Drug overdose deaths in the U.S. reached a grim milestone in 2020. The CDC estimates that 93,331 people died, representing the highest number of deaths recorded and a 29% increase over 2019. Opioid-involved overdose death rates rose 37% in 2020, with synthetic opioids involved in a majority of fatalities. Additionally, overdose deaths involving cocaine and methamphetamines also increased in 2020.
The COVID-19 pandemic has been a main contributor to this loss of life, but a major barrier has been and continues to be, a lack of access to treatment. Data from the Substance Abuse and Mental Health Services Administration shows that in 2019, only 1.5% of individuals aged 12 years and older received any form of substance use treatment.
Though there isn’t an evidence-based medication to treat all forms of substance use disorder (SUD), three do exist for opioid use disorder (OUD): methadone, buprenorphine, and naltrexone. Only half of clinicians with waivers to prescribe buprenorphine, however, actually do so in practice, according to a 2019 Pew study. Other research has shown that only 50% of nursing schools in the U.S. include education related to SUDs in their curriculums, and some findings are even direr.
Kristin F. Wason, NP, who works at Boston Medical Center‘s Office-Based Addiction Treatment (OBAT) Training and Technical Assistance (TTA), has been treating patients with SUDs for 12 years and recognizes the need for more addiction education in both nursing and medical schools. This is why she and her colleagues published the Addiction Nursing Competencies in The Journal of Nursing Administration. The first of its kind, the comprehensive toolkit outlines the framework and clinical skills necessary to educate, train, and evaluate nurses in the addiction space.
HealthCity recently spoke with Wason about what drove the creation of this toolkit and the steps needed to increase medication access for SUD.
HealthCity: Why are nurses so critical in the care continuum for patients with addiction?
Kristin F. Wason, NP: Substance use disorders are chronic medical conditions that are far too often life-threatening or fatal, despite safe and effective treatment options. Additionally, data shows that due to an increased risk for developing other chronic health conditions and acute care needs, persons with substance addiction present to the medical system more often than the general public—often for reasons other than primarily seeking treatment for their use disorder.
Nurses are a diverse group of frontline workers who are often the first healthcare provider that a person with SUD encounters when they present for care. Unfortunately, there continues to be a lack of addiction education within many nursing programs, leaving many nurses unprepared to appropriately screen and care for persons with SUDs. That is what motivated our team to develop this toolkit to support both individual nurses as well as nursing managerial teams in their efforts to build and evaluate nursing addiction care.
This toolkit, called Addiction Nursing Competencies, supports a holistic approach to patient care, focusing on an individual’s strengths, motivation, and personal definition of recovery. Paired with tools such as medications for addiction treatment and harm-reduction strategies, these competencies aim to enable nurses to safely and effectively deliver care to persons across the spectrum of the substance addiction from active use to long-term recovery.
HC: We know that keeping patients with SUD engaged in care can lead to additional improvements in health outcomes. Can you please describe these benefits?
KW: By engaging persons with SUD into care and providing education about harm reduction, we could also expect improvement in commonly co-morbid health conditions, such as HIV, hepatitis C, skin and soft tissue infections, and improvement in chronic health conditions, such as hypertension, diabetes, and respiratory illnesses.
Programs, like BMC’s OBAT, that are integrated within our primary care and other health systems help promote access to a variety of resources, such as family planning services and preventative healthcare. Our nursing teams have been vital in ensuring patients are adequately immune to hepatitis A and B, in particular, by checking titers and providing vaccines during addiction treatment appointments. We are also able to help coordinate and facilitate behavioral health treatment services within our institution and community.
HC: You’ve been treating patients with substance use disorders for a majority of your nursing career. Why did you choose to go into this specialty?
KW: I grew up within a community that very much struggled, and continues to struggle, with substance use and addiction. I have always carried a strong belief and understanding that good people are impacted by addiction and deserve care.
Upon graduating, I was not familiar with the role that nurses could have in caring for persons with addiction. It always seemed like a field that was more focused on “counselors” or 12-step programs.
Within a few days of working with the BMC OBAT team, I felt at home. The way the patients opened up and shared such intimate details about their lives was fascinating. The patients encouraged me to ask questions as they clearly enjoyed teaching me, a new young nurse, about the dangers of the drugs they were using, how they were using them, and all of the work that they were doing for their recovery. Many had been to numerous detoxes, meetings, counseling, residential programs, and psychiatric facilities. They had tried it all. They shared the barriers to recovery, and there were, and continue to be, many.
Some patients also said that the best treatment was finding a program, like OBAT, that provided ongoing treatment, including medication, which allowed them to feel normal, function during the day, and live their own life within their community safely and proactively. The medication for addiction treatment and care team support provided a form of relief and freedom.
I have been fortunate to work in the field of addiction for nearly my entire nursing career and it has been incredibly rewarding to partner with patients on their journey to recovery. Some patients I met immediately post-incarceration, who are still connected to OBAT, are now employed, housed, and maintaining long-term recovery. Many of my patients have become parents over the years and now bring their kids to our visits. It’s incredible.
HC: It’s clear that stigma still plays a role in both patients with SUD accessing treatment as well as clinicians’ willingness to treat patients struggling with addiction. How will publications like this help reduce the stigma on both sides of this equation?
KW: Substance use disorders are complex, chronic medical conditions that have been historically viewed as social rather than medical problems. Persons with substance use disorders deserve empathetic, respectful, evidence-based care for their condition, and the current lack of training and knowledge by clinicians and providers is a significant barrier to accessing care.
The Addiction Nursing Competencies aims to provide nurses, who are frontline staff trained in acute and chronic disease management, with the clinical and education guidance to provide safe and effective care to persons across the spectrum of substance addiction from active, ongoing use to sustained recovery.
While progress has been made, stigma still exists related to evidence-based care, particularly centered around ongoing medication treatment and harm-reduction strategies. We have a lot of work to do in terms of educating our workforce and the public about the benefits of comprehensive addiction treatment for all patients across the spectrum of substance use and recovery.
This interview has been condensed and edited for clarity. The original version of this article can be found at the HealthCity website.