Emergency Department (ED) Registered Nurses (RNs) spend significant time treating chronic pain patients. Chronic pain affects up to 100 million Americans (Simon, 2012) and as much as 30% of all opioid pain medications in the United States (US) are prescribed from EDs (Todd, Cowan, Kelly, & Homel, 2010). Abuse of these prescription drugs is America’s fastest growing drug problem (Paulozzi, Jones, Mack, & Rudd, 2011). For veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) and Operation New Dawn (OND), chronic non-cancer pain is the most frequent diagnosis (Higgins et al., 2014), and it is closely associated addiction disease.

RNs often use the stigmatizing label “drug-seeking” for certain key patient behaviors and may lack confidence to constructively intervene with these patients (McCaffery, Grimm, Pasero, Ferrell, & Uman, 2005). Screening Brief Intervention and Referral to Treatment (SBIRT) is a successful evidence-based, non-stigmatizing approach for managing patients with substance abuse issues (Agerwala & McCance-Katz, 2012) that can be conducted by nurses (Finnell, 2012).

In this commentary article, we advocate for RN-led SBIRT in both veteran and civilian EDs. Based on results of our SBIRT-readiness survey of ED nurses at one large urban Northern California ED, we found the need for increased RN training on addiction disease with 61% of nurses admitting to using stigmatizing terminology towards these patients, and 53.1% percent stating they given repeat chronic pain patients lower priority.

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