The announcement of a coordinated New Orleans strategy to tackle the opiate epidemic, left me, as a nurse, with more questions than answers. Nurses play an integral role in patient education and advocacy. We spend more time with our patients than anyone else, but will we have a seat at the table when it comes to deploying this strategy?
Nurses skilled in harm reduction are obvious partners in the city’s effort to address the opiate epidemic. Harm reduction is set of evidence-based strategies to meet drug users “where they are at.” Often patients who use injection drugs are “frequent flyers,” meaning they are in and out of our local emergency rooms or police departments. These frequent interactions provide an opportunity for engagement, education, and, perhaps, behavior change.
Harm reduction does not minimize the dangers posed by illicit drug use, but instead uses easy to understand interventions to educate drug users on a range of health topics relevant to them. Promoting healthy behaviors include: how to decrease vein trauma and spot infection; the appropriate use of antibiotics; how to clean needles and inject safely; and how to administer naloxone, the overdose reversal drug.
Nurses are coordinators of care, and the existing lack of access to specialists, for the uninsured and underinsured, is a near-constant frustration for us. Even if our patients want substance abuse treatment, we often cannot find them any place to go due to our incredibly low rates of Medicaid reimbursement. Physicians often cannot afford to see these individuals. This is a barrier to care. Nurses are aware of community resources and can provide much-needed advocacy around increasing access to treatment for these community members.
Harm reduction is not the only solution, but it is a critical part of the solution. Nurses are in the business of promoting health and preventing disease. The city should consider deploying “street nurses.” These nurses would provide wound care, antibiotic treatment, testing and treatment for sexually transmitted infections, pregnancy tests, rapid HIV and hepatitis C testing, and vaccinations for people who inject drugs in our city through standing orders with a collaborating physician or nurse practitioner. These Street Nurses would meet users who are living on the street and provide a gateway to care, treatment, and education. Street Nurses would provide education in our health professional schools, local hospitals, police headquarters, and prisons.
Nurses are not angels, we are radical patient advocates who have a part to play in addressing this epidemic in our beloved city. Please give us a seat at the table.