Posts Tagged ‘Nurses at Opioid Treatment Programs’

Lack of Knowledge, Lack Of Understanding

“…Poor management & security. No patients are held accountable for their misuse & the doctor allows patients to use other drugs over & over when getting treatment.”

I was tooling around on the internet. Somewhere between looking at recycled textile art on Etsy and viewing lists of the best audiobooks for 2021, I looked at job satisfaction reports on Indeed and found the above comment. It was written by a nurse who had worked at my facility. She was talking about me!

Before COVID, this nation faced significant nursing and other healthcare personnel shortages. COVD made this worse. Our opioid treatment program has had problems hiring and retaining nurses (and other personnel) just as other healthcare facilities have had. Most OTPs have early hours and lower pay than hospitals and other facilities, making it more difficult.

I wanted to get on Indeed to read about what nurses are saying about their job situations, hoping to find comments from nurses working at OTPs. I never dreamed I’d read a comment from a nurse who had worked at the same facility as me.

I felt angry and hurt when I read the comment, but then I felt sad. I didn’t do a good enough job educating her about the nature of addiction and the purpose of treatment programs. I missed an opportunity.

I can’t emphasize this enough: I can’t keep anyone from using drugs if that’s what they want to do. I don’t have that kind of power. No one does. Even placing people in prison doesn’t always stop people from using drugs.

Since I don’t “allow” or “disallow” anyone’s drug use, what good am I?

First, I can prescribe medication that keeps most opioid users off illicit opioids and on much safer and longer-acting medications. This allows them freedom from chasing opioids several times per day, and freedom from committing crimes to get money to get these illicit opioids. It usually improves their quality of life and here’s the big thing: It reduces their risk of dying. Since they are alive, they have a chance of participating in counseling.

Second, the chronic nature of opioid use disorder and other substance use disorders means we rarely see patients enter treatment and never use another drug. This disease doesn’t work like that. However, we can use evidence-based counseling techniques to assess patients’ willingness to change drug use behavior. We can use those techniques to help them decide what kind of action they’d like to take to change drug use habits.

Behavioral changes don’t happen quickly. Anyone who has tried to lose weight, exercise more, stop smoking or other things can probably relate to the difficulties of changing behavioral patterns. Sometimes we try things that don’t work, but we gain information about what may work for us in the future.

In the old days, I did taper people off their treatment medication (methadone or buprenorphine) if they continued to use illicit drugs. I’ve changed my approach, after learning more about how to support patients and help them in their recovery. These days, especially with fentanyl prowling around the drug scene, patients die when out of treatment. Accepted best practices show patients have best outcomes when we retain them in treatment and keep talking to them.

Obviously, the nurse who wrote the complaint wasn’t educated about this fact. I am one of several people who should have educated her about this.

I do lower doses if there’s another medical condition that makes methadone or buprenorphine dangerous, or if patients’ use of sedative drugs make dosing methadone or buprenorphine too dangerous. Even with these conditions, we try to talk the patient into going to an inpatient program for more intense counseling and help.

In fact, continued use of opioids is an indication to increase methadone/buprenorphine, not to decrease it.

Perhaps the writer of the complaint felt we should have stopped giving any take home doses to patients using illicit drugs. The comment was written after COVID started and we’ve been more liberal with take homes. State and federal regulations around take-home doses were relaxed so patients could dose at home and avoid crowds. We agreed this seemed appropriate to do. For the most part, our patients did well with these extra home doses.

Since I read the comment, I’m more careful to remind nurses and counselors during case staffing that we always must think about the risk/reward of treatment. In very few situations does excluding patients from treatment make sense. On the other hand, we don’t ignore drug use; every positive urine drug screen result must be addressed in counseling. But addressing drug use does NOT mean dismissing patients from treatment.

We recently had a nurse who worked only one day before she decided the job wasn’t for her. I hope she’s the one who wrote the comment. She didn’t have enough time to learn about what we do at the OTP. She didn’t work long enough to see all the miracles we see at OTPs.

I’ve said this many times before: I see more positive changes in people enrolled in opioid treatment programs than I ever saw back when I worked in primary care.

That’s the main reason why I love working at the OTP.  I’m sorry our nurse didn’t get a chance to see this for herself.