Narcotics M01

Care and Compliance Group, Inc. ‐ [email protected] ‐ (800) 321‐1727

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The abuse of prescription pain killers now ranks

d l b hi dsecond—only behind marijuana—as the Nation's most prevalent illegal drug

problem.

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Fact source: http://www.whitehousedrugpolicy.gov/

drugfact/prescr_drg_abuse.html

Safe Management of Narcotics

An online education course presented by Care and Compliance Group, Inc.

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Narrated byJosh Allen, RN

Care and Compliance Group, Inc.

Module 1


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Many residents in assisted living/residential care Communities have prescriptions for medications that contain a narcotic. Many narcotic medications are potent

Course Description

and must be self administered carefully according to physician’s orders to ensure resident safety. Additionally, many narcotic medications have the potential for addiction; thus, residents must be carefully monitored. Due to the high street value of many narcotic medications, safe medication room practices are imperative to prevent

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medication room practices are imperative to prevent diversion of narcotics to the illicit drug market.

By the end of this course the participant will be able to:

1. Identify the three classifications of analgesics.

2. Name the common examples for the three classifications of

Course Objectives

2. Name the common examples for the three classifications of analgesics.

3. Describe the groups of medications defined by the Controlled Substance Act also referred to as Drug Schedules.

4. Name the forms of narcotics and ways they may be administered or self administered in assisted

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administered or self administered in assisted living/residential care Communities.

5. Explain the importance of handling narcotics differently than other medications in assisted living Communities.


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By the end of this course the participant will be able to, cont.:

6 Explain the recommended medication room practices

Course Objectives

6. Explain the recommended medication room practices for safe handling of narcotics by staff.

7. Distinguish the signs to be aware of resident tolerance, dependence, or addiction to narcotics in assisted living Communities.

8. Describe the use of narcotics for residents on hospice

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care.

Introduction

Common narcotic and non-narcotic medications

C t ll d S b t A t/D S h d l

Course Outline

Controlled Substance Act/Drug Schedules

History and abuse

Safe medication room practices

Monitoring residents on narcotics

Narcotic use in hospice care

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Narcotic use in hospice care


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This course contains information in several short videos. The content contained in the videos is in addition to the written text.

It is strongly recommended that you have speakers on when

Audio and Video Content

viewing the videos.

The text in this course is also narrated. You will need to have your speakers on if you wish to hear the narrator read and comment on the text material.

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Several terms related to resident care are used throughout this course. While most of these terms are commonly accepted in the industry, there is some variation from state to state, and within different organizations. For ease of reading, we use commonly used terms in this course, and l if b l th i l t t d i th t t

Terminology Used In This Course

clarify below the equivalent terms used in other states.

• Community: The term “Community” (using a capital “C”) is used to describe the assisted living/residential care setting. The terms "facility,“ “agency,” or others are used in state regulations. We use the term “Community” to emphasize the homelike atmosphere of the care setting.

• Administrator: The term “administrator” is used to describe the person responsible for the every day management decisions in the Community. In many states this individual is referred to as “Manager” or “Operator.”

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• Direct Care Staff or Caregiver: This is the person providing the direct care to residents. Although there are exceptions, typically this person is not a licensed medical professional.

• Resident: The resident is the individual receiving care. In other healthcare settings the term "patient" or "client" may be used.


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Navigation Instructions

Let’s review these very important instructions before you begin.

This course is self-paced, feel free to take as much time as you need.

You may go forward to the next page or backwards to a previous page anywhere within

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this course (EXCEPT if you are taking a test—you can only go forward in the pretest or final exam).

Within this course may be some questions to help you check your understanding. These

Navigation Instructions

p y y gquestions are not graded; they are included to help you apply the material.

At the end of this course is a Final Exam. You

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must pass the Final Exam to complete the course.


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INTRODUCTION

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An analgesic is any member of a group of drugs used to relieve pain. An analgesic can be a:

Introduction

• narcotic (such as morphine)

• non-narcotic (such as Tylenol®), or

• combination of the two (such as Tylenol® with codeine)

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as Tylenol with codeine)


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What is a narcotic?

Medically, the term narcotic specifically refers to any psychoactive compound with morphine-like effects that in

Introduction

psychoactive compound with morphine like effects that in moderate doses relieves pain and induces deep sleep.

According to the DEA, “...the term is used in a number of ways. Some individuals define narcotics as those substances that bind at opiate receptors while others refer to any illicit substance as a narcotic. In a legal context,

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narcotic refers to opium, opium derivatives, and their semi-synthetic substitutes.”

Narcotics, also called opioidanalgesics or narcotic analgesics, cause central nervous system (CNS)

Introduction

depression and often carry a high risk of addiction.

From a legal perspective, narcotic refers to opium, opium derivatives, and their semi-synthetic substitutes.

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Narcotics have medical therapeutic uses such as to:

• Relieve pain

Introduction

Relieve pain

• Suppress cough

• Alleviate diarrhea

• Cause anesthesia

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The goals for the safe handling of narcotic medications in our assisted living/residential care Communities are to ensure safe use of narcotics by residents and to prevent

Introduction

diversion by staff members.

While to focus of this course is on narcotics, we are going to begin with a review of common medications prescribed in each of the three classifications of analgesics.

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COMMON NARCOTIC ANDCOMMON NARCOTIC AND NON-NARCOTIC MEDICATIONS

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It is important to know the different classifications of analgesics because narcotics and non-narcotics are treated differently in a Community. We’ll talk more about

Common Narcotic and Non-narcotic Medications

that later.

As we mentioned, the three general classifications of analgesics are:

• Narcotics

• Non-narcotics

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• Combination drugs

Let’s take a more detailed look at each of the classifications.


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Narcotic Analgesics

Here are some examples of commonly prescribed narcotics:


narcotics:

• Morphine

• Codeine

• Oxycodone

• Fentanyl

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Non-Narcotic Analgesics

Here are some examples of common over-the-counter and prescription non-narcotics:


prescription non narcotics:

• Aspirin

• Acetaminophen (Tylenol) ®

• Non-steroidal anti-inflammatory drugs (NSAID), such as Advil®

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Combination Analgesics

Here are some examples of common prescription combination analgesics that contain both non-narcotic and


combination analgesics that contain both non narcotic and narcotic compounds.

• Tylenol® #3 and #4 (Tylenol® that includes codeine)

• Vicodin (a mix of acetaminophen and hydrocodone)

• Percocet (a mix of acetaminophen and oxycodone)

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Narcotics can be administered in a variety of ways, such as tablets, syrups, transdermal patches, suppositories, injections, and in forms for inhalation.


Because of the potent nature of narcotics, narcotic medications must be administered according to physician’s orders.

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Which of the following drugs are considered narcotics?

CHECK FOR UNDERSTANDING

Tylenol® and Advil®

Hydrocodone and oxycodone

Both A and BClick on the

Correct Button

Click to Go Back

WHAT WAS YOUR ANSWER?

B is the correct answer. Hydrocodone and oxycodone are both narcotic drugsboth narcotic drugs.

Continue in Course

Click Either Button to Continue

Return to Question


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CONTROLLED SUBSTANCE ACT/CONTROLLED SUBSTANCE ACT/DRUG SCHEDULES

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In 1970 a federal law, known as the Controlled Substance Act, was passed to help control the use of narcotics. It classifies drugs based on abuse potential and clinical


usefulness. Drugs in each Schedule must adhere to specific rules. Your understanding of these rules and Schedules is critical to achieving our goal of safe narcotic use within our Communities.

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According to the U.S. Drug Enforcement Administration, the groups of medications defined by the Controlled Substance Act (CSA) are referred to as Drug Schedules. They range from Schedule I to Schedule V. Schedule I contains the drugs with the highest abuse potential and Schedule V contains drugs with the lowest abuse potential.

Let’s look at the definitions of each of the Schedules in more detail.

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Schedule I

A. The drug or other substance has a high potential for abuse.


B. The drug or other substance has no currently accepted medical use in treatment in the United States.

C. There is a lack of accepted safety for use of the drug or other substance under medical supervision.

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p


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Below are a list of drugs under the Schedule I category:

Heroin


Heroin

Lysergic acid diethylamide (LSD)

MDMA

Marijuana

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MethaqualoneLiquid heroin

Schedule II

A. The drug or other substance has a high potential for abuse


abuse.

B. The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.

C Abuse of the drug or other substances may lead to

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C. Abuse of the drug or other substances may lead to severe psychological or physical dependence.


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Drugs found in Schedule II:

Opium

M hi


Morphine

Cocaine

Phencyclidine (PCP)

Pentobarbital

MethadoneMethadone tablets

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Methadone

Methamphetamine

Some federal rules to be aware of for Schedule II drugs:

• Prescription refills are not allowed

E h ti di ti i d d it t b bt i d


• Each time a medication is needed it must be obtained by a new prescription written by the physician.

• Physicians must have a special license from the federal government to prescribe Schedule II drugs.

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Schedule III

A. The drug or other substance has a potential for abuse less than the drugs or other substances in Schedule I


less than the drugs or other substances in Schedule I and II.

B. The drug or other substance has a currently accepted medical use in treatment in the United States.

C. Abuse of the drug or other substance may lead to moderate or low physical dependence or high

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moderate or low physical dependence or high psychological dependence.

Drugs found in Schedule III:

Codeine

H d d ith i i T l l®


Hydrocodone with aspirin or Tylenol®

Amphetamine

Hexobarbital

Valium

Anabolic steroids

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Anabolic steroids


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Schedule IV

A. The drug or other substance has a low potential for abuse relative to the drugs or other substances in


abuse relative to the drugs or other substances in Schedule III.


C. Abuse of the drug or other substance may lead to limited physical dependence or psychological

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limited physical dependence or psychological dependence relative to the drugs or other substance in Schedule III.

Drugs found in Schedule IV:

Diazepam

Ph b bit l


Phenobarbital

Barbital

Xanax®

Chloral Betaine

Chloral Hydrate

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Chloral Hydrate

Meprobamate


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Schedule V

A. The drug or other substance has a low potential for abuse relative to the drugs or other substances in


abuse relative to the drugs or other substances in Schedule IV.


C. Abuse of the drug or other substance may lead to limited physical dependence or psychological

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limited physical dependence or psychological dependence relative to the drugs or others substances in Schedule IV.

Drugs found in Schedule V:

Cough syrups that contain codeine

Oth bi ti d ith ll titi f


Other combination drugs with small quantities of narcotic

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What Drug Schedule category contains drugs that contain hydrocodone and Tylenol® with


hydrocodone and Tylenol with codeine?

Schedule II

Schedule III

Schedule IVClick on the

Correct Button

Click to Go Back

None of the above; they are not narcotics


B. Schedule III is the correct answer.

Continue in Course


Return to Question


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HISTORY AND ABUSE

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History and Abuse

To understand why it is important to handle narcotics differently than other medications let’s take a look at the

History and Abuse

differently than other medications, let s take a look at the history of the drug.

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Morphine was the first narcotic identified in history. The opium poppy is the principal source of all

History and Abuse

natural opiates. Opiates are extracted from the opium poppy pods. Opium contains about 10% morphine. It has been used throughout history to relieve pain and produce euphoria Opium poppy pods

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and produce euphoria. Opium poppy pods

History and Abuse

In 1803 a German pharmacist isolated morphine from opium. And with that discovery the use ofAnd with that discovery the use of the drug proliferated. Even today morphine remains the prototype analgesic.

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It was not until the Civil War that the United States recognized the problem of morphine dependence, when morphine was widely used to treat wounded soldiers whose

History and Abuse

addiction subsequently became a significant social problem.

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Unfortunately, ALL narcotics have the potential for abuse and addiction. This remains to be a major objection to the use of narcotic pain relievers for chronic pain.

History and Abuse

Due to these fears, many physicians are reluctant to prescribe narcotics, and many persons with pain are reluctant to take them. It is important to understand the elements of addiction.

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The three elements to be aware of when dealing with narcotic use are:

1 Physical dependence

History and Abuse

1. Physical dependence

2. Tolerance

3. Addiction

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1. Physical dependence

Physical dependence occurs when taking a drug for long periods of time

History and Abuse

long periods of time.

It presents with abrupt medication changes. In other words, when a resident completely stops taking or drastically decreases the amount of drug taken.

Physical dependence leads to withdrawal reactions and symptoms

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symptoms.


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Some of the symptoms of physical dependence and withdrawal include but are not limited to:

• Runny nose

History and Abuse

Runny nose

• Goose bumps

• Sweating

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Later, more serious symptoms may occur such as:

• Restlessness

Diffi lt l i

History and Abuse

• Difficulty sleeping

• Muscle twitching

• Hot and cold flashes

• Abdominal cramping

• Nausea, vomiting, and/or diarrhea

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Nausea, vomiting, and/or diarrhea


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Physical dependence is not the same as addiction and can be avoided under the appropriate guidance of a resident’s physician. Proper dosing and proper adjustments of doses,

History and Abuse

and avoiding abrupt changes can avoid these types of withdrawal symptoms, which can not only be uncomfortable but also life threatening.

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2. Tolerance

The drug loses its pain relieving effect when being used over time The person becomes less responsive to the

History and Abuse

over time. The person becomes less responsive to the medication over time.

In other words, when you need to take more of the drug to experience the same effect of relief of pain. Usually, many people with chronic pain are able to take the same amount without needing to increase the dosage. Always f ll th h i i ’ d

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follow the physician’s orders.


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3. Addiction

Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use despite harmful

History and Abuse

causes compulsive drug seeking and use despite harmful consequences to the individual who is addicted and to those around them.

The current model to explain addiction suggests that addiction begins with the basic pleasure and reward circuits in the brain. Over time the changes in the brain send intense impulses to take drugs Persons with addiction take more

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impulses to take drugs. Persons with addiction take more than prescribed and have little to no control over the amount they take. People with addictions often cannot quit on their own. Addiction is an illness that requires treatment.

If you suspect a resident is experiencing dependence, tolerance, or addiction to a medication, it is important to contact the resident’s physician about your concerns.

History and Abuse

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One of the reasons narcotic medications should be handled differently in the assisted

History and Abuse

living/residential care Communities is due to concerns of physical dependence, tolerance and addiction. But this is not the only reason. Drug diversion is another serious concern in our Communities

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our Communities.

Drug Diversion

Dependency and addiction can lead to narcotics being inappropriately prescribed by physicians or even stolen by

History and Abuse

inappropriately prescribed by physicians or even stolen by staff members who have access to the medications in our Community. The act of a medical professional stealing or misprescribing a narcotic medication is known as “drug diversion.”

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A example of drug diversion in an assisted living/residential care Community would be the following:

A nurse or med aide documents that a resident had pain

History and Abuse

A nurse or med aide documents that a resident had pain and was given a dose of his/her narcotic medication. In reality the staff person took the medication for themselves or sold it on the street for illicit drug use.

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The appeal of narcotics to abusers lies in their ability to:

• Produce euphoria and a sense of well-being, meaning a feeling of being free from cares and worries

History and Abuse

feeling of being free from cares and worries

• Dull fear, anxiety, and tension

• Reduce sensitivity to psychological and physical stimuli

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Our goal is to ensure safe use of narcotics by residents and prevent diversion by staff

History and Abuse

members.

There are steps we can take to reach these goals and this is why it is important to handle narcotics differently than other medications th t t hi h i k f

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that are not as high a risk for abuse.

SAFE MEDICATION ROOM PRACTICES

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The Controlled Substances Act (1970) requires that complete and accurate records be kept of all quantities of

Safe Medication Room Practices

controlled substances so it is possible to trace the flow of any drug from the time it is first imported or manufactured, through the distribution level, to the pharmacy or hospital that dispensed it, and then to the actual patient who

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and then to the actual patient who received the drug.

There are a number of steps you can take to control the narcotic use in your Community.


F ll C it ’ liFollow your Community’s policy

It is important to understand and follow your Community’s policy. Check with your supervisor and follow your policy and procedure manual to verify the appropriate

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manual to verify the appropriate steps you should take when handling narcotics in your Community.


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Keep narcotic drugs secure

Take steps to ensure that narcotics do not fall into the hands of unauthorized persons One of the simplest but most


of unauthorized persons. One of the simplest but most effective things you can do is to ensure narcotic drugs are properly secured.

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ALL medications, but especially narcotics, must be locked at all times. They must be kept under lock and key.

Some of the possible storage locations for these may be


Some of the possible storage locations for these may be secured in a medication room, medication cabinet, medication cart, or if allowed and appropriate, in a resident’s room.

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Many Communities “double lock” narcotic drugs. For example, it may be policy to keep the med cart locked at all


times. And, for narcotic medications, the medication cart may have a container within one of the drawers that has another lock. The second lock ensures that only the appropriate individual has access to the narcotics

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individual has access to the narcotics. Since this second lock is not always required you will want to check with your policy and state regulations.

Carefully follow physician’s orders

It is vital that you follow the instructions given by the physician Due to the potent nature of narcotic drugs it is


physician. Due to the potent nature of narcotic drugs, it is important to carefully administer the correct amount of medication at the proper time intervals. Medication errors with narcotics have the potential to cause serious discomfort and harm to a resident.

Let’s review two basic medication pouring rules as they

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apply to narcotics.


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If the liquid form of this medication is prescribed:

• Measure the dose carefully using a special measuring device


device.

• Do not use a household spoon because you may not get the correct dose. This can be very dangerous.

• Be careful not to confuse the dose of morphine liquid in milligrams (mg) with milliliters (mL).

A k i h i t if t

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• Ask your supervisor or pharmacist if you are not sure how to measure this medication.

If the capsule or tablet form of medication is prescribed for narcotic use:

• Do not crush chew or break an extended-release


Do not crush, chew, or break an extended release capsule. Have the resident swallow the capsule whole. It is designed to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.

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Plan for timely refills

Unlike other prescription drugs, controlled substances are subject to


controlled substances are subject to additional restrictions. So it is very important to plan ahead to make sure your residents obtain their refills in time to prevent missing a dose. The next few pages have a brief summary of the

i ti i t f h

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prescription requirements for each Schedule of drug.

Schedule II prescription orders may not be telephoned into the pharmacy (except in an emergency). In addition, a prescription for a Schedule II drug may not be refilled; the


physician must write a new order for the medication.

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Prescription orders for Schedule III and IV drugs may be either written or oral (that is, by telephone to the pharmacy). In addition, the resident may (if authorized by


the practitioner) have the prescription refilled up to five times and at anytime within six months from the date the prescription was issued.

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Schedule V includes some prescription drugs and many narcotic preparations, including antitussives and antidiarrheals. Dispensing of these medications has some


restrictions beyond those normally required for the over-the-counter sales.

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Perform Shift Counts

Shift counts of narcotic drugs are extremely important. Count each narcotic drug in the med room at each change


Count each narcotic drug in the med room at each change of shift. It is a good practice to always have two people conduct the shift count, such as the med aide going off shift with the med aide coming on the shift. Check with your Community policy as well as state regulations regarding second counts.

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Narcotic count records often have a column where a preprinted count of medications is written. Additional


columns provide for date and signatures. During a shift count, the number of narcotic doses are counted and documented. Changes in the number of doses left should correspond with the number of doses given to a resident Thus all narcotic doses can

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resident. Thus, all narcotic doses can be accounted for through what was given to the resident and what remains available.


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The narcotic count is critical. Three main purposes for documentation of narcotic counting are :

• To ensure appropriate resident care


To ensure appropriate resident care

• To create a legal record of care

• To prevent drug diversion by staff

Because theft of narcotics is a rising problem in our Communities today, keeping accurate counts of this

di ti i t l f l i ti di i

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medication is extremely useful in preventing diversion.

Here are some additional things you can do to ensure the security of narcotics.


N l di ti tNever leave medications out in a common area or out in the open. For instance, if a resident takes his/her medications during dinner, do not leave them setting on the

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table. Stay with the resident until he/she has consumed the medication.


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Do not prop open the medication room doors. It is not safe to leave the door open, even if you feel like you need to run down the hall for just a quick second to grab a phone


call.

It may take longer to lock the medication room door, but it is time well spent to ensure that these medications are controlled properly.

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Monitor self-storage. In many states and many Communities, residents are able to store their own medications with proper


physician authorization. If this is the case in your Community make sure those medications must be locked appropriately.

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Documentation

Documenting the use of narcotics is essential. Any time a narcotic is


is essential. Any time a narcotic is given to a resident it must be properly documented.

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Following these recommended Medication Room practices, along with


following your Community and state policies, will help obtain the goal for safe handling of narcotics.

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Why is it important to count narcotic medications at the time of a change in shift?


To prevent drug diversion

To provide legal documentation

To ensure proper resident careClick on the Correct Button

Click to Go Back

All of the above


D All of the above is the correctD. All of the above is the correct answer.

Continue in Course


Return to Question


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MONITORING RESIDENTS ONMONITORING RESIDENTS ON NARCOTICS

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Watch for any side effects or adverse effects from the use of the narcotics. If you notice any adverse

Monitoring Residents on Narcotics

changes with the resident using narcotics, notify the physician immediately.

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Narcotics can have significant side effects including:

• Euphoria, hallucinations, or confusion

• Trouble breathing (respiratory depression)


g ( p y p )

• Itching, rashes, flushed skin

• Orthostatic hypotension (a condition which a person’s blood pressure will drop when they stand from a sitting or lying position) which increases the risk for falls

• Constipation, nausea, vomiting, or diarrhea

• Urinary retention

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y

• Allergic reaction

Side Effect: Respiratory Depression

Respiratory depression is one of the most dangerous side effects of narcotics Many narcotic drugs given in too high


effects of narcotics. Many narcotic drugs given in too high or too excessive of a dose can actually cause a person to breathe slower and more shallow. This can be serious in persons who already have COPD or emphysema.

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If you think a resident is in danger, call 911 or follow your Community’s policy for emergencies.

When paramedics arrive be sure to inform them of what


When paramedics arrive be sure to inform them of what your resident is taking. This can assist the physician in the hospital to determine the root cause of the resident’s symptoms and provide appropriate treatment.

If a person has overdosed on a narcotic or having serious side effects from a narcotic, there are other medications

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that can be given in the hospital that counteract those effects and may save the resident’s life.

Monitor for overuse or signs of abuse. In addition to monitoring for side effects, you should also monitor for appropriate use of narcotic medications when a resident is


taking them. Residents may become dependent or addicted to narcotic medications and ask for more dosages than the physician has prescribed. This is why proper documentation is so resourceful. Each shift needs to know what medications a resident has been given recently.

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Timing of PRN (“as needed”) narcotics is important. Again, follow physician’s instructions. Provide a


resident with a PRN medication as directed by physician’s orders. Do not wait for pain to reach such high levels that it is excruciating and severe for the resident. The purpose of the narcotic medication is to prevent pain

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narcotic medication is to prevent pain from reaching that point.

Monitor the effects of the drug. Is the medication effective? For example, if you notice that the resident is not getting pain relief, speak with the resident’s physician. It


may mean that an adjustment needs to be made.

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Monitor the intent of the resident’s request for medications. In some cases, a resident may feel like the time


they have with the staff administering medications is the only time they have good one-on-one interaction. They appreciate the opportunity where a staff member is spending time only with them Although it may seem unusual it

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them. Although it may seem unusual, it may be that the interaction is specifically what the resident is seeking and not the actual drug.

NARCOTIC USE IN HOSPICE CARE

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Hospice care is end-of-life care provided by health professionals and volunteers. Hospice provides

Narcotic Use in Hospice Care

medical, psychological and spiritual support. One of the central goals of hospice care is effective control of pain for terminally ill residents.

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Hospice staff try to control pain and other symptoms so a person can remain as


alert and comfortable as possible. Hospice typically coordinates all medications that are related to the hospice diagnosis and those that are intended to

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those that are intended to alleviate symptoms.


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Having prescribed medications available to the hospice resident on time is one way staff can support


pain management efforts. In most cases, physicians will begin to treat pain with over the counter pain medications such as acetaminophen (Tylenol®), ibuprofen (Motrin®) aspirin or

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ibuprofen (Motrin ), aspirin, or others.

However, as a terminal disease with pain involvement continues to take its toll, pain levels will likely


increase to the point where the physician will prescribe other stronger medications. Narcotic medications, such as morphine, are commonly used as they are needed to relieve pain in the

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needed to relieve pain in the terminally ill.


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With the terminally ill resident there are neither concerns nor fears about the resident “becoming addicted” to a narcotic given for pain. Although many individuals have


strong beliefs about avoiding narcotic drugs due to its addictive properties, the legal use of narcotic medications for pain is totally appropriate and a welcome relief from the severe pain which plagues certain residents. Addiction is not a concern for those who are dying.

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Let’s take a look at some hospice myths and facts adapted from High Peaks Hospice and Palliative Care, Inc. (http://www.highpeakshospice.com).


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MYTH

Narcotic drugs such as morphine are always offered

FACT

The stage of a terminal illness is not what dictates


morphine are always offered to residents when death is

imminent.

illness is not what dictates which medicine is prescribed to the hospice resident; it is the degree of pain that the individual is experiencing. Some people may never

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need narcotics while others may require it for longer

periods of time.

MYTH

Residents using narcotic medications are too sleepy

FACT

Drowsiness may be experienced in the


medications are too sleepy to function.

experienced in the beginning. For most

residents whose pain is well managed and controlled on narcotic medications, they

are not disturbed by unusual drowsiness Like all

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drowsiness. Like all medications, narcotics can have stronger effects on

different individuals.


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MYTH

Weird feelings after taking narcotic medications are a

FACT

As in any medications, a resident may experience


narcotic medications are a sign of allergic reactions.

resident may experience allergies to narcotic

medications. Some residents may experience unpleasant

mental sensations when they initially take narcotic

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medications, but this is not an allergy.

MYTH

Hospice residents should avoid taking morphine

FACT

Use of narcotic medication, such as morphine when it is


avoid taking morphine before their pain is severe

because it may lose its effect.

such as morphine, when it is needed early in the course

of a terminal illness does not decrease the effectiveness later in the disease. If the

hospice resident

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experiences increased pain, the physician may increase

the dose prescribed.


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Narcotic use in hospice care can be very valuable to providing medical support in obtaining the goal to help residents who are dying to have peace and comfort during


their final stage of life and to help control pain and other symptoms so a person can remain as alert and comfortable as possible.

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In this course you learned about the types and uses of narcotic drugs. Narcotics are frequently used for residents in assisted living/residential care Communities. Narcotics

Summary

are a valuable aid for residents who are on hospice to remain as comfortable as possible. Medication room practices ensure safety for residents and to prevent diversion of narcotics to the illicit drug market. Following the practices outlined in this course will help you safely manage narcotic medications in your Community

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manage narcotic medications in your Community.


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Narcotics M01

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Transcript of Narcotics M01