral Therapy as a means of addressing chronic pain.
    The Washington State Depart­ment of Labor & Indus­tries now pays ARNPs 100% of allow­able charges for providing therapy to injured workers and assisting in their return to work.
  • Learn the location of your nearest needle exchange program.
    You can find it on the NASEN direc­tory (https://​nasen​.org/​d​i​r​ectory/wa/). Provide the infor­ma­tion to patients.
  • Keep local and state legis­la­tors informed and ask for their support. Tell you lawmakers about effec­tive, evidence-based substance use disorder treat­ment options and ask them to support and fund these services in our communities.
  • Partic­i­pate in the Univer­sity of Washington Telepain confer­ences.
    http://​depts​.washington​.edu/​a​n​e​s​t​h​/​c​a​r​e​/​p​a​i​n​/telepain/
    Submit infor­ma­tion on a patient problem and experts will provide feedback and sugges­tions for care. Observe and earn contin­uing educa­tion credits.