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As I’ve progressed through this course, I feel that I’ve grown to be able to better recognize and address my own biases and stigma-driven thoughts and behaviors. I thought that having us all reflect on our own biases was a great way to begin the course that only got more valuable as we progressed through the coursework. 

I found the topics surrounding prescribing for MAT to be the most interesting thing we learned. The way that the field is evolving is really cool. I particularly enjoyed learning about the public policy component to this field and how it is constantly changing to allow for better care for our patients. 

I thought the bias reflections were the most valuable thing that we have learned and also the most uncomfortable. It takes some real soul searching to acknowledge that one has these biases and there is some innate discomfort involved in that. I think that the uncomfortable nature of this kind of reflection is what helps us grow the most in the end.

The biggest thing that I am taking away from this course into my profession as a nurse is to be an advocate for public policy. I’ve encountered several times in my career already times when the people at the ‘top’ don’t know what front line healthcare workers really need. I think that all nurses need to be advocates and it should become the norm for nurses to run for public office so that we can see some real change in our healthcare policy across the world.

• Share your thoughts on the barriers mentioned for treating SUD.
• Reflect on the critical elements listed for a successful nurse management model for treatment of SUD.
• Could you see yourself working in this type of nursing role?  Why/why not?

I found this podcast very interesting as it came from a primary source in the fight against addiction – the Director of Boston Medical Center’s Office-Based Addiction Treatment Program, Colleen LaBelle. Given her first hand experience in working with healthcare providers treating addiction, her insight into the effectiveness of what has been done and what needs to be done in the future to combat addiction is extremely valuable.

Out of the biggest two barriers mentioned in the podcast the lack of nursing support didn’t surprise me as much as the lack of office support and knowledge of the payment system. The lack of nursing support, even though it seems like a no-brainer to have nurses in this field, didn’t surprise me so much because I had already known that nurse practitioners got the ability to prescribe buprenorphrine several years after physicians did. The lack of office support surprised me because I figured that large healthcare systems might jump on this new industry to take care of patients. With a model forming around the treatment of addiction, it seems like that would be a new market opening up that healthcare systems could get into, but perhaps there is no money in it, or the stigma surrounding addiction made it an undesirable business venture.

I found it really telling that the critical elements listed for a successful management model for treatment of SUD revolved around nurses. This makes sense as nurses are the primary contact of patients undergoing treatment and for many patients, they never actually see a physician, but rather a nurse and a nurse practitioner. Having highly trained, qualified individuals carrying out these roles is extremely important as they make up the bulk of the care these patients receive. I thought it was particularly interesting that there are more nurse practitioners working in primary care now than there are physicians. A question for another day is why are physicians exiting the primary care field and what is driving NPs to fill these positions?

Personally, I don’t see myself working this type of role as a nurse. I have undying respect for those that work in this area, but I don’t think I have the patience to do it. However, I have been growing an interest in public policy. I met one of my girlfriend’s extended relatives over the summer who is a nurse and is currently Wood County’s health commissioner. I thought it was really cool talking to him about his job and all that he does. He works with all kinds of public health issues including addiction resources within his county. I could see myself working in some kind of public health office much later in my career.

Compare patients with substance use disorders to patients with other chronic health conditions (such as diabetes, heart disease etc).

• Are there differences in how patients with each are treated by healthcare professionals and within the healthcare system?  Provide examples.
• Are there similarities in how patients with each are treated by healthcare professionals and within the healthcare system?  Provide examples.

There are absolutely differences in how patients with substance use disorders are treated compared to patients with other chronic health conditions. As compared to a patient with heart disease who may be given the benefit of the doubt, the patient with a opioid abuse issue may be viewed as weak or immoral for using illicit drugs before a person even meets them. I think the difference is never more stark than when it comes to treating a person’s pain. I’ve seen in my own practice numerous times where a nurse is reluctant to give the same amount of pain medicine to a hospitalized addict than they are to a person in the next room with no history of substance abuse.

I want to make clear in this post that I’m not chiding nurses for their poor practice. There are reasons for healthcare professionals to be skeptical of patients with known addictions asking for drugs. Some of this comes from a genuine care for doing whats best for the patient. If they have an abuse issue, it could be an ethical issue for a nurse to give them pain medicine when they could be contributing to their substance abuse. In addition to this, healthcare professionals of all settings are all too aware of the abuses that patients with substance use disorders are capable of dolling out when they are craving. Nurses especially are victims of unseemly rates of workplace violence. While I am sympathetic to the real feelings that patients are going through during withdrawal, the lack of support from upper administration that nurses get when they are assaulted in the workplace is shocking. Whether its right or not to let the actions of those few addicts impact the treatment of the substance abuse population as a whole, it isn’t surprising that it happens.

Despite the need for real change in that part of the system, we as nurses should maintain respect for all of our patients and not assume that all of our addicted patients are in that violent minority. Something that I have heard in my career working in healthcare that has stuck with me pertaining to this issue is that an individual generally uses a substance because it takes away pain, and therefore withdrawal is bottled up pain coming back all at once. I know that this isn’t the actual pathology behind addiction, but this simplistic explanation (made for kids actually) has stuck with me because it makes me stop and consider what an addict interprets not having that drug as.

• Share your thoughts on the stigma patients with a substance use disorder face within the healthcare system and how this impacts patients.  Feel free to share examples you have seen in the media and/or your own practice. Please omit names/places/any identifying information in any personal/professional stories you share.
• Share 1 tip that might help combat stigma.

Stigma is definitely a factor that negatively impacts our patients’ care. I think that this is very prevalent in our hand-off reports on patients with substance use disorders. I’ve seen and received reports from PCAs and nurses that lead off with “he’s a junkie” or something to that effect. Having this first comment on the patient really sets a tone for the rest of the report and makes it nearly impossible to not have that bias effect the care that you provide. It also implies that the patient’s condition is somehow their fault and not a real diagnosis.

I am guilty of some of this behavior myself. I can’t think of any specific instances, but I have definitely given reports to other PCAs that showed my own dislike of a patient before, especially patients that I was sitting as a 1:1 for. Often these patients had a sitter for a mental health reason and I wasn’t even thinking of substance abuse, but as we all know, people with mental illness are very likely to also have a substance use disorder so they experienced discrimination nonetheless. This is something that I think I definitely need to work on and reflecting, it really bothers me that my own frustration with a patient could’ve caused them to have their care negatively impacted.

A skill that we can use the combat stigma is to set an example for our coworkers by giving unbiased reports on patients that tend to be frustrating mentally ill patients. We should always try our best to remember that behavioral issues are symptoms of a mentally ill person’s disease process and shouldn’t be taken personally.

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