In the Trenches of the Opioid Crisis

There’s often more to drug addiction than just bad choices.

Understanding the pathophysiology and the neurobiology of adverse childhood events and drug addiction can help emergency nurses be more empathetic to patients caught in the opioid epidemic that has gripped the country.

In the Trenches of the Opioid Crisis

2:30 – 3:30 p.m.


Room 319, 320, 321

While emergency nurses understand the pathophysiology of many diseases and conditions, some might understand less about addiction. To alleviate such knowledge gaps, Darris Bohman and Jennifer Williams of Cincinnati-based TriHealth will lead a session today to highlight staff education that helped increase awareness of the changes that happen in the brains of patients with addiction.

“We understand the pathophysiology of diabetes and heart disease very well, and we are not judgmental when these patients have recurrent issues. But we understand very little about how adverse childhood events change the way people are wired,” Bohman said. 

Darris Bohman

“The opioid crisis has taken its toll on first responders, and our department is no exception,” she continued. “We, however, have started to give training on trauma-informed care, which seems to be helping our staff have more empathy and decrease compassion fatigue.” 

Making the connection from tragedy and trauma to a patient’s drug use was a breakthrough for Bohman in her efforts to understand the grip opioids have on so many patients. 

“It helps to understand that our patients may have lived through incredible tragedy or trauma in their lives and that this is the coping skill they use,” she said. “It does not in any way condone drug use, but to understand that their brains may be hardwired differently than mine, helps me to have empathy.” 

The federal Substance Abuse and Mental Health Services Administration suggests health care workers should treat patients as a “whole person,” recognizing significant past events and the subsequent coping mechanisms. 

“It changes the question, ‘What is wrong with you?’ to ‘What happened to you?’” Bohman said of the trauma-informed care concept. “And while we do not want to delve into their nuanced childhood in the ED, just understanding there is probably a story behind their behaviors increases empathy.” 

Bohman said the trauma-informed care approach helps build trusting relationships with patients.

“Care is all about trust,” she said. “Patients should think, ‘I trust that if I tell you the truth about what brought me to the ED you won’t judge me. I trust that you want what is best for me and will treat me with all the science and art of nursing you know. I trust that I will get good care.’” 

ED nurses should have authentic healing relationships with their patients and understand how to help them be successful, Bohman explained, suggesting if the patients trust the nurses, they will get the treatment they need when the nurses suggest it.

“This is a great opportunity to reframe the way we think about the patient who is an opioid user and make our work less frustrating so we can start to really care again,” she concluded. 

More Opioid Sessions

This week, there are plenty of opportunities to learn more about opioids and the opioid crisis. The session “My Patient Is in Pain and on Buprenorphine … Now What?” scheduled for today and Saturday afternoon, will delve into the drug buprenorphine, which can be an effective alternative to pain management and in some situations, treat opioid addiction. 

Saturday morning will feature “Opioid Crisis: Implement a Team-Based Naloxone Saturation Campaign,” in which a team of presenters will facilitate a discussion on how existing Screening, Brief Intervention, and Referral to Treatment protocols in emergency medicine served as the foundation for launching a system-level Naloxone Saturation Campaign. 

In addition, there are several sessions throughout the conference that discuss ketamine, a drug that has been making a resurgence in EDs as an opioid alternative.