The Role of The Nurse
In The Treatment Of Opioid Addiction
The Character of the nurse is as important as the knowledge she possesses ~Jarvis, 1996
Currently, advanced practice nurses and NP's may not prescribe or dispense Buprenorphine products for the treatment of addictions even in States that allow them to prescribe scheduled medications under certain controls, supervisions, and other restrictions.
The nurse's roles with patients receiving Buprenorphine for the treatment of addiction (1) may be subject to State Practice Regulations and (2) may include, but not be limited to:
- Conducting screening, assessment, treatment monitoring, counseling and supportive services
- Educating patients, their family members, or other supportive individuals about Buprenorphine therapy as well as risks, benefits, potential side effects, interactions, program requirements, consents, and treatment contracts
- Involving patients in the developement of the treatment plan, and working with the patients' needs
- Enhancing treatment readiness, supporting treatment completion, ensuring safety and promoting sustained recovery outcomes for individuals undergoing Buprenorphine treatment for opioid addiction
- Improving access, identifying community resources, and providing information about them and explaining reimbursement options for office-based Buprenorphine treatment
- Assisting patients in accessing care elsewhere when the present practice is not a suitable option for them and
- Assisting patients in accessing other treatment options as needed (e.g. day treatment, residential, outpatient, methadone detoxification)
non physician health care professionals such as nurses, nurse case managers and NPs are permitted to conduct various activities under SAMHSA regulations. For example, under 42 CFR 8.12(f), an authorized health care professional under the supervision of the program physician may conduct the required initial physical examination.
On the other hand, only a medical director or program physician shall determine a patient's eligibility for take-home medications under 42 CFR 8.12(i)(2)
In office-based settings,
non physician health care professionals such as nurses, nurse case managers, and NPs may be permitted to conduct physical examinations and other procedures. These procedures should be conducted under the supervision of the physician and documented in the job description, if they are permissible under the Nurse Practice Act in the State in which the nurse practices. However, the physician must determine the patient's dosage of buprenorphine medication and the amount of medication permitted for take-home medication or the amount of medication to be dispensed with a prescription.
Nurses may be instrumental in the development of a treatment plan that contains (1) clear and achievable targets and time scales(e.g. number of sessions that a patient attends), (2) the venue in which care/intervention will be offered, and such as counseling and psychotherapy. Also, nurses must consider the patient's motivation and treatment accessibility throughout the treatment process. Nurses should actively involved the patients in development of the treatment plan, including discussing appropriate behavior, explaining reasons for which medication may be discontinued, making a psychiatric referral or referral for other ancillary service, and explaining what happens if a patient in noncompliant. Also patient participation in self-help support programs during and after treatment often is helpful in maintaining recovery. (Clancy, Coyne and Wright, 1997)
It is crucial for nurses to monitor patients before and during the induction phase. Possible drug use during treatment must be monitored continuously, as it is not unusual for relapses to occur during treatment. Objective monitoring (urinalysis and other tests) helps patients withstand urges to use. Monitoring can provide early evidence of drug use so that the treatment plan can be adjusted. Finally, feedback to patients who test positive for illicit drug use is an important element of monitoring. (Clancy, Coyne, & Wright, 1997)
Ongoing Treatment Monitoring
Treatment must be assessed continually to ensure that it meets changing needs. Matching treatment settings, interventions, and services to each individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society. No single treatment is appropriate for all individuals. Moreover, because individuals who are addicted to drugs may be uncertain about entering treatment, taking advantage of opportunities when they are ready for treatment is crucial.
Treatment must be readily available. Potential treatment applicants can be lost if treatment is not immediately available or is not readily accessible.
It is also important to remember that as the nurse and/or other office support staff, your role is of the upmost importance. You are the one the patient will often see or talk to the most.
It is hard for patients when first entering into treatment to be able to talk about their past or current drug usage. The relationship that you establish from the beginning of treatment will have a lot to do with how the patient responds to treatment. Whether or not they feel able to talk to you opening and honestly.
Patients will often call the office with questions because they either forgot to ask them when they were in the office or they just didn't think about it at the time or they might not understand. Sometimes you will come across the patient who sometimes speaks rude or seems to be demanding. Learning how to deal with these situations takes time and it doesn't help anyone, the patient, nurse or provider when things get heated and out of control. One of the worse things a patient can hear from the nurse or support staff is "We can't help you" or "there's nothing I can do about it".
Hearing those words can make them feel hopeless and like they don't matter. But showing empathy and trying to help them understand why it is you can't help them does, in its own way help.
Reference: TAP 30, Buprenorphine: A Guide for Nurses
SAMSHA, Treatment Improvement Protocol: Use of Buprenorphine in the Treatment of Opioid Addiction
Compiled and Written:
Dee Black/Assistant Editor/Director
Deborah Shrira CEO/ Editor 21 June 2011