Issue link: https://digital.copcomm.com/i/1200039
6 Working Nurse l WorkingNurse.com January 13–February 17, 2020 ON THE QUICK Nursing & Healthcare News Germany's Opioid Policy Are there lessons for the U.S.? U nlike the U.S. and many other countries, Germany has largely avoided the opioid epidemic. This outcome stands as a reminder that public health policy can make a real difference. Opioid Use in Decline Back in the early '90s, Germany implemented strict national protocols for the use of opioid medications in outpatient set- tings. German doctors can usually only prescribe opioids after other pain management strategies have failed, with restrictions on maximum dosages and length of treatment. Since Germany has universal health coverage, patients who do take prescription opioids also have more consistent mon- itoring for dependency or adverse effects. Because these policies were adopted well before the late '90s opioid boom, Germany never suffered the opioid over- prescription that became such a problem in the U.S. and elsewhere, effectively stopping the crisis before it began. A recent study in the journal Deutsches Ärzteblatt con- cluded that the rate of opioid addictions and opioid-related deaths in Germany "has barely changed in the last 20 years." Drogenkonsumräm Another reason Germany's incidence of opioid-related deaths is dramatically lower than in America is a strategy that remains highly controversial here: offering a place where addicts can obtain clean needles and use drugs in a clinically supervised environment. Germany now has almost two dozen of these drogenkonsumräm (which translates as "drug consumption rooms"). Some argue that such facilities encourage drug use and create a moral hazard. However, German public health offi- cials say the sites reduce overdose fatalities and limit the transmission of diseases like HIV. USC nursing professor Kathleen Woodruff, DNP, ANP- BC, believes that such supervised injection sites — which U.S. drug laws have made almost impossible to legally operate — also encourage addicts to seek treatment. "You've built up a rapport of making them safer; they feel able to talk to you," Woodruff explains. "You are available when they're ready for treatment to get them into the appropriate type of care." WN ANTIBIOTIC RESISTANCE 2.9 million infections a year, but hospital efforts are helping A new CDC report estimates that antibiotic-resistant infections now kill almost 36,000 people a year in the U.S., but hospitals have made some important progress in infection control. Strong Improvement Two weeks before Thanksgiving, the CDC published "Antibiotic Resistance Threats in the United States, 2019," an updated version of a report previously issued back in 2013. The latest report offers some sobering estimates: Antibiotic-resistant (AR) bacteria and fungi now cause at least 2,868,700 infections and 35,900 deaths each year in the U.S. However, the good news is that hospital-associated AR infections have fallen 28 percent since 2012, meaning that hospital efforts to combat these infections are helping. Hospital deaths due to Clostridioides difficile and MRSA infec- tions — which together cause more deaths than all other drug-resistant infections combined — have also declined by almost 30 percent. That's important progress. Michael Craig, MPP, of the CDC's Antibiotic Resistance Coordination and Strategy Unit notes that "healthcare-associated resistant infections account for 85 percent of the deaths" due to drug-resistant microorganisms. New and More Dangerous Despite this encouraging progress, the CDC warns that appropriate antibiotic stewardship and infection control efforts remain vitally important. New and more dangerous antibiotic-resistant threats pop up all the time. The 2019 report identifies several AR threats that weren't even on the radar six years earlier! These include drug-resistant Candida auris, an invasive fungal infection whose case fatality rate can be as high as one in three. "With emerging threats like this, the modern medicine available to us today may very well be gone tomorrow if we don't slow the development of antibiotic resistance," says CDC Director Robert Redfield, M.D. "Antibiotic resistance remains a significant enemy." You can download the 2019 threat report at www.cdc.gov/DrugResistance. WN For direct links to the websites cited, find these articles at WorkingNurse.com