3 Ways CRNAs Can Fight the Opioid Crisis

Certified registered nurse anesthetists, or CRNAs, administer more than 49 million anesthetics to patients every year in a wide variety of settings, according to a 2019 survey by the American Association of Nurse Anesthetists (AANA). They are also the primary providers of anesthesia in rural settings.

As a result, CRNAs are important members of the care team who can make a real difference in addressing the ongoing crisis of opioid dependence.

“CRNAs are uniquely qualified and positioned to help mitigate the opioid crisis, and we’re calling on the healthcare community at large to utilize opioid-sparing pain management techniques to better prevent opioid addiction and abuse,” said AANA President Kathryn Jansky, MS, CRNA, APRN.

How serious is the opioid crisis?

Approximately 2.1 million people struggled with an opioid use disorder in 2016, according to the 2017 National Survey on Drug Use and Health, Mortality in the United States. Opioid overdoses were responsible for more than 42,000 deaths that year, as well.

Since 1999, deaths involving opioids have increased by more than five times, and an average of 130 people die each day from an opioid overdose, including prescription and illicit opioids, according to the Centers for Disease Control and Prevention (CDC).

In 2017, the U.S. Department of Health and Human Services declared the opioid epidemic a “public health emergency” and released a five-point strategy to combat the problem.

While there have been some positive developments recently, including a downward trend in the number of heroin users, opioid abuse remains a crisis that has yet to be solved.

Three ways CRNAs are combatting opioid dependency

Here are a few key elements that CRNAs can offer toward the goal of combatting opioid abuse and addiction:

1. Experience and education

CRNAs are advanced practice nurses who are prepared with the education and clinical experience necessary to do their jobs and share their knowledge with others. “As part of their educational preparation, CRNAs are required to learn and demonstrate competence in the management of pain, a critical component in the delivery of anesthesia care,” said Jansky.

CRNAs work with many patients who are “opioid naïve,” and can contribute to educating these patients. But they are also prepared to work with patients who may struggle with an addiction or substance abuse problem. CRNAs have been proactive about educating themselves about the best way to help such people, Jansky said. The AANA has also developed practice considerations to guide nurse anesthetists when working with a patient who is affected with a substance use disorder.

CRNAs have also been advocates for the use of medication-assisted treatment (MAT) like buprenorphine to help people who are addicted to opioids. CRNAs were already able to prescribe MAT in some states, as the AANA noted in its support for the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act, which became law in October 2018.

The SUPPORT Act set up a pilot program for advanced practice nurses, including CRNAs, to receive a waiver from the Drug Enforcement Agency (DEA) so they can prescribe MAT. That waiver application is not yet available, but the AANA and other groups are continuing to push for it.

2. Enhanced Recovery After Surgery (ERAS)

CRNAs can carry out Enhanced Recovery After Surgery (ERAS®) opioid prescribing recommendations. These recommendations are patient-centered, evidence-based pathways developed to reduce a patient’s surgical stress response, optimize their physiologic function and facilitate recovery, according to Jansky. The pathway begins during pre-admission and continues through every phase of the patient’s hospital stay until the patient is home again.

These protocols include “robust patient communication” as well as opioid-sparing techniques like peripheral nerve blocks, regional anesthesia, and others to help patients control their pain. And research shows that adopting them can lead to numerous significant improvements.

“Specifically, patients experience faster recovery, shortened hospital stays, and significantly fewer complications,” said Jansky.

3. A multi-modal approach to pain management

Healthcare providers are encouraged to use a multi-modal approach, rather than relying just on opioids for pain management.

Whereas a patient might have relied on just one type of pain management medication in the past, today’s patients may be offered both pharmacologic and nonpharmacologic therapies to help them manage their pain, including post-surgical pain. CRNAS may determine that a patient could benefit from using medications in different pharmacologic analgesic classes, such as NSAIDs or perhaps COX-2 inhibitors, depending on the patient’s health.

Multi-modal pain management is also integrated as a key element of ERAS protocols to manage pain.

“Adopting a multi-modal approach to pain management offers patients greater transparency, understanding, and engagement in their care,” explained Jansky.

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