NURS2172 Workforce Challenges For Take Home Naloxone Program
Question:
Describe the workforce or community challenges fortraining/policy.
Make recommendations for implementation of effectivestrategies.
Answer:
Introduction
Take home naloxone program in Australia is a turning point in the health care system since it began in 2012.It inculcates the naloxone kit which consists of the 400milligrams ampoule containing naloxone,gloves,needles and swabs to take home.One of its major aims is saving lives.Due to opioid overdosage naloxone is administered and it displaces the opioid from its receptor hence reversing respiratory depression which causes death.Another aim is to reduce opioid-related fatalities such as suicide.The program involves training of trainers,drug users,peer groups and sometimes family of a drug user.The training aspect is a stepping stone in the success of take home naloxone program.It faces various challenges and there is need to overcome them for a successful program.
Workforce and community challenges for training/policy
The person of interest who is at risk of opiate overdose faces the majority of challenges in training of take home naloxone program.The major challenge is the user’s worry that the nearby persons who administer the naloxone may not have knowledge of administering naloxone.Galea et al(2015) state the majority of drug users had a recurring fear on the competency of the bystanders.Therefore drug users should be trained on the benefits of the take home naloxone outshining their fear and saving their lives.
Economical constraints since training require payment of the trainers and necessitate additional trainers,infrastructure hence increasing the cost.(Behar,Santos,Wheeler,Rowe &Coffin,2015) explains the correlation between limitation of training programs and high expenditure of the same.High training costs inhibit the effectiveness of the program and the spread of take home naloxone programs.Consequently proposals should be made to various government agencies, nongovernmental organizations and donors for funding.
Legal obstruction is a challenge facing training for home naloxone program. This is two dimensional to the health care provider due to medical-legal issues concerning prescription of naloxone to friends or family members of users. (Rees, Sabia, Argys, Latshaw&Dave,2017) states that a layperson is permitted to dispense naloxone in opioid overdose. The other dimension is harassment of the user by law enforcement officers if found with the naloxone kit in the car or public places. Local laws should be amended to ensure the safety of medical providers while prescribing naloxone. Also legal documents provided to users to show they are licensed to have the naloxone kits.
Stigma related to abuse of opioids may lead to reluctance in participation of naloxone take home training. (Olsen,2015) states that a huge proportion of community attribute opioid abuse as a result of moral weakness rather than as a medical illness. The affected individual is hesitant to seek medical care due to stigma. The healthcare workers often underestimate the role of opioids in illnesses leading to misdiagnosis. Mass education to the public would demystify stereotypes associated with opioid abuse. Health care workers are trained in sole opioid abuse management and dealing with clients respectfully.
Implementation of effective strategies
Training health care providers on risks of overprescribing opioids, how to identify opioid overdosage and take home naloxone kits would not only save lives but also ensure proper dispensing of opioids. (Winograd,Davis,Niculete,Oliva&Martielli,2017) states that some providers believe they lack knowledge of opioid overdose prevention techniques and hold concerns on overdose education and naloxone distribution. Hence training enhances knowledge and dealing with emergency opioid overdose.
Involvement of law enforcement officers and the legal arm of the federal government during policy making of take home naloxone programs.(Deonarine,Amlani,Ambrose&Buxton,2016) states that facilitating communication between take home naloxone program participants and other stakeholders may address some of the confusion and remove potential barriers to further improving program outcomes.Therefore harmony is ensured if the law officers have knowledge on naloxone kits, therefore, no arrest of someone with a warrant or legal document.
Investment towards the take home naloxone program aids in ensuring its success. (Strang, Bird, Dietze, Gerra&McLellan,2014) states that funding of naloxone program to drug companies ensures smooth flow of naloxone distribution during the training programs but there is a need for additional funding. This may be facilitated by writing proposals to non-governmental organizations and donors interested in such a drive requesting for funding.As a result it will enhance smooth operations of the program.
Use of peer drug groups to educate friends together on how to use naloxone in case of an emergency. This would not only increase awareness but also help in efficient reversal. (Kerr,2014) states that a majority of peers were positive towards naloxone distribution and they were willing to participate in a training program. The inclusion of peer groups would lead to vast spread of information on take home naloxone program.
Education towards the family members is a crucial factor in success of take home naloxone. This is because opioid overdose occurs at home. According to (Bagley,2018) family members are active participants in responding to overdose and rescuing them. Therefore, involving the family is a positive step towards ensuring success of naloxone take home program.
Nursing education
This involves a prompt reversal of opioid overdose and ensuring normal physiological mechanisms disrupted are restored. (Warner, Darke&Day,2015) states that there is extensive morbidity associated with heroin overdose as some require immediate hospitalization due to complications. There is a great need for nurses to be aware of naloxone in managing opioid overdose. The nurse should be trained on recognizing an overdose,positioning of the patient to enable breathing, performing cardiopulmonary resuscitation, measuring the naloxone dose and giving the intramuscular injection. The nurse is also involved in training and distribution of naloxone supply under a physician order.
Client education
The main focus is on client-oriented care hence a client is given knowledge regarding the take home naloxone. Strang et al. (2014) argue that users can be trained in effect actions in overdose. This includes use of naloxone, cardiopulmonary resuscitation ,rescue breaths and intramuscular injection in the thigh.
Conclusion
Challenges facing training and policy are present and with cooperation from the government and various stakeholders involved to ensure they are dealt with appropriately and spread of same.
References
Bagley, S. M., Forman, L. S., Ruiz, S., Cranston, K., & Walley, A. Y. (2018). Expanding access to naloxone for family members: The Massachusetts experience. Drug and alcohol review, 37(4), 480-486.
Behar, E., Santos, G. M., Wheeler, E., Rowe, C., & Coffin, P. O. (2015). Brief overdose education is sufficient for naloxone distribution to opioid users. Drug and alcohol dependence, 148, 209-212.
Deonarine, A., Amlani, A., Ambrose, G., & Buxton, J. A. (2016). Qualitative assessment of take-home naloxone program participant and law enforcement interactions in British Columbia. Harm reduction journal, 13(1), 17.
Galea, S., Worthington, N., Piper, T. M., Nandi, V. V., Curtis, M., & Rosenthal, D. M. (2015). Provision of naloxone to injection drug users as an overdose prevention strategy: early evidence from a pilot study in New York City. Addictive behaviors, 31(5), 907-912.
Kerr, D., Dietze, P., Kelly, A. M., & Jolley, D. (2014). Attitudes of Australian heroin users to peer distribution of naloxone for heroin overdose: perspectives on intranasal administration. Journal of Urban Health, 85(3), 352-360.
Olsen, Y., & Sharfstein, J. M. (2015). Confronting the stigma of opioid use disorder—and its treatment. Jama, 311(14), 1393-1394.
Rees, D. I., Sabia, J. J., Argys, L. M., Latshaw, J., & Dave, D. (2017). With a little help from my friends: The effects of naloxone access and good samaritan laws on opioid-related deaths (No. w23171). National Bureau of Economic Research.
Strang, J., Bird, S. M., Dietze, P., Gerra, G., & McLellan, A. T. (2014). Take-home emergency naloxone to prevent deaths from heroin overdose. BMJ: British Medical Journal (Online), 349.
Strang, J., Manning, V., Mayet, S., Best, D., Titherington, E., Santana, L., … & Semmler, C. (2014). Overdose training and take?home naloxone for opiate users: prospective cohort study of impact on knowledge and attitudes and subsequent management of overdoses. Addiction, 103(10), 1648-1657.
Warner?Smith, M., Darke, S., & Day, C. (2015). Morbidity associated with non?fatal heroin overdose. Addiction, 97(8), 963-967.
Winograd, R. P., Davis, C. S., Niculete, M., Oliva, E., & Martielli, R. P. (2017). Medical providers’ knowledge and concerns about opioid overdose education and take-home naloxone rescue kits within Veterans Affairs health care medical treatment settings. Substance abuse, 38(2), 135-140
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