Copyright By Melissa Gore 2019 How the Opioid Epidemic is Affecting Palliative Care Patients By Melissa Gore A Research Study Presented to the Faculty of the Department of Public Policy and Administration School of Business and Public Administration CALIFORNIA STATE UNIVERSITY BAKERSFIELD In Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCE – HEALTH CARE ADMINISTRATION SPRING 2019 H w Lhe Opioid Epidemic i ffecLing Palliali e are Patienl By Meli a Gore Thi the i has b en accepted on behalf f the Department f Publi P Ii y and dmini trati n by their upervi r ommitte : BJ Dat Date OPIOID EPIDEMIC AND PALLIATIVE CARE i Acknowledgements First and foremost, I would like to thank Dr. B.J. Moore for guiding me throughout this program. You have helped me grow and further my education. Without her knowledge and advice, I would not be here. I appreciate both my readers Tony Pallitto and Erika Delmar for assisting me with my thesis. Next, I would like to say thanks to my boss and former coach, Chris Hansen. This opportunity in the HCA program would not have been possible without him. Next, I am very grateful for the friends I have made over the last two years. They have helped motivate me and I have gained some life-long friends. Lastly, I would like to say thanks to my family and boyfriend. They have given continuous support and words of encouragement during my time in this master’s program and I am forever thankful. OPIOID EPIDEMIC AND PALLIATIVE CARE ii Abstract Over the past decade the opioid epidemic has caused many deaths related to drug abuse and addiction in the United States. Palliative and end-of-life care patients rely of various types of opioids to help reduce pain. With new restrictions and regulations, access to prescription opioids has become much harder. The purpose for this study was to explore how the opioid epidemic is affecting palliative and end-of-life care patients. The literature revealed an increase over the last decade of prescription opioids. Multiple factors have aided in the epidemic and since then, regulations and laws have been put in place, making it harder to access prescription opioids. Patients find it difficult receiving proper pain management. Little research has been done on the opioid epidemic and the affect it may have on palliative and end-of-life care patients. Interviews were conducted with eight females from various levels of management in palliative and hospice care organizations. Data was analyzed to develop categories from the participants responses to answer the research question. The categories that were created include: access to prescriptions, alternative medication and treatments, destruction of medications, need for education of MDs, and cultural beliefs. Recommendations were based on the responses from the participants and the literature and included improving the education of physicians and healthcare organizations adoption of evidence-based practices by health care organizations. OPIOID EPIDEMIC AND PALLIATIVE CARE iii Table of Contents Acknowledgements .......................................................................................................................... i Abstract ........................................................................................................................................... ii Chapter One: Introduction .............................................................................................................. 2 Problem Statement ...................................................................................................................... 3 Purpose ........................................................................................................................................ 3 Usefulness ................................................................................................................................... 3 Chapter Two: Literature Review .................................................................................................... 4 Palliative Care ............................................................................................................................. 4 History of Opioids....................................................................................................................... 8 Addiction ................................................................................................................................... 12 Opioid Epidemic ....................................................................................................................... 12 Effect on Palliative care ............................................................................................................ 20 Theory ....................................................................................................................................... 21 Summary ................................................................................................................................... 23 Chapter Three: Methods ............................................................................................................... 24 Research Design ........................................................................................................................ 24 Sample frame ............................................................................................................................ 24 Sample size ............................................................................................................................... 25 Data collection .......................................................................................................................... 25 Data analysis ............................................................................................................................. 25 Methodological rigor ................................................................................................................ 26 IRB approval ............................................................................................................................. 27 Confidentiality .......................................................................................................................... 27 Limitations ................................................................................................................................ 27 Chapter Four: Results ................................................................................................................... 29 Findings .................................................................................................................................... 29 Access to Prescriptions ............................................................................................................. 29 OPIOID EPIDEMIC AND PALLIATIVE CARE iv Alternative Medications and Treatment .................................................................................... 31 Need for Educating Physicians ................................................................................................. 33 Destruction of Medications ....................................................................................................... 33 Cultural Beliefs ......................................................................................................................... 34 Analysis..................................................................................................................................... 36 Theory ....................................................................................................................................... 36 Chapter Five: Summary and Recommendations ........................................................................... 38 Recommendations ..................................................................................................................... 38 Appendix A ................................................................................................................................... 49 Appendix B ................................................................................................................................... 50 Appendix C ................................................................................................................................... 51 Chapter One: Introduction Opioids are prescribed to patients as a standard way to help manage pain. In the early nineties, managing pain was viewed differently than today. In the mid to late 1990’s the “fifth vital sign” was created to help assess a patient with pain that was usually done while Opioids were prescribed until essentially the patient was relieved of their severe pain (Knight, et al. 2017). This might suggest the lack of evidence-based research on the long-term effects of these opioids, or how addicting the drugs are. When patients reported pain from this model, the lack of education on pain management leads to prescribing opioids as an easy and sometimes unnecessary response (Morone &Weiner, 2013). According to the National Association on Drug Abuse (NADA), in 2002 overdoses from opioids, excluding methadone, was just under ten thousand deaths where in 2016 there had been over nineteen thousand deaths per year. Findings from the U.S Department of Health and Human Services data from 2015 indicate on average; ninety Americans die each day (Rudd, Seth, David, & Scholl, 2016). The rise in overdoses is apparent and suggest the