• Patricia E Maloy, Megan O Iacocca, and Benjamin J Morasco.
• Patricia E. Maloy is a nurse care manager at the VA Portland Health Care System, Portland, OR, where Benjamin J. Morasco is principal investigator and, at the time of this writing, Megan O. Iacocca was a clinical research associate. Iacocca is currently a research associate at Kaiser Permanente in Portland. Contact author: Patricia E. Maloy, patricia.maloy3@va.gov. This work was supported by award No. 1I01HX001583 from the U.S. Department of Veterans Affairs, the Health Services Research and Development Service, and resources from the VA Health Services Research and Development-funded Center to Improve Veteran Involvement in Care at the VA Portland Health Care System (CIN 13-404). The authors and planners have disclosed no potential conflicts of interest, financial or otherwise. The content of this article is solely the responsibility of the authors and does not represent the official views of the Department of Veterans Affairs.
• Am J Nurs. 2019 Nov 1; 119 (11): 22-29.

AbstractChronic pain, stemming primarily from musculoskeletal conditions and severe headaches, is a growing problem in the United States, affecting as many as 43% of adults. Opioids are frequently prescribed to manage chronic pain despite limited data on their long-term efficacy and the potential risks of long-term use. In 2017, more than 47,000 people died as a result of an opioid overdose involving illicit opioids (such as heroin), illicitly manufactured opioids, diverted opioids, prescription opioids, or some combination thereof. Although it's been more than three years since the nationwide opioid crisis prompted the Centers for Disease Control and Prevention (CDC) to release a guideline outlining safe practices for prescribing opioids to patients with chronic pain (unrelated to active cancer or palliative and end-of-life care), opioid misuse remains a significant concern. Historically, physicians have been tasked with the primary responsibility for implementing opioid safety measures, but nurses in the primary care setting are being increasingly relied on to incorporate these measures as part of their practice. In this article, we discuss the use of five tools outlined in the CDC guideline: prescription opioid treatment agreements, urine drug screening, prescription drug monitoring program databases, calculation of morphine milligram equivalents, and naloxone kits. Primary care nurses can use these tools to promote opioid safety among patients receiving opioid therapy for chronic pain.

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