At-risk opioid use and opioid use disorders are distinguished by problems related to the use of opioids and recurrent tendencies to overuse or underuse them in unhealthy ways. These disorders range from mild to severe according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V). Appreciating the significant health risks of the range of opioid use disorders and the extremely high rate of overdoses and overdose deaths, this special edition aims to highlight articles addressing a wide range of topics on opioid use and opioid use disorders, with a special consideration of screening for, intervening with, and treating at-risk opioid use and opioid use disorders in special populations, interdisciplinary approaches, international perspectives, and implications for nursing and other healthcare professionals. We have gotten reports of original research, clinical case studies, and literature reviews.
We received an overwhelming number of submissions for this special edition on "The Opioid Epidemic," and unfortunately not all of the submissions were able to be published in this edition. After careful peer review, we are hopeful that the articles that appear in this edition will be of interest to readers of the Journal of Addictions Nursing: A Journal for the Prevention and Management of Addictions.
We also have five columns in this special issue: Clinical Reviews, Innovative Roles, Policy Watch, Research Reviews, and Perspective.
The purpose of the "Social Support among Women Undergoing Methadone Maintenance Treatment in Iran" article is to examine perceived social support among women undergoing methadone maintenance treatment in Iran using a mixed method approach. Results indicated that women in Iran undergoing methadone maintenance treatment had unmet social support needs, which could affect the patients and their treatment and recovery processes.
The purpose of the "Integration of Medication Assisted Treatment Information for Opioid Use Disorder into a Graduate Nursing Curriculum" article is to show how nurse practitioner students had exposure to medication-assisted and evidence-based treatment modalities within their graduate curriculum. The students were exposed to a substance use framework within their advanced nursing curriculum and, specifically, medication-assisted treatment within the pharmacology course. Results indicated that student knowledge increased significantly. Educators must resolve to include substance use information into all areas of nursing study.
The purpose of the "Naloxone Effectiveness: A Systematic Review" article is to focus on the application of take-home naloxone and its association with decreased mortality. The take-home program focuses on overdose recognition education with naloxone kit distribution. Evidence supports that take-home naloxone programs are effective in preventing fatal opioid overdoses, with the limitation that there is a lack of randomized controlled trials because of ethical considerations in this area.
The purpose of the "Evaluating Emergency Department Opioid Prescribing Behaviors after Education about Mandated Use of the Pennsylvania Prescription Drug Monitoring Program" article is to highlight a program to educate emergency department providers in the use of the Pennsylvania Prescription Drug Monitoring Program (PDMP) and examine opioid prescription rates posteducation. Provider knowledge increased significantly, and there was a decrease in observed opioid prescriptions during the project period. A number of barriers to PDMP use were also identified.
The purpose of the "Screening Adults with Substance Use Disorder for Adverse Childhood Experiences" article is to report on assessing the incidence of Adverse Childhood Experiences (ACEs) and evaluating the efficacy and feasibility of a trauma-informed screening protocol among individuals with a substance use disorder in a recovery program. Gaining knowledge about the impact of ACEs on the patient's recovery seemed to provide participants with a sense of relief and a feeling that they were "normal." Trauma-informed care promotes mindfulness of the impact of ACEs on patients with substance use disorders so that evidence-based interventions can be provided with the goal of improving client outcomes.
The purpose of the "Evaluation of an Opiate Overdose Educational Intervention and Naloxone Prescribing Program in Homeless Adults that Use Opiates" article is share information on implementing an opiate overdose training and routine naloxone prescribing program for patients at a homeless clinic. Education consisted of risk factors, signs of an overdose, how to respond to an overdose, and how to administer naloxone. Prescription fill rates were also monitored. Patients had a significant increase in knowledge, whereas about one third of prescriptions were filled, which varied by housing status, insurance coverage, and other prescription medication statuses.
The purpose of the "Opioid Overdose and Naloxone Kit Distribution: A Quality Assurance Educational Program in the Primary Care Setting" project is to provide an educational intervention on opioid overdose and naloxone distribution kits to primary care providers at a Veteran's Administration facility in the southeast. After the educational program, participants had an increase in knowledge and comfort level regarding the safe administration of opiates and an increase in awareness of naloxone kit availability.
The editors of this special edition of the Journal of Addictions Nursing, "The Opioid Epidemic," hope you enjoy reading the articles that have been published and gain an increased knowledge about numerous programs and treatment options that are available to impact the overdose and mortality rates among persons who use opioids. It is our hope that you are able to take away information to inform your practice based on evidence from numerous sources.