June 15, 2018

Opioid Addiction: Nursing Facilities Adapting to Admission and Resident Care Challenges

By Steven Lavenda and the Marcum Midwest Healthcare Team

Opioid Addiction: Nursing Facilities Adapting to Admission and Resident Care Challenges

In May, the Justice Department placed a $5,000 civil penalty on a Norwood, MA, nursing facility for denying admission to a patient who had been receiving treatment for opioid dependency. The main issue at hand was the ability of the facility to prescribe and administer the drug Suboxone, which is used in the treatment of opioid addiction. Due to state and federal regulations, there are specific requirements that staff would need to meet in order to treat residents who are battling addiction. The facility felt it was ill-equipped to handle this patient and denied the admission.

In its claim against the nursing facility, the Justice Department stated that the actions of the nursing facility failed to comply with the Americans with Disabilities Act, and therefore, nursing facilities may not turn away residents due to the need for opioid addiction treatment.

Despite the Justice Department’s efforts to crack down on this issue, there is good news in the fight against the opioid crisis, which will directly affect nursing facilities. Several private sector as well as government entities are working on long-term solutions to the opioid epidemic.

One of the biggest private sector moves comes from Aetna, Anthem, and Cigna, which have removed pre-authorization requirements for medications that assist with opioid withdrawal. With the removal of pre-authorization requirements for opioid dependency treatment, other insurance companies may follow suit. This will help materially with accessibility to medications that are used in treatment.

In addition, the Department of Health and Human Services (HHS) has developed a strategy that will focus on better prevention, better data on the epidemic, better pain management, better targeting of overdose-reversing drugs, and better research on pain and addiction. HHS has also promised $485 million in funding and prevention/treatment grants.

While the fight against opioid addiction continues, nursing facilities are still faced with the dilemma of how to handle admissions of patients facing addiction. Only specially equipped facilities can handle full-blown addiction patients, but what about a senior who is recovering from knee surgery, who is admitted to a nursing facility and is still suffering from pain and using medications that have addictive characteristics?

The Center for Disease Control (CDC) has recommendations for post-acute care (PAC) facilities that can help to prepare and equip the facility should the case arise:

  • Facilities should consider nonpharmacological therapy and non-opioid pharmacologic therapy for chronic pain. Opioid therapy should be used only if the expected benefits for both pain and function are anticipated to outweigh risks to the patient.
  • Before starting opioid therapy for chronic pain, facilities should establish treatment goals with the resident, including realistic goals for pain and function.
  • Before starting and periodically during opioid therapy, facilities should discuss with patients known risks and benefits of opioid therapy.
  • When opioids are started, small doses should be prescribed first, with reassessments performed regularly.
  • Staff should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation.
  • Staff should review the patient’s history of controlled substance prescriptions using stat prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or dangerous combinations that put the patient at higher risk for overdose.
  • Facilities should avoid using opioid pain medication and benzodiazepines at the same time, whenever possible.

As serious as the opioid epidemic is, there are efforts being made to cut down on the number of addictions. But it will take time. Currently, nursing facilities are under scrutiny for their admission practices regarding opioid addiction, but with knowledge and recommendations from the CDC, there are steps that can be taken to help manage these challenges.

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