10.7 Opioid Analgesics and Antagonists
Opioid analgesics are prescribed for moderate and severe pain. There are several types of opioids, as listed in Table 10.4 in the previous “Applying the Nursing Process to Pain Management” section. Before discussing morphine, the prototype opioid analgesic, and its antagonist, naloxone, let’s discuss the opioid epidemic in the United States, efforts to stop this epidemic, and the dangers of drug diversion.
Understanding the Opioid Epidemic
The drug overdose epidemic continues to worsen in the United States. Overdose deaths remain a leading cause of injury-related death. In the United States, drug overdoses have claimed over 932,000 lives over the past 21 years. The majority of overdose deaths involve opioids. Deaths involving synthetic opioids (i.e., illicitly made fentanyl) have increased in recent years, especially during the COVID-19 pandemic.[1]
The rise in opioid overdose deaths can be outlined in three distinct waves. See Figure 10.7[2] for a graphic representation of the waves of opioid deaths.
The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone). The second wave began in 2010 with rapid increases in overdose deaths involving heroin. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, especially those involving illicitly manufactured fentanyl.[3]
CDC’s Educational Campaigns
To save lives from drug overdose, the Centers for Disease Control and Prevention (CDC) launched four education campaigns to reach young adults (ages 18-34). The campaigns provide information that can save the lives and highlight actions the public can take to help prevent overdose. Specifically, the campaigns provide critical information about these topics[4]:
- Dangers of fentanyl
- Risks and consequences of mixing drugs
- Life-saving power of naloxone to reverse an opioid overdose
- Importance of reducing stigma to support treatment and recovery
Read more information about the CDC campaigns to stop overdose deaths.
CDC Guidelines for Prescribing Opioids for Chronic Pain
In addition to establishing educational campaigns to prevent opioid deaths, the CDC has also established new clinical practice guidelines regarding the prescription of opioids to ensure clients have access to safer, effective pain treatment while also reducing the number of people who misuse or overdose from these drugs. The CDC’s Clinical Practice Guidelines for Prescribing Opioids – United States, 2022 was developed for the prescribing of opioid pain medication for clients 18 and older in primary care settings. Recommendations focus on the use of opioids in treating acute pain (pain lasting less than one month), subacute pain (pain lasting one to three months, and chronic pain (pain lasting longer than three months). This clinical practice guideline is intended to improve communication bet