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Why are nurses still afraid of opioids?

  • Comments (10)

Nurses’ understanding of pain treatment is essential for its effective management. Yet effective pain control often eludes those who most need it particularly when opioid analgesics are involved.

Last month NICE clinical guideline on prescribing opioids to relieve pain was published. It highlighted that up to two-thirds of people with cancer that experience pain need strong opioid and the number is similar in many other advanced and progressive conditions. Yet pain remains under-treated in these groups of patients.

Opioids, especially morphine are vital drugs in our treatment of pain but the public and many health professional misunderstand and misinterpret their use. Myths surround morphine: it is often viewed as a drug of last resort for those who have no hope. We have all seen relatives shake their heads and whisper “They’ve started him on morphine” or met patients who tolerate pain and pride themselves on resisting their opioid medication because they do not want to become addicted. How many nurses believe you can’t give opioids to patients with COPD? Yet they are vital drugs in the management of breathlessness at the end of life.

The Harold Shipman case has left its mark on how prescribers view opioids and I wonder if fear of scrutiny has resulted in an over cautious approach or avoiding prescribing opioid drugs at all. Yet these anxieties should not exist in a health service that has considerable expertise in pain control and palliative care. All health professionals should be able to access this expertise and be confident in their understanding of pain, the drugs used to treat it and their ability to communicate this to patients.

The new NICE guidance highlighted the vital role nurses have in demystifying opioid analgesia for patients and ensuring they understand the benefits and side effects of treatment. To do this, nurses need to challenge their own beliefs and anxieties about these drugs and ensure they approach this vital part of care as knowledgeable practitioners.

  • Comments (10)

Readers' comments (10)

  • Anonymous

    You identified much of the reason yourself, I suspect: legal concerns post Shipman.

    Also, I think, a combination of non-familiarity with opioid administration, and confusion about the law.

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  • If this finding directly affects your practice, then surely as part of continuing professional development you should make yourself familiar with opioid administration and the law in relation to this subject.

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  • It has all got to do with the area you work in, use large amounts for pain relief in your area and there really isn't any mystery. As long as you can count a patients resps, see their eyes and have narcan ready, then no-one should have the jitters to give it. What next, people afraid to go to the barbers because of Sweeney Todd?

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  • Anonymous

    It is a strange scenario, the ambulance service give opoids, trained practitioners with vast experiance and expertise are not permitted to prescibe. i do think that in most instances we should build up to opoids, taking into consideration whether the patient may be driving home after treatment, what the patient needs. But we also need to be aware of the regular attenders with disease e.g. sickle cell, who may expect morphine all the time when there may be occasions when it is not required. Conversly the dislocated ankle who might just be goven volteral. Monitoring of all drugs is reqired including codeine

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  • Anonymous

    I am working in Saudi Arabia, where adequate pain relief for my patients is a daily battle, i am confident in my knowledge of analgesia (as a surgical nurse i give it every day) but i deal with Dr's who are scared to prescribe any kind of opioid for the fear of the patient becoming addicted, and in fact i got told recently by one Dr that there is evidence to show that a person can get addicted to morphine after one dose, and this was her rationale for not prescribing anything more than 650mg of paracetamol for a patient following a laparotomy! This is a huge frustration as lack of knowledge isnt just limited to nurses.......its doctors too!

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  • Anonymous

    I too am a surgical nurse and confident in my knowledge of analgesia and so too are the Doctors we work with...The Dr prescribing 650mg of paracetamol might want to undergo a Laparotomy herself, I can't begin to imagine the pain the patients must be experiencing or maybe some have a higher threshold for pain. The patients I have nursed having undergone this procedure have needed more then paracetamol for management of pain.

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  • Anonymous

    Anonymous | 22-Jun-2012 5:50 pm

    looks like you have an educative role to play there.

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  • Anonymous

    Anonymous | 22-Jun-2012 11:36 pm

    I wish my role in education could be greater, but working with Dr's over here feels like nursing has gone backwards 30 years! My opinion matters to very few even when i present the evidence to back it up! and yes they do need more than paracetamol but the nature of the culture tends to be to put up and shut up as they think analgesia may somehow effect them and their religion!

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  • Anonymous

    Anonymous | 23-Jun-2012 7:01 pm

    from Anonymous | 22-Jun-2012 11:36 pm

    it crossed my mind when I wrote the comment. I guess you have your place in their society and don't have much to say but I thought things were gradually changing with all the highly educated women fighting for their rights. again
    I can only suppose that, assuming you are a foreigner there you are in a different position. I would also imagine, as you point out, that their religious beliefs could play a role as they seem to have so many prohibitions 'in the name of religion'. It is a great shame for you and tragic for the patients.

    I am sure it is an interesting and very valuable professional, personal and cultural experience but I imagine you have to tread very carefully and know you place but I am sure you could gradually exert a little pressure for change very slowly and subtly.

    all the best.

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  • Quite a lot of drugs between Paracetomol and Morphia.Non opiods plus adjuvant for low pain, Small dose opiod +/- adjuvant, or non opiod for mod pain and step up doses for servere pain. morphine should not be 1st choice and should be used with caution. That's why it's DD. Risk of OIH. which I have experienced once and that was enough-it's intractable. Take care, pals

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