Buprenorphine Treatment: A Nurse’s Story
“We actually counted the number of patients across those 19 health centers before we started, and there were 324 patients total. A year later, we had 1,600 patients enrolled,” Ms. LaBelle explained.
At each site, nurses enroll an average of 2 to 3 new patients a week until they reach 100 active patients, which is considered “a manageable caseload” for a full time nurse. “In addiction treatment, people come on and come off all the time,” said Ms. LaBelle. “It’s not uncommon for patients to come and go many times in the course of their treatment as they work through their disease.”
Buprenorphine is a life-changing medication for individuals who can’t move forward in their disease of addiction because of how it affects their brain. People can take this medication at home when they get up in the morning. They take their medication and get on with their lives.
Find out more about buprenorphine or search the physician locator at SAMHSA’s Web site. You can also call SAMHSA’s Center for Substance Abuse Treatment (CSAT) for information at 1-866-287-2728 (1-866-BUP-CSAT) or email email@example.com.
Technical Assistance Publication (TAP) 30, Buprenorphine: A Guide for Nurses is currently available from SAMHSA’s Health Information Network at 1-877-SAMHSA-7. Ask for publication number SMA09-4376.
Nurse care-managers typically handle the initial screening — either by telephone or onsite — for a patient who is seeking medication-assisted treatment with buprenorphine.
Initial screening includes medical, psychiatric, social, and substance abuse histories. “We ask where they’re at in their treatment process, whether they’re safe, and whether they’re on any medications that may be contraindicated, and what their treatment goals are,” said Ms. LaBelle.
If patients are found to be appropriate candidates for outpatient treatment, they come in to meet with the nurse for an intake assessment. The initial screener intake is reviewed to make sure the information is accurate and to add details as needed.
“If a patient is already in the medical system, we review the medical history, medications, and current treatment, along with education about buprenorphine,” said Ms. LaBelle. That means letting a patient know what the medication is, how it works, how it’s administered, and what the program entails. “We want to be sure that the patient can meet the program requirements.” Questions include the following: Are they going to be able to come in and see the nurse weekly? Will they be able to go to counseling? Do they live nearby? Have transportation? Do they work? Have any legal issues?
In addition, nurses do an “education,” on the disease of addiction, the medication, the induction process, and potential complications (e.g., injuries, hospitalizations, emergencies, pregnancy). After that, the patient signs a treatment agreement and a consent of treatment.
“Every buprenorphine program has a consent of treatment, letting the patient know that this is an opioid, that individuals can become dependent, and there’s the potential for withdrawal symptoms if the person comes off the medication,” said Ms. LaBelle.
In a meeting with the treatment team, patients agree to program requirements in a treatment agreement, so patients know what to expect up front. “When patients are going through the intake process, they will promise you the moon because they want the medication,” said Ms. LaBelle. “It’s understandable. People are desperate for treatment. As we move forward and patients stabilize, we always review the treatment plans and agreements so that patients remember what they committed to. We work through the treatment process step by step with everyone on the same page.”
Treatment agreements are standard program requirements and the treatment plans are specific to a patient’s treatment needs. “We try to meet folks where they are at in their disease and make modifications and changes to assist them in the recovery process,” added Ms. LaBelle.
After the various screenings, the patient is scheduled to see a doctor who has a waiver and is permitted to prescribe buprenorphine. When that patient meets the doctor, all of this up-front work is done. The doctor sees the patient after the initial assessment, history, education on the treatment and program, lab work, urine tox, treatment agreement, consents, and the education. “The doctor does a physical exam for the patient, reviews all the information, confirms an opioid dependence diagnosis, and quickly moves the patient to start buprenorphine with the support of the nurse who facilitates this process,” said Ms. LaBelle.
“Typically, when a patient gets through the screener, through the nurse, and makes it in to see the doctor, that patient is appropriate for treatment. The doctors make the final decision, and work with the team to move this patient to induction. They are key to the success of this process.”
For more on buprenorphine, visit SAMHSA’s Center for Substance Abuse Treatment.