Understanding the Opioid Epidemic Through the Lens of Forensic Nursing

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Pills spill out of a bottle onto a tabletop next to a spoon

In the late 1990s, healthcare providers prescribed opioids at higher rates under the assurance from pharmaceutical companies that newly developed drugs would not cause patient addiction. This grave miscalculation planted the seeds of an ongoing epidemic.

According to the National Institute on Drug Abuse (NIDA), nearly 50,000 people died in the U.S. due to opioid-related overdoses in 2019. NIDA statistics estimate that between 21 and 29 percent of patients misuse prescribed opioids, and 8 to 12 percent of individuals taking an opioid for chronic pain develop an opioid use disorder. In a 2021 report by the Centers for Disease Control and Prevention (CDC), the opioid epidemic’s economic cost to the country was estimated at $1,021 billion in 2017.

All nurses have a part to play in society’s ongoing fight against opioid dependency. These roles range from educating patients on the dangers of prescription opioid use to promoting non-opioid pain management alternatives such as relaxation techniques and naturopathic approaches.

The forensic nursing field, a specialized discipline for nurses holding a master’s degree in nursing, is positioned to handle a key aspect of the opioid crisis: the use of opioids (and other drugs, both legal and illegal) in abuse and rape cases. Forensic nurses are responsible for collecting evidence from, and offering care to, victims of recent abuse. Evidence can include DNA samples (from trace amounts of skin, blood, saliva and even clothing), photographs of injuries, and toxicology reports.

The Bigger Picture of Nursing and the Opioid Crisis

Nurses, including forensic nurses, can do their part to take on the seemingly insurmountable task of quelling the opioid epidemic by helping their patients manage pain in healthier, less risky ways.

Patients can effectively manage chronic pain through various techniques. These can include training the body to use better posture, the use of ice and heat, relaxation techniques, proper rest, non-narcotic medication, acupuncture, and massage. Nurses can educate patients on the methods best suited to their particular type of pain.

The public can also play an instrumental role in helping stem opioid addiction by developing an increased awareness of the problem. Medical professionals, especially nurses, often play the role of teachers in their communities.

This education can start with helping the public learn the key symptoms and signs of opioid abuse. The American Society of Anesthesiologists points out these signs can be related to changes in various human traits. Some of these traits involve direct behavioral or emotional changes, such as mood swings, eating less, social withdrawal or becoming involved with different groups of people. Other signs involve residual effects of these behaviors, such as experiencing financial hardships or run-ins with the law.

By teaching communities to be vigilant in identifying the signs of opioid abuse, and also providing resources for the treatment of addiction, nurses can help lead the nation away from its current trajectory toward an ongoing opioid epidemic. Forensic nurses can perform this service while simultaneously fulfilling their other professional obligations.

Additionally, nurses should scrutinize patients’ electronic health records concerning past opioid use. This can be achieved by paying attention to prescription drug monitoring programs (PDMP). These are programs described by the NIDA as “state-run electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients.” PDMP records can be critical to determining if an opioid prescription is the right treatment method for a patient to continue.

Finally, it’s important for nurses to remember that opioids are intended to help individuals alleviate acute and chronic pain. Studies indicate that nurses are more judicious in prescribing opioids: A 2019 CDC report indicated there was a 19 percent reduction in annual opioid prescribing rates between 2005 and 2017. While this metric correlates to a more diligent approach to opioid prescriptions, it doesn’t mean opioids aren’t available. It’s vital for nurses to use their discretion to determine whether the use of opioids is an appropriate option for a patient’s pain relief.

What Do Forensic Nurses Do?

Forensic nurses work at the intersection of healthcare and the law. They provide patient care for patients experiencing acute and long-term health issues stemming from either violence or victimization. They also collect samples and information for criminal investigations, and can be called upon to offer testimony in court as expert witnesses.

Patients who are treated by forensic nurses include victims of domestic violence, sexual assault, child abuse, elderly abuse and human trafficking. They may even gather evidence in the event of a victim’s death. Forensic nurses analyze data and interpret their findings to determine the health- and medical-related details of a victim’s condition. In some cases, their work can be used to determine the use of opioids.

Forensic Nurses and Toxicological Evidence

The media promotes the idea that the more traditional date rape drugs, such as flunitrazepam (Rohypnol or “roofies”), are the most common drugs used in sexual assaults. However, other drugs ranging from alcohol to opioids, cocaine and even marijuana are used far more frequently.

The use of alcohol or illicit substances in sexual assault cases — whatever the substance may be — is unfortunately common. The Bureau of Justice Statistics (BJS) revealed that approximately 39 percent of sexual assaults in the U.S. between 2005 and 2010 were associated with a victim who was under the influence of drugs or alcohol, this is according to a 2019 report by the National Institute of Justice.

Forensic nurses must be prepared to collect toxicology samples in cases where their patients exhibit signs of intoxication, when they suspect a victim may have been drugged, or when a patient is experiencing memory problems. Forensic nurses should also be aware that toxicology screening supplies are not part of a standard sexual assault forensic evidence kit (or “rape kit”) and must be obtained separately.

Toxicology screening is important even when the patient’s drug use may have been voluntary; documentation and proper evidence collection are still important processes that forensic nurses must be careful with.

Forensic nurses must thoroughly explain toxicology procedures to patients, helping them understand the tests’ importance and the type of confidentiality that surrounds test results. Patients also should know the risks involved with declining a toxicology test (i.e., there may not be sufficient evidence to obtain a conviction).

Prepare for a Career as a Forensic Nurse

The demand for forensic nurses has always been strong throughout our society. This demand is projected to grow, especially in light of the continuing opioid crisis and the ongoing use of various substances in sexual assaults.

Students enrolled in the Duquesne University online Master of Science in Nursing (MSN) program have the opportunity to specialize in forensic nursing. The online MSN curriculum includes classes that focus on criminal law, pharmacology, healthcare ethics and healthcare administration — the foundations of the forensic nursing field.

Program graduates are prepared to work as nurse investigators, forensic corrections nurses, forensic psychiatric nurses and advanced practice sexual assault nurse examiners.

Learn how our program can prepare you to make a wholly unique difference in the world of healthcare.

Recommended Readings

Confidentiality and the Sexual Assault Victim

Forensic Nurses Managing DNA Evidence

Nurse Educators Integrating Social Justice in the BSN Curriculum for the Forensic Nursing Field


American Society of Anesthesiologists, Opioid Abuse

Centers for Disease Control and Prevention, Prescribing Practices

National Institute on Drug Abuse, Misuse of Prescription Drugs Research Report: How Can Prescription Drug Misuse be Prevented?

National Institute on Drug Abuse, Opioid Overdose Crisis

Nurselabs, Forensic Nurse: All You Need to Know About Forensic Nursing

Safeta.org, Examination Process — Alcohol and Drug Facilitated Sexual Assault