recognition is critical to reducing severe outcomes. During a comprehensive review of systems, the clinician should ask about the recent use of e-cigarettes or vaping. If confirmed, ask about the type of substance (THC, nicotine) utilized.
Laboratory tests should be guided by clinical findings as well as practice guidelines. Community-acquired pneumonia and influenza are evaluated since EVALI is difficult to differentiate from these diagnoses (CDC, 2020).
OPIOID USE DISORDERS
use leading to clinically significant impairment or distress, with at least two of the following in a 12-month period: ● An individual takes opioids in larger amounts over a more extended period than intended. ● A persistent desire or unsuccessful efforts to cut down on opioid use occur. ● A great deal of time is spent in activities necessary to obtain opioids. ● An individual has a craving or strong desire or urge to use opioids. ● Recurrent opioid use occurs despite failing to fulfill significant work obligations. ● Opioid use continues despite having persistent recurrent social and interpersonal problems caused by opioids. ● Important social, occupational, or recreational activities are given up or reduced because of opioid use. ● Recurrent opioid use occurs in situations that are physically hazardous. ● Continued opioid use occurs despite knowledge of persistent or recurrent psychological or physical problems. ● Tolerance means a need for a markedly increased amount to achieve intoxication and markedly diminished effect with continued use of the same amount of opioids. ● Withdrawal occurs. (APA, 2013) Epidemiology of opioid use disorders From 1999 to 2020 more than 564,000 individuals died from an overdose involving opioids (CDC, 2020). The rise in opioid overdose deaths is outlined in three distinct waves. The first wave began in 1999 with increased opioid prescribing. The second wave started in 2010 with rapid increases in overdose deaths involving heroin. Finally, the third wave started in 2013 with synthetic opioids like fentanyl, which now comes across the border and is responsible for hundreds of thousands of deaths (CDC, 2022). Risk factors in opioid use disorders In general, individuals take substances for a variety of reasons, including (1) pleasure; (2) an escape from social anxiety, stress, and depression; (3) to increase performance; (4) curiosity and social pressure (National Institute on Drug Abuse [NIDA], 2020). Therefore, no single factor determines whether an individual becomes addicted to drugs, whether biological or environmental (NIDA, 2020). Biological influences include genetics, gender, and mental disorders, while environmental impacts include chaotic home situations, parental use and attitudes, peer influences, community attitudes, and low academic achievement (NIDA, 2020). Risk factors for substance abuse include (1) aggressive behavior in childhood, (2) lack of parental supervision, (3) peer refusal skills, (4) drug experimentation, (5) availability of drugs at school, and (6) community poverty (NIDA, 2020). Protective factors reduce an individual’s risk of substance use and include (1) self-efficacy affected by personal and home situations, (2) parental monitoring and support, (3) positive relationships, (4) extracurricular activities, (5) anti-drug policies at school, and (6) neighborhood resources (NIDA, 2020). One of the most significant changes during development in adolescence is the maturing prefrontal cortex, which is responsible for assessment of situations, making sound
Opioid use disorder (OUD) has reached epidemic proportions with substantial negative impacts on society. OUD is a chronic, relapsing disease influenced by genetics, stress response, and prior experimentation or exposure (Brown & Capili, 2020). Mu opioid receptors (MORs) modulate nociception, stress, temperature, respiration, endocrine activity, memory, mood, and motivation (Herman et al., 2022). MORs bind opioids, delta opioids, kappa opioids, and nociception receptors to increase drug tolerance. Physical dependence can develop between 2 and 10 days of continuous use, with withdrawal symptoms occurring when stopped abruptly (Herman et al., 2022). Nurse practitioners (NPs) care for patients with many ailments in many healthcare settings. Patients might seek care for an acute illness or the worsening of a chronic condition. Often, pain is the leading reason for seeking medical care. Appropriate prescribing practices are critical for all medications, but drugs considered controlled substances require additional attention. The Drug Enforcement Agency (DEA), the Food and Drug Administration (FDA), and the U.S. Department of Health and Human Services (HHS) all have a role in determining the scheduling of prescription medications. As prescribers, NPs must understand federal and state requirements for prescribing all controlled substances. In addition, inappropriate prescribing practices resulting in misuse/ or abuse of opioids have led to many changes, including new safety and quality recommendations. Prescribing any medication must be performed with care while considering possible patient-specific risks. Prescribing controlled substances requires a heightened awareness for both patient and provider. Federal and state laws and regulations must be followed when prescribing controlled substances. Additionally, other issues, including the more widespread availability of medical marijuana and the opioid epidemic, have increased the complexity of the controlled substance prescribing process. All prescribers must be aware of federal and state laws regulating controlled substances. Prescribing opioid analgesics for acute and chronic pain has come under intense scrutiny as the opioid epidemic has worsened. In 2020, the U.S. Department of Health and Human Services estimated that 10.1 million people misused prescription opioids. Opioid overdoses, prescription and illicit, accounted for 42,000 deaths; 40% involved a prescription opioid (HHS, 2021). Appropriately prescribing first-time opioid analgesics for acute pain is critical in preventing future opioid abuse (Goldstick et al., 2021). Individualized tapering plans minimize symptoms of opioid withdrawal while maximizing pain treatment with nonpharmacologic therapies and nonopioid medications (CDC, 2022a). Understanding patient-specific risk factors and prescribing strategies for chronic pain management is also critical in preventing misuse and abuse of opioid analgesics. OUD can occur at any age but is usually first identified in the late teens or early 20s (American Psychological Association [APA], 2013). It is considered a problematic pattern of opioid use leading to clinically significant impairment or distress, with at least two of the following in a 12-month period. OUD can occur at any age but is usually first identified in the late teens or early 20s (American Psychological Association [APA], 2013). It is considered a problematic pattern of opioid
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