Opioid use disorder: Why are nurses denied proven treatment?

Authosr(s): Julie Cullen

By Julie Cullen, Managing Editor, American Nurse Today

Earlier this year, American Nurse Today ran a two-part series called “When a BON disciplinary process is based on substance use disorder.” (Read part one and part two.) I learned a lot while working on these articles. What impressed me most were the redemptive approaches offered to help nurses recover from the disorder and guide them back to practice. So, I was surprised when I read a story on Kaiser Health News about how medication-assisted treatment for opioid use disorder (OUD) isn’t an option for most healthcare professionals.

Another article that appeared in American Nurse Today this year discussed the nurse practitioner’s role in medication-assisted treatment for OUD. This continuing nurse education article covers the various opioid agonist medications (methadone, buprenorphine, suboxone, and naltrexone) used as part of comprehensive OUD treatment. Medication-assisted treatment is an evidence-based intervention that’s been shown to significantly decrease the rate of relapse and overdose.

So, why the hesitation to use this proven treatment for nurses and other healthcare professionals who are recovering from OUD? The main argument against their use seems to be a belief that they are merely a substitute for the opioid the person is addicted to. And because the medications bind to the same brain receptors as the opioids, some believe they may hinder the professional’s ability to perform his or her job safely. However, what they actually do is help reduce relapses and cravings by stimulating the same pathways as opioids, but in a controlled manner that prevents a person from feeling “high.”

Dr. Peter Grinspoon, a physician in treatment for OUD who was interviewed for the Kaiser Health News article, made what seems to be a good point: “Doctors could be taking other medications that affect their performance but face no repercussions. For example, he said, they may take benzodiazepines for anxiety or Ambien to help them sleep.”

Bill Kinkle, RN, also was interviewed for the Kaiser Health News article. Kinkle lost his license after developing an OUD. He’s tried various recovery programs but relapsed and overdosed several times. He asked his peer nurse assistance program if he could use Suboxone (buprenorphine/naloxone) as part of his treatment but was told he couldn’t unless he had a detailed plan for tapering off of the medication.

In the American Nurse Today and Kaiser Health News articles, the subject of stigma comes up. Most people suffering from OUD may already feel shame about their condition and then they’re made to feel ashamed for asking about medication-assisted treatment. They may even be told that they’re just switching one addiction for another. As Dr. Grinspoon said in the Kaiser Health News article, “There are tons of pharmaceuticals that could affect our performance—all of which doctors are allowed to take. And it’s just because of the stigma that they’re singling out addiction.” As for nurse Kinkle, he says he’s “white knuckling” it without medication. His treatment includes participation in a 30-day inpatient program, partial hospitalization for 3 weeks, 3 months of intensive therapy, attendance at AA meetings 3 to 5 days a week, and random urine tests. He feels that he wouldn’t haven’t suffered through his relapses and overdoses if he’d been able to include medication as part of his treatment plan.

Source: Kaiser Health News

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