Willingness to Provide Naloxone Resources for Patients at Risk of Opioid Overdose: A National Survey of Emergency Registered Nurses.

INTRODUCTION: Opioid-related events continue to claim lives in the United States at alarming rates. Naloxone-dispensing rates fall dramatically short of national expectations. Emergency registered nurses are uniquely poised to connect at-risk patients with naloxone resources. This study sought to (1) describe the emergency registered nurses' willingness to provide naloxone resources and (2) explore variables that may influence the nurse's willingness to provide resources. METHODS: A cross-sectional, survey-based design was deployed using an online branch logic approach to include a national sample of emergency registered nurses. The Willingness to Provide, a validated questionnaire, measured the registered nurse's willingness to provide naloxone resources for patients at risk of opioid overdose. Eight variables were assessed for potential influence on willingness. RESULTS: A total of 159 nurses from 32 states and the District of Columbia completed the online survey via the Research Electronic Data Capture platform. The results revealed a mean Willingness to Provide score of 38.64 indicating a willingness to provide naloxone resources. A statistically significant relationship was identified between the nurse's willingness and years of nursing experience (P = .001), knowledge (P = .015), desire (P = .001), and responsibility (P < .001). DISCUSSION: In this representative sample, emergency nurses are willing to provide naloxone resources; furthermore, results indicate that higher knowledge, desire, and responsibility scores increase the nurse's willingness to provide naloxone resources; with education and clear expectations, emergency nurses may be able to improve the connection of patients at risk of opioid overdose with naloxone, a potentially lifesaving connection.

Nonpharmacological interventions for acute pain management in patients with opioid abuse or opioid tolerance: a scoping review.

OBJECTIVE: The objective of this scoping review was to identify and map the evidence on nonpharmacological interventions for acute pain management in patients with opioid tolerance or opioid abuse. INTRODUCTION: Opioid therapy is the mainstay of pain management for adults experiencing moderate-to-severe acute pain. However, considering the known risks of opioid use and the growing number of patients with opioid tolerance or opioid abuse, nonpharmacological pain management interventions are of increasing interest to health care providers. Nonpharmacological techniques have shown potential in reducing postoperative pain, opioid consumption, stress, and anxiety. INCLUSION CRITERIA: Eligible studies included participants in either inpatient or outpatient health care settings who were experiencing acute pain and a tolerance to opioid medications or opioid abuse. Studies that examined nonpharmacological interventions for treating acute pain in these patients were considered. Nonpharmacological interventions included, but were not limited to, acupuncture, electroacupuncture, massage, mindfulness, electroanalgesia, low-level light therapy, meditation, biofeedback, hypnosis, and relaxation techniques. METHODS: MEDLINE, CINAHL, Scopus, Embase, Europe PubMed Central, PsycINFO, Cochrane Central Register of Controlled Trials, and the US National Library of Medicine ( https://ClinicalTrials.gov/ ) were searched, as were sources of unpublished studies on December 30, 2020. Only studies published in English were included, and there was no limit on date of publication. After screening the titles and abstracts of identified citations, 2 independent reviewers retrieved potentially relevant full-text studies and extracted data. Data are presented in diagrammatic format, and accompany the narrative synthesis. RESULTS: Fourteen articles were included in the study, including 10 expert opinion papers or chapters, 3 case reports, and 1 implementation report. The most common setting was the perioperative setting, specifically orthopedic surgery. Nonpharmacological pain interventions identified in the literature included physical interventions such as acupuncture, physical therapy, therapeutic exercise, yoga, bracing, heat, cold, elevation, compression, chiropractic interventions, massage, manual therapy, transcutaneous electrical nerve stimulation, and pulsed electromagnetic field therapy. Behavioral and psychological modalities included positive affirmations, cognitive behavioral therapy, acceptance and commitment therapy, mindfulness, distraction, guided imagery, meditation, biofeedback, relaxation, hypnosis, breathing exercises, and energy healing. Many expert opinions included only brief mentions or recommendations for nonpharmacological interventions without full explanations, evidence from the literature, or discussion of the level of support for the recommendation. CONCLUSIONS: The findings of this review indicate that nonpharmacological interventions for patients with opioid tolerance or dependence include physical, psychological, and multimodal approaches. Nonpharmacological interventions in this scoping review were often presented as combined with opioid or non-opioid medications for a pain management regimen that is opioid-sparing, opioid-free, or drug-free. More primary research is needed on the nonpharmacological acute pain management of patients with opioid dependence or opioid tolerance.

The lived experiences of families of an adult community-dwelling person who uses drugs: a qualitative systematic review protocol.

OBJECTIVE: The objective of this review is to identify, appraise, and synthesize available evidence related to the lived experiences of families with an adult community-dwelling person who uses drugs. INTRODUCTION: The stigma experience of persons who use drugs is documented in the literature, yet little is known about the families' lived experience with a loved one who uses drugs. While often identified as an important adjunct to treatment, evidence regarding the families' lived experiences relevant to their psychosocial, physical, mental, and family health needs has received less attention. The stigma, as well as other experiences associated with a family member's substance use, warrants further investigation. This review seeks to understand the lived experiences of families with an adult community-dwelling person who uses drugs as documented within the literature. INCLUSION CRITERIA: Studies published in English that include families of an adult community-dwelling person who uses drugs, from any race or geographical location, and that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, and feminist research will be included in the review. METHODS: Information sources to be searched are CINAHL, PubMed, PsycINFO, Psychology and Behavioral Sciences Collection, ProQuest Dissertations and Theses, MedNar, and Scopus. A three-step search strategy will be undertaken. Included studies will be assessed for methodological quality independently by two reviewers, and findings will be extracted and synthesized. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020175645.

Non-pharmacological interventions for acute pain management in patients with opioid abuse or opioid tolerance: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify and map the evidence on non-pharmacological interventions for acute pain management in patients with opioid tolerance and opioid abuse. INTRODUCTION: The mainstay of pain management for adults experiencing moderate to severe acute pain is opioid therapy. However, in light of the known risks of opioid use and the growing number of patients with opioid tolerance or opioid abuse, non-pharmacological interventions are of increasing interest to healthcare providers. Non-pharmacological techniques have shown potential in reducing postoperative pain, opioid consumption, stress and anxiety. INCLUSION CRITERIA: Eligible studies will include participants in a hospital or healthcare facility who are experiencing acute pain and have a tolerance to or dependence on opioids. Studies that examine non-pharmacological interventions for treating acute pain in these patients will be considered. Non-pharmacological interventions may include, but are not limited to, acupuncture, electroacupuncture, massage, mindfulness, electroanalgesia, laser therapy, low-level light therapy, meditation, biofeedback, hypnosis and relaxation techniques. Only studies published in English will be included, and there will be no limit on dates of publication. METHODS: PubMed, CINAHL, Scopus, Embase, Europe PubMed Central, PsycINFO, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov will be searched, as well as sources of unpublished studies. After screening the titles and abstracts of identified citations, two independent reviewers will retrieve potentially relevant full-text studies, assess methodological quality and extract data. Data will be presented in diagrammatic or tabular form, and a qualitative thematic analysis will be undertaken. A narrative summary will accompany the tabulated results.