Clinical DIMENSIONOpioids Understanding How Acute Actions Impact Chronic ConsequencesHines, Cheryl B. EdD, MSN, CRNA; Owings, Clara R. EdD, MSN, FNP-BCAuthor Information Cheryl B. Hines, EdD, MSN, CRNA, has worked with and around opioids and anesthetic agents in her role as a certified registered nurse anesthetist for over 35 years. In addition, as a nurse educator, at the Capstone College of Nursing, for both graduate and baccalaureate nursing students, she has worked with educating students to develop clinical judgement in complex situations. Her passion for pharmacology and nursing education has guided her current research focus: educating baccalaureate nursing students in opioids, opioid toxicity and the nurse’s role in this urgent/emergent situations. Dr Hines has presented her work extensively at state, national, and international conferences. Clara R. Owings, EdD, MSN, FNP-BC, is an assistant professor in the Capstone College of Nursing, where she is responsible for providing in-person and online instruction in the traditional undergraduate and registered nurse undergraduate and graduate programs at the University of Alabama. She is a doctorally prepared registered nurse with degrees in instructional leadership in nursing education (EdD), a master of science degree in nursing, family nurse practitioner concentration, and holds bachelor of science degrees in nursing and biological sciences. As an educator, she has received awards for her work in curricular innovation and teaching excellence. Her background as a principal investigator includes nurse residency program evaluation, critical care simulation research, and curricular innovations. She has published and presented her work nationally and internationally. Address correspondence and reprint requests to: Cheryl B. Hines, EdD, MSN, CRNA, College of Nursing, University of Alabama Capstone, 650 University Blvd. E, Box 870358, Tuscaloosa, AL 35487 ([email protected]). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dccnjournal.com). Dimensions of Critical Care Nursing: 9/10 2021 - Volume 40 - Issue 5 - p 268-274 doi: 10.1097/DCC.0000000000000487 Buy SDC Metrics Abstract In the last decade, critical-care nurses have seen a surge in acute opioid overdose admissions to intensive care units; there have also been significant increases in intensive care unit admissions due to opioid-related illness such as dependence, tolerance, and hyperalgesia. Despite these issues, opioids continue to be the criterion standard of pain management, and the search for opioid alternatives has not produced a clear replacement. A contributor to this problem has been the prevailing opinion that once bound to a receptor, all opioids engaged in the same types of intracellular signaling, which resulted in the same types of responses, only differing in the magnitude of those responses. Contemporary research with G-protein–coupled receptor models (eg, opioids) has demonstrated that this oversimplification is incorrect or incomplete. Understanding the complexity of opioid pharmacodynamics and pharmacokinetics helps us to grasp the intricacies of opioid-related adverse effects. Although there are many potential adverse effects related to opioids, this review focuses on the major adverse effects commonly seen in critical care, namely, respiratory depression, tolerance, hyperalgesia, and central sensitization. In addition, a case study has been incorporated to aid in understanding of strategies nurses can incorporate into their practices: that help mitigate the development of these effects. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.