House of Representatives

Bill 5172
NOPAIN Act: Non-
Opioids Prevent
Addiction in the Nation
Alex Wheeler
Azusa Pacific University
Background
• 12% of patients reported addiction or
dependency to opioids after operation
• 18 million people in the past year reported
opioid misuse
• 130 American deaths/day from opioid
overdose
• Economy spends over $78 billion a year in
prescription opioid misuse
• Insurance companies refuse monetary
coverage for non-opioid pain treatment
• Centers for Medicare and Medicaid (CMC)
create financial incentives to use opioids https://www.mtpr.org/post/id-now-required-pick-opioid-painkillers-montana

(CDC, 2018; GovTrack, 2020; H.R. 5172, 2019; National Institute on Drug Abuse [NIDA], 2018)
Health Policy
• First introduced in November 2019 – in the first
stage of the legislative process waiting to be
sent to subcommittees
• Requires coverage of non-opioid pain
treatments for outpatient post-op pain
• Non-opioid treatments are successful
• Physical therapy, implantable devices, non-
opioid medication, acupuncture, etc
• Gives patients the freedom to choose

https://www.mtpr.org/post/id-now-required-pick-opioid-painkillers-montana

(GovTrack, 2020; H.R. 5172, 2019)

 Supporters/Opponents

Supports Opposes
• American Society of Addiction • Centers for Medicare and Medicaid
Medicine (ASAM) has founded the
Coalition to Stop Opioid Overdose
(CSOO)
• Many supporters including:
• American Psychological
Association
• American Association of Nurse
Anesthetists
• Voices for Non-Opioid Choices

(American Society of Addiction Medicine [ASAM], 2020; GovTrack, 2020)

 Justice
Distributive justice
• All have the same access to both fair
and appropriate benefits
• All patients have the right to
appropriate healthcare benefits
(Beauchamp & Childress, 2013; CDC, 2018; H.R. 5172, 2019)
Utilitarian theory of justice:
• Seeks to promote a cost-benefit
analysis
• 191 million opioid prescriptions
• 11.5 million Americans misusing
opioid prescriptions
• Seek to decrease this number to
promote positive value
Justice
The Other Side
Fair Opportunity Rule
• “Should not be denied social benefits on the
basis of undeserved disadvantageous
properties, because they are not responsible
for these properties,” (Beauchamp & Childress,
2013, p. 262)
• Could be applying past patient history to create
a bias towards all future patients
• Physician concern with losing license
increased monitoring patients for opioid
misuse biased treatment https://www.americanprogress.org/issues/criminal-
justice/news/2018/02/27/447225/revolution-values-u-s-criminal-justice-
system/
• Not treating every patient with human dignity
(Beauchamp & Childress, 2013; Webster et al., 2019)
 Beneficence

Positive Beneficence Paternalism

• Demands that we act to help others • Medical paternalism:
• Physicians determine their
• NOPAIN Act fights for the outcome
that will most benefit the patient opinion overrides their patient’s
desires
• “Remove conditions that will cause • Physicians think they know best
harm to others,” (Beauchamp & and want to “protect” they’re
Childress, 2013, p. 202) patients
 Loss of autonomy

(Beauchamp & Childress, 2013; H.R. 5172, 2019; Manworren & Gilson, 2015)
 Nursing and H.R 5172
Provision 1:1
• Human Dignity
• Every patient has the right to
human dignity  treated as an
individual
• Hooten et al. (2017) suggests
algorithm upon assessment
• Individual pain action plan
Provision 1:4
• Self Determination
• Nurses must provide patients
with adequate information to
promote self-determination
• Educate patients on opioid risks
including addiction, overdose,
and death
(Fowler, 2015; Hooten et al. 2017; Manworren & Gilson, 2015)
Nursing and H.R
5172
Provision 9:1
• Social justice
• Nursing promotes health, prevents illness,
relieves suffering in a holistic way of healing
• Social justice gives patients the freedom of
choice
• Non-opioid pain treatment clinically proven to
be successful
• Denying patients a successful treatment option
 not acting under the provision of justice
https://www.newsweek.com/20-most-painful-conditions-nhs-1191081

(Fowler, 2015; Jaiteh, Steinauer, & Frei, 2019)

 Cultural
Considerations
• Physicians create their own bias based off
cultural research that shows a relationship with
African American culture and higher risk of
drug addiction
• Providers more closely monitor African
American patients
•  Caucasian patients monitored less
Increased opportunity for Caucasian
patients to misuse and become addicted
• Under the Fair Opportunity Rule – this is unjust

http://www.bris.ac.uk/news/2018/may/implicit-racial-bias.html

(Anastas, Hollingshead, Miller, Ashburn-Nardo, & Hirsh, 2017; Becker et al., 2011; Hollinshead, Matthias, Bair, & Hirsh, 2016).
Own Perspective
• Patients fear addiction
• Order for opioids  nurses freely offer the
opioid for pain

This bill calls for change:

• Pain treatments not covered by insurance:
• Physical therapy, acupuncture,
chiropractor visits

https://www.therecoveryvillage.com/drug-addiction/news/#gref

(H.R. 5172, 2019)

References
• American Society of Addiction Medicine. (2020). Coalitions. Retrieved from
https://www.asam.org/advocacy/coalitions
• Anastas, T., Hollingshead, N., Miller, M., Ashburn-Nardo, L., & Hirsh, A. (2017).
Patient race and socioeconomic status influence providers’ recommendations about
opioid therapy and workplace accommodations for chronic pain. Journal of Pain,
18(4), S33. https://doi.org/10.1016/j.jpain.2017.02.122
• Badzek, L. Henaghan, M., Turner, M., & Monsen, R. (2013). Ethical, legal, and social
issues in the translation of genomics into health care. Journal of Nursing
Scholarship, 45(1),15 – 24.
• Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics. New York,
NY: Oxford University Press.
• Becker, W. C., Starrels, J. L., Heo, M., Li, X., Weiner, M. G., & Turner, B. J. (2011).
Racial differences in primary care opioid risk reduction strategies. Annals of Family
Medicine, 9(3), 219–225. https://doi.org/10.1370/afm.1242
• Center for Disease Control and Prevention. (2018). Understanding the Epidemic.
Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html
• Fowler, M.D.M. (2015). Guide to the code of ethics for nurses: With interpretive
statements (2nd ed.). Silver Springs, Maryland: American Nurses Association.
References
• GovTrack. (2020). H.R. 5172 – 116th Congress: NOPAIN Act. Retrieved from
https://www.govtrack.us/congress/bills/116/hr5172
• Hollinshead, N. A., Matthias, M. S., Bair, M., & Hirsh, A. T. (2016). Healthcare
providers’ perceptions of socioeconomically disadvantaged patients with chronic
pain: A qualitative investigation. Journal of Health Disparities Research and Practice,
9(3), 35-44. Retrieved from
https://digitalscholarship.unlv.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&arti
cle=1410&context=jhdrp

• Hooten, M., Thorson, D., Bianco, J., Bonte, B., Clavel Jr, A., Hora, J., …Walker, N.
(2017). Pain: assessment, non-opioid treatment approaches and opioid
management, eighth edition [PDF file]. Institute for Clinical Systems Improvement.
https://www.icsi.org/wp-content/uploads/2019/01/Pain.pdf
• Jaiteh, C., Steinauer, R., & Frei, I. A. (2019). Individuals with opioid dependence
using polysubstances: how do they experience acute hospital care and what are
their needs? A qualitative study. Journal of Addictions Nursing, 30(3), 177–184.
https://doi.org/10.1097/JAN.0000000000000294
References
• Malone, R. E. (2005). Assessing the policy environment. Policy, Politics, & Nursing
Practice, 6(2), 135–143. https://doi.org/10.1177/1527154405276141
• Manworren, R. C. B. & Gilson, A. M. (2015) Nurses’ role in preventing prescription
opioid diversion. American Journal of Nursing, 115(8), 34-40.
https://www.nursingcenter.com/cearticle?an=00000446-201508000-00021&Journal
_ID=54030&Issue_ID=3152763

• National Institute on Drug Abuse. 2018. Misuse of Prescription Drugs. Retrieved

from
https://www.drugabuse.gov/publications/research-reports/misuse-prescription-dru
gs

• NOPAIN Act, H.R. 5172, 116th Cong. (2019). Retrieved from

https://www.congress.gov/bill/116th-congress/house-bill/5172/text
• US Department of Health and Human Services. (2018). Introduction: About HHS.
Retrieved from
https://www.hhs.gov/about/strategic-plan/introduction/index.html#
• Webster, F., Rice, K., Katz, J., Bhattacharyya, O., Dale, C., & Upshur, R. (2019). An
ethnography of chronic pain management in primary care: The social organization
of physicians’ work in the midst of the opioid crisis. Plos One, 14(5), e0215148.
https://doi.org/10.1371/journal.pone.0215148