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This course has been enlightening for me as working in primary care at a FQHC we see patients with substance abuse problems on a daily basis. Also, having working in a opioid rehab in the past I see things so differently now. In primary care you are seeing the patient entire medical history. Since we, also, have behavioral health patients mental health come into play along with physical health. Substance use seems to increase chronic illness and coexist with mental health issues.  This has changed how I question patients about past and present medical, mental, and substance use issues.

What I found the most interesting is motivational interviewing. I have dealt briefly with it, but have not been experienced as extensively as this course has provided. I look forward to using it more in the future to help patients with issues they are dealing with. The topic I found most uncomfortable is MAT since I worked in an Opioid rehab and sadly saw patients misusing the medication and not seeing it work as it should and could if used properly. This, however, does not make against MAT, but I did think it needs to be prescribed in very controlled settings.

What a very interesting discussion. Having worked in this field before a lot of this came into effect I learned a lot of new things. So many barriers exist when it comes to treating opioid use disorder. Many doctors may not want to have “addicts” coming to their office with other patients who do not have OUD. So few doctors want to deal with the hassles of treatment of OUD. Reimbursement for OUD, like most medical treatment, is tricky, finding qualified support staff to provide support in the office setting, and the stigma of being a provider that prescribes a medication that not everyone in the medical community support.

Successful nurse management model would train more nurses to understand MAT. Have more RN’s and NP’s working in addiction. Using Nurse Care managers to facilitate treatment would help with long waiting lists and provide the care for more patients instead of having long waiting lists.

No, I would never want to work in this field. I did it once and I found it was not for me. I love the patients and I love what MAT ca do for a patient. There are so many gray areas for nurses working in this field that it is too risky. Kudos to anyone how can do this.

There are many differences in how patients with substance abuse disorders are treated compared to those who have other chronic issues. Many providers will look at patient’s with a past of addiction very differently. Prior to entering a room I have, in the past, heard providers state they know they are only seeking pain medication. When in reality the patient was their for something totally unrelated. Patient’s with a history of substance abuse have a “Scarlet Letter” on their chest. It seems like it is not understood that what may be a minor pain to those who are not addicted is a horrific pain to someone who has been addicted to opioids. Addicts may, also, be thought of as mentally ill or “crazy”. The life experiences an addict has had is different from the rest of us and they may see things far differently than we would.

The similarities between patients with substance abuse disorder and those who are not are similar in my opinion. Similarities include access to healthcare, getting treatment for health conditions, and getting a proper diagnosis. My point of view is biased by the company I work for. I must say that my current job has a staff who does not treat any patient differently regardless of circumstances. Each facility will treat patients differently, but the differences are becoming less and less.

For two years I worked in a Suboxone Clinic. This was a great learning experience for me. I saw people from all walks of life who had been addicted to opioid drugs. There were so many stigma’s that these patients faced. From criminal records to how the drugs changed their physical appearance. A very common issue who scars on the skin either from shooting up or from scratching themselves so much they had permanent scars. I recall discussing how many people might not notice it. At the time I was a new RN. I have since realized I look for those tell tale signs for drug use in my patients during initial assessment. I am not looking to judge, but to help. Working in an FQHC, now,  I see a lot of former drug users and it saddens to hear their stories of the treatment they get in an ED or other medical facility because of a history of addiction. Many abandon medical treatment because they are ignored when they need medical assistance as so many medical professionals think they are drug seeking. As a healthcare professional I try not to judge someone based on looks, history, or anything else. We all have our own crosses to bear. Treating the patient as we want to be treated is what all healthcare professionals need to do. Think of how hard it must be for someone who has not had medical care since they were sober to reach out for it. We are on the front line of making the experience a positive one.

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