Introduction
Fentanyl is a synthetic opioid drug used in pain management due to its analgesic and anesthetic effects. However, it is also spread as an unregulated substance, which leads to a problem of addiction. While the literature on fentanyl addiction among adults is often published, the same does not apply to the research on the problem among teenagers. It is essential to address the gaps in the current theoretical basis and how the available information can be used in psychiatric mental health nurse practitioners’ (PMH NP) work. To achieve that, a literature review should be conducted to determine the implications for the PMH NP, especially in the fields of practice, treatment, education, counter-transference, and advocacy.
Practice Issues
The fentanyl addiction problem has greatly affected mental health treatment practices over the last few years. The most prominent factors in this are the growing number of people with an addiction and overdose accidents (Gonzalez & Camenga, 2022; Lee, 2023; Tanz et al., 2022). This was especially relevant during the pandemic, when the number of deaths increased by 94% (Knopf, 2022).
This creates a concern that needs to be addressed regarding every ward patient who may have a problem with substances. A thorough investigation needs to be performed before administering any regulated medications, as it may reinforce the addiction. Thus. A good PMH NP should know the current situation and suggest this as a common practice in their facility.
This problem is related explicitly to PMH NPs, as the patients they observe are at a higher risk of having a history of illegal substance use. These preexisting conditions also have a chance to include fentanyl as an addictive drug. Therefore, the issue increased the need for fentanyl awareness among the PMH NPs, which added to the minimum number of tests for new patients. The skill to adapt to changes in the field corresponds with the program’s goals to promote critical thinking, responsibility, and essential competencies.
Properly evaluating the patient and diagnosing a possible addiction is also challenging for healthcare providers. As Appel et al. (2021) suggest, the availability of fentanyl test strips is low, which creates a problem for their use in general practice. These elements would help save time and energy for the workers, but the budget and social stigma still limit the resources. While the recent legal acts have made fentanyl test strips more available to healthcare providers, their use remains sparse. Thus, these test strips should be normalized, as they can save teenagers’ lives and medical facilities’ resources.
Treatment Implications
The treatment methods should be modified to include the possibility of the patient’s fentanyl addiction. A study by Stoecker (2023) describes the need to keep naloxone in every facility that may encounter an opioid overdose. Naloxone is an anti-opioid drug that may prevent the lethal symptoms of excess intake and, as a result, save a person’s life. As the statistics suggest, this initiative proves to be reasonable due to an acute increase in fentanyl addiction rates in recent years (Eckembrecher, 2022; Gonzalez & Camenga, 2022; Tanz et al., 2022).
However, as other opioids like morphine are still used in pain management among teens, the preexisting fentanyl misuse may cause unwanted side effects. They include acute respiratory depression, neuronal hypermetabolism, and cardiovascular symptoms such as bradycardia and myocardial ischemia (Han et al., 2019). All of these effects may result from increased opioid intake and should be treated urgently. Therefore, any treatment that includes opioid anesthetics should be carefully controlled and supported by naloxone supplies.
The treatment of fentanyl addiction differs from other forms of misuse. As it is an opioid, the withdrawal syndrome may be extremely harmful and should be treated cautiously (Ramin, 2020). Professionals should treat addiction with the help of trained nurse practitioners who demonstrate responsibility and accountability for advanced nursing practice and use critical thinking and diagnostic skills in practice.
Specific literature should support all the procedures, as the withdrawal damage can be avoided (Ramin, 2020). However, currently, there are no specific protocols for treating fentanyl addiction among teenagers, which suggests that other algorithms should be modified in these cases. In conclusion, PMH NPs and therapists should collaborate on treating teenage opioid addiction.
Psycho-Education
Increasing the quality of parents’ psycho-education associated with fentanyl and the symptoms of its use among teenagers is extremely important in preventing accidents with substance use. The parents should recognize the risk factors that could lead to the development of addiction and address the issues as soon as they occur. These elements may include the family’s economic state, increased stress levels due to abuse or neglect, peer pressure, or other psychological or somatic disorders (Cook-Sather et al., 2021; Sachan et al., 2019). All of these factors apply to fentanyl addiction, with the pain-inducing clinical conditions being more prominent than in other substance-misuse scenarios. To conclude, the increased level of awareness may be helpful in the early identification of substance abuse by parents, which can be time-saving for PMH NPs.
While the parents’ awareness of fentanyl abuse symptoms may draw attention to the case in earlier stages, the issue may be detrimental to the family dynamics. It can cause significant stress for all family members and result in estrangement before or after the treatment. This should also be addressed in further research, as the current literature does not sufficiently cover these stigmas’ psychological effects. Therefore, carefully addressing the family members’ concerns about the teen’s fentanyl addiction is crucial for the family’s future.
The teens should also have access to information about the dangers of fentanyl and the symptoms of its use. As Sachan’s (2019) article addresses peer pressure as one of the factors of substance use, children should be able to recognize the risks of taking unprescribed drugs and avoid them. Gonzalez and Camenga (2022) also support the need to increase awareness of fentanyl, as harmful doses of this chemical can be found in other compounds that have a less dangerous reputation among teenagers.
The PMH NPs may function as part of interdisciplinary teams of educators and healthcare providers, giving the latter a chance to inform parents and children about fentanyl during school meetings (Cook-Sather et al., 2021). This corresponds to the nurse practitioner program’s goal of being able to work in different settings. As a result, all the target demographics will be achieved and educated with the least resources spent.
Counter-Transference Issues
Counter-transference issues connected with fentanyl addiction in teenagers are not well-discussed in the existing literature. The only problems that may be translated into this field are the interpersonal relationships between nurses and patients in mental institutions (Cavaiola et al., 2021; Davidson et al., 2021). However, these works only have advice for the residents and are not aimed at teaching PMH NPs.
They also only feature fentanyl as one of the examples and do not discuss the critical details that need to be adjusted when treating a person with a fentanyl addiction. Moreover, the age of the patients is not mentioned in the research, which leads to the conclusion that no particular information can be applied to the teenage demographic. Therefore, there is a need for specific research on this topic that will create a theoretical basis for future personnel training.
This topic is especially related to PMH NPs, as it describes the increased level of engagement that mental health professionals have compared to some other fields. As the program’s goals suggest, the practitioner should be able to meet the national standards for certifications, which include using an ethical approach to communicating with patients. This is especially important in practice, as counter-transference issues may affect the quality of diagnosis by projecting the nurse’s personal feelings onto the teenage subject. This is unacceptable in a professional environment and goes against the values of the national standard regulations. Thus, understanding the effects of counter-transference connected to fentanyl use among teenagers is crucial for achieving the program’s goals.
Policy and Advocacy Issues
As fentanyl is a prescription drug that may cause addiction, there are specific policies and legal acts that regulate its distribution. The current status of this substance allows its use as an anesthetic due to its increased efficiency (Alkureishi, 2023; Appel et al., 2021; Ramin, 2020). However, the distribution of illicit fentanyl is prohibited by US law, which is similar in other countries. As a result, the rules that apply to any controlled drug in the opioid group also apply to fentanyl, which is important for all medical professionals who prescribe or store it.
Another important legal topic in the fentanyl discourse is the use of fentanyl test strips. The distribution rules of these instruments changed in 2021 when the CDC allowed medical facilities to purchase them for several purposes (Appel et al., 2021). This created more options for medical professionals who need to identify the drug the patient used to prescribe the proper treatment. Therefore, medical facilities can edit their policies per these new regulations and provide help to teenagers with fentanyl addiction more effectively.
Conclusion
In conclusion, the current literature on the topic of fentanyl addiction among teens is not sufficient to fully prepare PMH NPs for all situations that may occur with these patients. Although some literature describes opioid addiction in general, specific works on fentanyl are rare and lack proper implementable conclusions. The most recognized gap is in the counter-transference issues, special treatment features, and particular family counseling techniques. These topics are crucial for improving the quality of help that medical professionals, especially PMH NPs, can provide.
The existing literature still provides substantial data that includes specific information on the teenage demographic. The works accent the urgency of the issue with the increase in overdoses that result in deaths, as well as the major rise in the number of people with a substance use disorder that occurred during the pandemic. The data states the symptoms professionals should notice and suggests keeping naloxone as a first-aid drug.
The literature states the importance of psych-education and raising awareness, with the most effective methods being public talks in collaboration with educators. The literature also informs us of the current regulations regarding fentanyl and test strips. These implementations are crucial for PMH NPs’ work and should be used in practice.
References
Alkureishi, L., A. (2023). What every family with a teenager should know—the role of naloxone in the opioid crisis. Pediatric Annals, 52(2). Web.
Appel, G., Farmer, B., & Avery, J. (2021). Fentanyl test strips empower people and save lives—so why aren’t they more widespread? Health Affairs. Web.
Cavaiola, A. A., Giordano, A. L., & Golubovic, N. (2021). Addiction counseling: A practical approach. Springer Publishing.
Cook-Sather, S. D., Urban, E., Romano, V. A., & Romano, M. A. (2021). When fentanyl finds an outlier: Talking with teenagers about the danger. Pediatrics, 148(4). Web.
Davidson, S. M., Connery, H. S., Greenfield, S. F., & Hill, K. P. (2021). Teaching residents to treat substance use disorders: Overcoming 10 common patient-perceived barriers to outpatient treatment engagement. Academic Psychiatry: The Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 45(2), 217–221. Web.
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Knopf, A. (2022). Illicit fentanyl cited a huge increase in teen OD deaths. The Brown University Child & Adolescent Psychopharmacology Update, 24(6), 5–5. Web.
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Stoecker, W. V., & Kopel, J. (2023). The deadly Missouri fentanyl epidemic: 2023 update and why we carry naloxone. Missouri Medicine, 120(3), 183.
Tanz, L. J., Dinwiddie, A. T., Mattson, C. L., O’Donnell, J., & Davis, N. L. (2022). Drug overdose deaths among persons aged 10-19 years – United States, July 2019-December 2021. Morbidity and Mortality Weekly Report, 71(50), 1576–1582. Web.