Following my C-section earlier this year, I was fortunate to be able to access heavy-duty pain medication. Until we discovered my pain pump wasn’t working.
That was unfortunate, but luckily I was young(ish), in good health(ish) and had a new baby. But as AMDA – The Society for Post-Acute and Long-Term Care (PALTC) Medicine President Cari Levy, M.D., Ph.D., recounts, many nursing home professionals have stories of people they’ve cared for who couldn’t access pain medication.
“Everybody has one of those in their brains, where the resident was suffering,” she told me Thursday following the announcement of new guidelines from AMDA. “We had to get prescriptions faxed, and it was a weekend and there were all of these hurdles. That’s so unnecessary. That’s a lot of what drives the motion around it.
AMDA has two main goals with its new policies: One, “provide access to opioids when indicated to relieve suffering and to improve or maintain function” and two, “Promote opioid tapering, discontinuation and avoidance of opioids when the above goals are not achievable, to prevent adverse events, dependence and diversion.”
While it’s always been challenging to make sure nursing home residents receive the right amount of pain medication, the opioid epidemic has resulted in some states cracking down to a point that paralyzes effective pain management. Providers have to balance the responsibility to prevent theft of medications with making sure residents are not in pain.
“The epidemic of opioid addiction has affected every sector. That’s the most difficult thing,” said AMDA Executive Director Chris Laxton. “One of the federal responses to the opioid epidemic has been to restrict them. That has resulted in some of our residents who have been well managed to not get access to pain meds when they have needed them.”
He noted that states vary tremendously on rules, which can make it difficult for a national organization to give blanket guidelines.
“We would really like to see a more consistent approach from state to state,” he said.
Of course, how states manage opioids can often depend on how badly hit citizens have been by opioid addiction. In communities devastated by overdoses, it would follow that a clampdown on the drugs would result in perhaps overcorrection in nursing homes.
“Opioids are poorly understood,” Laxton said. “When people say, ‘We can’t ever use opioids,’ that’s not an appropriate approach to take.”
At the same time, AMDA and other organizations know drug division happens across all settings. Staffers have to be screened appropriately, and a “team-based” approach is needed to managing cases.
“Pain management is the poster child for team-based care,” Laxton says.
When discussing when opioids are appropriate, clinicians should look at side effects, Levy notes. For example, a resident may be very constipated, or immobile from the opioids. That might mean tapering the drug.
It all can feel like a lot to take in, which is why medical directors should appreciate AMDA’s work on the guidelines. There is no magic switch to better opioid management, but we can move forward.
“I don’t think it will ever be possible to prevent 100 percent [of diversions], but we can do a better job,” Laxton said.
On behalf of those coming out of surgery pressing their pain pump, we thank every provider who agrees.
Follow Senior Editor Elizabeth Newman @TigerELN.