I learned so much this semester and honestly enjoyed this course more than I originally thought that I would. Going through the content each week kept myself in check with my own opinions and biases. What I learned about myself as I have progressed through this course is that I definitely have/had biases about individuals who illegally use drugs. This course has made me confront those opinions that I didn’t really notice that I have and learn to work through them, keeping in mind that addiction really is a disease.
The topic that I found most interesting was the information included in the Module 3 content on Brain Chemistry and the Brain Reward System. Specifically, I saved the video “Addiction Neuroscience 101” that was given in our Module 3 content. I even sent this video to a few people to have them watch it. I think this video is what finally clicked for me with how addiction really is a disease that completely warps one’s brain in every aspect. The topic that I found to be the most uncomfortable was surrounded around how hard it is for individuals with substance use disorders to get treatment. Between the lack of resources to help them, to a lack of providers that are able to prescribe medications that are needed to treat addiction, and to a general stigma that most of the country has towards these individuals, this all makes getting adequate treatment so incredibly hard for most of them.
I will carry a lot of what I have learned in this course into my future practice as a nurse. Most importantly, I want to adopt my new understanding of making sure to stop and listen to everyone’s story before making judgements about anyone. Every single person has a story and hidden troubles that we can’t see from the outside. Pausing in my practice, will allow me to remember that we are all humans and everyone deserves to be treated with empathy and love.
With the national crisis of the opioid epidemic currently going on, I find it surprising with how many barriers there are for treating the crisis. It surprised me that in 2017, there were only around 39,000 physicians that were trained and certified to prescribe buprenorphine. Then out of those certified, 8.5% of the physicians took on the max patient load of 275. This can then lead to very long waits for individuals with SUDs to get treated and those individuals may just give up on the idea. For the hundreds and hundreds of thousands of individuals suffering from SUDs, these numbers are simply not enough to treat the epidemic. I don’t expect physicians to take on 275 patients, because that seems extreme and may lead to not adequate treatment, but I think it needs to be encouraged that more primary care medical professionals get trained and certified so they can help so many of their patients that are going through this. The fact that NPs and PAs can now get certified is definitely a good thing leading in the right direction. Another barrier to individuals getting treatment is that many insurances don’t cover the treatment necessary which I find very upsetting as many people with this problem don’t have money to afford to pay for help by themselves. Along with all of that, stigma by health care professionals and the public prevent many from getting proper treatment.
There are many critical elements for successful treatment of SUD within the nurse management model. This model allows for nurse care managers to work with physicians to deliver outpatient addiction treatment with buprenorphine and injectable naltrexone. This model would be fully integrated into primary care where there is the biggest lack of treatment providers. This model empowers nurses and allows for more proper training to help them with this crisis. Having nurses step in to help treat these individuals will help eliminate waiting times and make sure that those with SUDs get the proper care when and where they need it. Having these nurse care managers work hand-in-hand with physicians allows for a better team based approach on treating these individuals. Health care providers can focus more on each individual patient and their needs instead of just handing them a medication. This then leads to improved compliance with treatments plans, counseling, and scheduled appointments.
As for if I could see myself in this type of nursing role, I personally can not. I do not have the internal passion and drive to work in this type of field. I know that this is an area that needs great attention to and I appreciate and have respect for all of those that serve in this type of role, I just simply know that this is not my niche and I would not be happy doing it. My niche is with the pediatric population. I know that many of my future kids will have family members suffering through this and I will be happy to point them towards the resources that I know about to help them, I just don’t want to be the one providing the direct treatment. I also know that many of my future kids will be susceptible to falling into an SUD and that is how I can still have a role in treating this epidemic by working at the pediatric level to prevent children them from falling into it.
Patients with substance use disorders (SUDs) face many challenges in the health care system. This can range from instant negative judgement from health care professionals taking care of them to professionals criminalizing them for their actions. When comparing those patients with SUDs to patients with other chronic health conditions such as diabetes, heart disease, obesity, etc., and how they are treated by healthcare professionals and within the health care system, I think there are a lot of similarities and differences. However, what I think it comes down to in the end is a patient’s attitude and personality.
As for similarities, I think both groups of people have instant negative stigma when most health care professionals think of these groups. I think many see someone with an SUD as it being the patient’s fault and the same goes for someone who is overweight and has type II diabetes. In some situations, these patients could have prevented their chronic conditions if they did not make certain lifestyle choices. However, that is not always the case as someone could develop an SUD from being prescribed pain killers after an intensive surgery. However, I think a major difference between patients with SUDs and those with other chronic health conditions is the extra negative stigma that is associated with those who have SUDs. These individuals can sometimes be criminalized as they may be breaking the law if they are using illegal substances whereas it isn’t against the law for an overweight person to eat McDonalds every day. Knowing that a patient is an addict to anything can make a lot of people instantly judge them without even knowing their story.
With all of that being said though, I think how a person is going to be treated, at least in an inpatient healthcare setting, is centered around the patient’s attitude and personality. If a person who is overweight with cardiovascular disease and type II diabetes is a total pain to take care of and is very demanding and rude to the nurses, I think that patient is probably going to get treated worse compared to the nurse’s other patient who has a substance use disorder and is polite and appreciative for what health care professionals are doing for them and vice versa. However, where the stigma surrounding those with SUD comes into play is that if this is an inpatient setting, these individuals might have to go into withdrawal in the hospital and that leads them to having poor attitudes and personalities while inpatient. I think how well someone is treated also depends on one’s attitude to get better. If the extremely overweight patient with T2D and CVD is not making any changes in their life to get healthier, I think they might get treated just as poorly as a patient with an SUD who refuses to look into treatment options
My heart often breaks when I think about the challenges that patients who have substance use disorders often face in the healthcare system due to the stigma surrounding them. I think that a lot of the challenges arise from fear and isolation. I think these individuals sometimes fear themselves due to everyone surrounding them acting like they are fearful of those who have these disorders. Some of the stigma surrounding users is that these individuals should be feared because they may be dangerous and untrustworthy. This constant environment of people fearing them may eventually make them fear themselves because they might start to believe the lies that are constantly being thrown at them. This fear of themselves can lead them to not want to seek help from the healthcare system to begin with so they might isolate themselves and not seek medical help. If medical help is sought out, I think many are left feeling patronized in the health care system because health care providers can often think that they know what is best for those with disorders and don’t let the patients help in their recovery plan. In turn, this can lead to users isolating themselves because they can feel like they’re being talked down upon and not truly being listened to. I think most of these individuals often anticipate mistreatment so that can be another reason for decreased willingness to access health services. I have many times heard people refer to users as being “sick” and I think this term should be avoided because it implies and labels them as being pathologically sick which can lead to sickness of character for these individuals and not sickness of the brain. I know it is easier said then done, but I want to not aid in the challenges that these individuals face and want to learn all that I can so that I can avoid joining the stigma that often surrounds those who have substance use disorders.
Combating stigma can be difficult. It’s hard to fight stigma and entirely change a way of thinking with other people but especially within one’s self. What I find myself doing in a lot of challenging situations is to pretend that the patient or person that I am caring for is someone I deeply love. If I am caring for an elderly patient, I’ll pretend that they are my grandparent. If it is someone middle aged, I’ll pretend that they are my parent, and if I am caring for a child, I’ll pretend they are one of my siblings. Putting that perspective into play has drastically changed how I treat people on a personal level. If I have to leave people with a single tip to help combat stigma, it would be to pretend that person you are dealing with is someone you love and it can help you put away your judgements and lead you to focus on the goal of helping them.