Fewer Diabetes Patients Have Been Getting Their Insulin During Pandemic

Fewer Diabetes Patients Have Been Getting Their Insulin During Pandemic

Insulin is as essential as water for many people with diabetes. Of the more than 30 million Americans with diabetes, approximately 7.4 million rely on insulin to manage their condition. But it is one of the most costly drugs on the market, and the COVID-19 pandemic has intensified the already rampant problem of insulin hoarding or rationing.

Not only is diabetes associated with an increased risk of severe COVID-19 infection, but COVID-19 is also associated with both an increase in new diabetes diagnoses and a worsening of preexisting diabetes complications. By September 2021, death rates for people with diabetes were 50% higher than before the pandemic, a net increase of more than twice the overall death rate of the general  population.Originally published in The Conversation - USE THIS LOGO

I am a pharmacist who studies ways to improve clinical, economic and quality-of-life outcomes in vulnerable populations. My recent study on how insulin prescription rates have changed because of the pandemic underscores the challenges that people with diabetes face in accessing care.

Managing diabetes during a pandemic

Although insulin is a vital component of diabetes management, the pandemic has led many patients to forgo the prescriptions they need.

My recent study looked at the insulin prescription claims of 285,343 people in the U.S. between January 2019 and October 2020. In the first week of 2019, there was an average of 17,037 new and existing insulin prescriptions picked up by patients per week. This number increased by 11 claims each week leading up to the pandemic.

By the first week of the pandemic in March 2020, however, insulin prescriptions decreased significantly by an average of around 396 prescriptions. Prescriptions continued to decrease an average of around 55 per week as the pandemic progressed through to October 2020. This decline may result from a combination of health insurance loss owing to unemployment, restricted access to clinicians and pharmacies and rationing or stockpiling of medications by both pharmacists and patients.

And the effects of the pandemic on diabetes go beyond just insulin prescriptions. Diabetes management involves visits with a variety of health care providers and routine testing. But diabetes patients in the U.S. had a significant drop in usage of health care services in 2020 compared with 2019, because of clinic closures and reduced capacities, health insurance loss and transportation difficulties. Patients are left in a bind, risking potentially life-threatening complications from missing needed diabetes care as well as risking exposure to COVID-19 if they need emergency care for those complications.

Ongoing effects of care delays

As COVID-19 overwhelmed health care systems, people with chronic conditions like diabetes have experienced significant disruptions in routine and emergency medical care. By the end of June 2020, an estimated 41% of U.S. adults had delayed or avoided medical care.

[Over 115,000 readers rely on The Conversation’s newsletter to understand the world. Sign up today.]

Even now, with hospitals crowded with unvaccinated COVID-19 patients, nearly 1 in 5 American households had to delay care for serious illnesses in the past few months. These care delays have the potential to worsen chronic conditions and contribute to excess deaths directly and indirectly caused by COVID-19.

The full effect that the COVID-19 pandemic continues to have on diabetes management and care, however, has yet to be fully understood. More research on how the pandemic has affected people with diabetes is needed to ensure that these patients receive the care that they need.

The Conversation

Success of Covid Antiviral Pills Hinges on Access to Speedy and Accurate Tests

Success of Covid Antiviral Pills Hinges on Access to Speedy and Accurate Tests

Within a few weeks, perhaps before many Americans finish decorating for the holidays, the U.S. could have access to a new antiviral pill from Merck expected to alter the deadly trajectory of the covid-19 pandemic — with a second option from Pfizer to follow shortly after.

Now under federal review, both pills are being hailed by infectious-disease doctors not prone to superlatives.

“This is truly a game changer,” said Dr. Daniel Griffin, an expert on infectious diseases and immunology at Columbia University. “This is up there with vaccines. It’s not a substitute for vaccines; we still want to get people vaccinated. But, boy, this is just another great tool to have.”Originally published in Kaiser Health News.

The new regimens, which require 30 or 40 pills to be taken over five days, have been shown to dramatically reduce hospitalizations and prevent deaths in adults with mild to moderate covid who are at risk for severe disease because of age or underlying conditions. But experts say the success of the treatments would hinge on one uncertain factor: whether high-risk patients infected with covid will be able to get tested — and then treated — fast enough to make a difference.

“Early, accessible testing and access to the results in a time frame that allows us to make a decision is really going to be key to these medications,” said Dr. Erica Johnson, who chairs the Infectious Disease Board of the American Board of Internal Medicine. “It puts the onus on our public health strategy to make these available.”

In clinical trials, molnupiravir, the antiviral drug developed by Merck & Co. and Ridgeback Biotherapeutics, was given to non-hospitalized, unvaccinated, high-risk adult patients within five days of their first covid symptoms. Pfizer’s product, Paxlovid, was tested in similar patients as early as three days — just 72 hours — after symptoms emerged.

Results from the Merck trial, released last month, showed the drug reduced the risk of hospitalizations by about 50% and prevented deaths entirely. It will be considered by an advisory panel to the federal Food and Drug Administration on Nov. 30. Pfizer officials, who requested FDA emergency authorization for their drug on Nov. 16, said Paxlovid cut the risk of hospitalizations and deaths by 89%. Both drugs work by hampering the way the covid virus reproduces, though they do so at different points in the process.

But those promising results assume the drugs can be administered in the narrow window of time used in the trials, a proven challenge when getting antiviral treatments to actual patients. Similar drugs can prevent dire outcomes from influenza if given early, but research shows that only about 40% of high-risk patients during five recent flu seasons sought medical care within three days of falling ill.

“That’s just not human nature,” said Kelly Wroblewski, director of infectious disease programs for the Association of Public Health Laboratories. “If you have a sniffle, you wait to see if it gets worse.”

Even when patients do seek early care, access to covid testing has been wildly variable since the start of the pandemic. U.S. testing capacity continues to be plagued by a host of problems, including supply-chain bottlenecks, staffing shortages, intermittent spikes in demand and results that can take hours — or far longer.

PCR, or polymerase chain reaction tests, the gold standard to detect SARS-CoV-2, can require scheduled appointments at medical offices or urgent care centers, and patients often wait days to learn the results. Rapid antigen tests are faster but less accurate, and some medical providers are hesitant to rely on them. Over-the-counter tests that can be used at home provide results quickly but are hard to find in stores and remain expensive. And it’s not yet clear how those results would be confirmed and whether they would be accepted as a reason for treatment.

“Get ready,” Griffin said. “You don’t want to call someone four days later to say, ‘Ooh, you’re now outside the window,’ and the efficacy of this oral medication has been lost because of problems on our end with getting those results.”

The situation is expected to improve after a Biden administration push to invest $3 billion in rapid testing, including $650 million to ramp up manufacturing capacity for rapid tests. But it could be months before the change is apparent.

“Supplies will be getting better, but it’s going to be slow,” said Mara Aspinall, co-founder of Arizona State University’s biomedical diagnostics program, who writes a weekly newsletter monitoring national testing capacity.

If getting tests will be tough, acquiring doses of the antiviral drugs is expected to be tougher, at least at first. The federal government has agreed to purchase about 3.1 million courses of molnupiravir for $2.2 billion, which works out to about $700 per course of treatment. The Biden administration is planning to announce a deal to pay $5 billion for 10 million courses of the Pfizer drug, paying about $500 per treatment course, according to The Washington Post.

Doses of the drugs distributed by the federal government would go to states and patients at no cost. But only a fraction of the planned inventory will be available to start, said Dr. Lisa Piercey, Tennessee’s health commissioner, who has been part of a small group of state health officials working on the distribution plans.

Under one scenario, in which 100,000 courses of the Merck drug are available as early as Dec. 6, Piercey said Tennessee would receive just 2,000 patient courses even as the state is reporting more than 1,200 new cases a week on average. Deciding which sick patients receive those scarce supplies will be “an educated stab in the dark,” Piercey said.

U.S. Department of Health and Human Services officials have said the antiviral treatments will be distributed through the same state-based system adopted for monoclonal antibody treatments. The lab-made molecules, delivered via IV infusion or injection, mimic human antibodies that fight the covid virus and reduce the risk of severe disease and death. Federal officials took over distribution in September, after a covid surge in Southern states with low vaccination rates led to a run on national supplies. They’re now allotted to states based on the number of recent covid cases and hospitalizations and past use.

The antivirals will be cheaper than the monoclonal antibody treatments, which cost the government about $1,250 per dose and can carry infusion fees that leave patients with hundreds of dollars in copays. The pills are much easier to use, and pharmacies likely will be allowed to order and dispense them for home use.

Still, the antiviral pills won’t replace the antibody treatments, said Dr. Brandon Webb, an infectious-disease specialist at Intermountain Healthcare in Salt Lake City.

Questions remain about the long-term safety of the drugs in some populations. Merck’s molnupiravir works by causing mutations that prevent the virus from reproducing. The Pfizer treatment, which includes Paxlovid and a low dose of ritonavir, an HIV antiretroviral, may cause interactions with other drugs or even over-the-counter supplements, Webb said.

Consequently, the antivirals likely won’t be used in children, people with kidney or liver disease, or pregnant people. They’ll need to be administered to patients capable of taking multiple pills at once, a couple of times a day, and those patients should be monitored to make sure they complete the therapy.

“We’ll be on an interesting tightrope in which we’ll be trying to identify eligible patients early on to treat them with antivirals,” Webb said. “We’re just going to need to be nimble and ready to pivot.”

Texas Providers See Increased Interest in Birth Control Since Near-Total Abortion Ban

Texas Providers See Increased Interest in Birth Control Since Near-Total Abortion Ban

In September, when Texas’ near-total abortion ban took effect, Planned Parenthood clinics in the Lone Star State started offering every patient who walked in information on Senate Bill 8, as well as emergency contraception, condoms and two pregnancy tests. The plan is to distribute 22,000 “empowerment kits” this year.

“We felt it was very important for patients to have as many tools on hand to help them meet this really onerous law,” said Elizabeth Cardwell, lead clinician at Planned Parenthood of Greater Texas, which has 24 clinics across the northern and central regions of the state and provides care to tens of thousands of people annually.Originally published in Kaiser Health News.

Most of their patients — who tend to be uninsured and have annual household incomes of less than $25,000 — had not known about SB 8 the first several weeks after implementation, said Cardwell. But once they learned about it, patients seemed to rush to get on birth control, she said.

SB 8 allows private citizens, in Texas or elsewhere, to sue anyone who performs an abortion in the state or who “aided or abetted” someone getting an abortion once fetal cardiac activity is detected. This is generally around six weeks, before most people know they’re pregnant. It’s had a chilling effect in Texas, where access to abortion was already limited.

Medical staffs are doubling down on educating patients about birth control. They recognize the strategy isn’t foolproof but are desperate to prevent unintended pregnancies, nearly half of which nationwide end in abortion.

“It’s more important now than it ever has been,” said Cardwell. “I’ve been in abortion care 30-plus years, and my go-to line was ‘You’ve got plenty of time. You don’t have to feel rushed. Talk with your partner. Talk with your family,’” she said. “Now we don’t have that luxury.”

Patients, too, seem to feel a sense of urgency. During September, according to data from Planned Parenthood of Greater Texas, medical staff provided patients with some form of birth control — for example, pill packs, Depo-Provera shots or IUD implant insertions — in more than 3,750 visits, 5% more than in September 2020.

Dr. Jennifer Liedtke, a family physician in West Texas, said she and her nurse practitioners explain SB 8 to every patient who comes to their private practice and saw a 20% increase in requests for long-acting reversible contraceptive methods, known as LARCs, in September.

LARCs, a category that includes intrauterine devices and hormonal implants, have become increasingly appealing because they are 99% effective at preventing pregnancy and last several years. They are also simpler than the pill, which needs to be taken daily, or the vaginal ring, which needs to be changed monthly.

Still, LARCs are not everyone’s preferred method. For example, inserting an IUD can be painful.

A doctor’s office is one of the few opportunities for reliable birth control education. Texas law doesn’t require schools to teach sex education, and if they do, educators must stress abstinence as the preferred birth control method. Some doctors opt to explain abortion access in the state when naming birth control options.

Liedtke is used to having to explain new laws passed by the Texas legislature. “It happens all the time,” she said. But the controversy surrounding SB 8 confuses patients all the more as the law works its way through the court system with differing rulings, one of which briefly blocked the measure. The U.S. Supreme Court heard related arguments Nov. 1.

“People just don’t understand,” said Liedtke. “It was tied up for 48 hours, so they are like, ‘It’s not a law anymore?’ Well, no, technically it is.”

Not all providers are able to talk freely about abortion access. In 2019, the Trump administration barred providers that participate in the federally funded family planning program, Title X, from mentioning abortion care to patients, even if patients themselves raise questions. In early October, the Biden administration reversed that rule. The change will kick in this month. Planned Parenthood can discuss SB 8 in Texas because Texas affiliates do not receive Title X dollars.

Dr. Lindsey Vasquez of Legacy Community Health, the largest federally qualified health center in Texas and a recipient of Title X dollars, said she and other staff members have not discussed abortion or SB 8 because they also must juggle a variety of other priorities. Legacy’s patients are underserved, she said. A majority live at or below the federal poverty level.

Nearly two years into the covid-19 pandemic, “we’re literally maximizing those visits,” Vasquez said. Their jobs go beyond offering reproductive care. “We’re making sure they have food resources, that they have their housing stable,” she said. “We really are trying to make sure that all of their needs are met because we know for these types of populations — patients that we serve — this may be our only moment that we get to meet them.”

Specialized family planning clinics that receive Title X dollars do have proactive conversations about contraceptive methods, according to Every Body Texas, the Title X grantee for the state.

Discussions of long-acting reversible contraception must be handled with sensitivity because these forms of birth control have a questionable history among certain populations, primarily lower-income patients. In the 1990s, lawmakers in several states, including Texas, introduced bills to offer cash assistance recipients financial incentives to get an implant or mandate insertion for people on government benefits, a move seen as reproductive coercion.

“It’s important for a client to get on the contraceptive method of their choice,” said Mimi Garcia, communications director for Every Body Texas. “Some people will just say, ‘Let’s get everyone on IUDs’ or ‘Let’s get everybody on hormonal implants’ because those are the most effective methods. … That’s not something that’s going to work for [every] individual. … Either they don’t agree with it philosophically or they don’t like how it makes their body feel.”

It’s a nuanced subject for providers to broach, so some suggest starting the conversation by asking the patient about their future.

“The best question to ask is ‘When do you want to have another baby?’” said Liedtke. And then if they say, ‘Oh, gosh, I’m not even sure I want to have more kids’ or ‘Five or six years from now,’ then we start talking LARCs. … But if it’s like, ‘Man, I really want to start trying in a year,’ then I don’t talk to them about putting one of those in.”

The Biden administration expected more demand for birth control in Texas, so Health and Human Services Secretary Xavier Becerra announced in mid-September that Every Body Texas would receive additional Title X funding, as would local providers experiencing an influx of clients as a result of SB 8.

But providers said improved access to contraception will not blunt the law’s effects. It will not protect patients who want to get pregnant but ultimately decide on abortion because they receive a diagnosis of a serious complication, their relationship status changes, or they lose financial or social support, said Dr. Elissa Serapio, an OB-GYN in the Rio Grande Valley and a fellow with Physicians for Reproductive Health.

“It’s the very best that we can do,” said Cardwell, of Planned Parenthood of Greater Texas. “There’s no 100% effective method of birth control.”

Top Nursing Organizations Address Nurses Who Provide Dangerous Misinformation About Covid-19

Top Nursing Organizations Address Nurses Who Provide Dangerous Misinformation About Covid-19

On November 16, the NCBSN and six other top US nursing organizations issued an urgent policy brief to remind members of the most trusted profession to honor that trust and fight misinformation related to Covid-19. “When identifying themselves by their profession, nurses are professionally accountable for the information they provide to the public,” the brief states, and warns nurses that “dissemination of misinformation not only jeopardizes the health and the well-being of the public but may place their license and career in jeopardy as well.”

The full text of the brief, issued by the National Council of State Boards of Nursing (NCSBN), the ANA, NSNA, and other major nursing organizations follows.

Policy Statement: Dissemination of Non-scientific and Misleading COVID-19 Information by Nurses

Purpose

To address the misinformation being disseminated about COVID-19 by nurses.

For the purposes of this statement, misinformation is defined as distorted facts, inaccurate or misleading information not grounded in the peer-reviewed scientific literature, and counter to information being disseminated by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).

Statement

Nurses are expected to be “prepared to practice from an evidence base; promote safe, quality patient care; use clinical/critical reasoning to address simple to complex situations; assume accountability for one’s own and delegated nursing care” (AACN, 2021).

SARS-CoV-2 is a potentially deadly virus. Providing misinformation to the public regarding masking, vaccines, medications and/or COVID-19 threatens public health. Misinformation, which is not grounded in science and is not supported by the CDC and FDA, can lead to illness, possibly death, and may prolong the pandemic. It is an expectation of the U.S. boards of nursing, the profession, and the public that nurses uphold the truth, the principles of the Code of Ethics for Nurses (ANA, 2015), and highest scientific standards when disseminating information about
COVID-19 or any other health-related condition or situation.

When identifying themselves by their profession, nurses are professionally accountable for the information they provide to the public. Any nurse who violates their state nurse practice act or threatens the health and safety of the public through the dissemination of misleading or incorrect information pertaining to COVID-19, vaccines, and associated treatment through verbal or written methods including social media may be disciplined by their board of nursing. Nurses are urged to recognize that dissemination of misinformation not only jeopardizes the health and
well-being of the public but may place their license and career in jeopardy as well.

References

American Association of Colleges of Nursing (AACN). (2021). The Essentials: core competencies for professional nursing education. Retrieved from https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf

American Nurses Association. (2015). Code of Ethics for Nurses. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/

Endorsements

  • National Council of State Boards of Nursing (NCSBN)
  • Accreditation Commission for Education in Nursing (ACEN)
  • American Association of Colleges of Nursing (AACN)
  • American Nurses Association (ANA)
  • American Organization for Nursing Leadership (AONL)
  • National League for Nursing (NLN)
  • NLN Commission for Nursing Education Accreditation (CNEA)
  • National Student Nurses’ Association (NSNA)
  • Organization for Associate Degree Nursing (OADN)
Nurse of the Week: Hospice Liaison Nurse Ligaya “Joy” Villanueva Bercasio

Nurse of the Week: Hospice Liaison Nurse Ligaya “Joy” Villanueva Bercasio

As angels have been known as messengers and guides from time immemorial, it is not necessarily hyperbole for patients and families to refer to hospice liaison nurse – and Nurse of the Week – Ligaya “Joy” Villanueva Bercasio, BSN-RN as an “angel.”

Of her calling as a nurse, Bercasio says “Caring, I think, is really a feeling of happiness for me. You know, fulfillment. I really do believe it is a calling for me. I’m in the right profession, I think.”

The depth and extent of the 30-year nursing veteran’s compassion moved the son of two patients so much that he has virtually adopted her as an honorary family member. Bercasio, who works at Hawaii’s St Francis Healthcare System, was a true guide to Roland Bueno as she comforted him after his parents died. She first met the Buenos in September 2020, when she visited them to talk about providing hospice care for their father. Their encounter was far more eventful than any of them had anticipated.

Almost at once, they established an unusual rapport. As Bercasio recalls, while talking with Roland, his mom, and his father, it felt “like we’ve known each other for a long time… You know, we really established rapport [in a] very short period of time! Nana sharing her love story in the Philippines with Tata, showing their pictures and everything.” (Angels tend to be welcomed on that sort of beyond-first-name basis).

Ligaya “Joy” Villanueva Bercasio, BSN-RN

Ligaya “Joy” Villanueva Bercasio, BSN-RN.

But the visit had a dramatic conclusion. “Nana” had left the room, and as Bercasio was readying to leave, they heard a loud thump in the house. She recalls, “Me and Roland ran back to inside the house and we saw Nana on the kitchen floor unresponsive, not breathing, and no pulse. So I immediately did CPR on her, hoping we could revive her.”

Sadly, although Bercasio was initially able to get a response from Nana (Ms. Bueno), Roland’s mother passed away in the hospital. Shortly afterward, her ailing, grieving spouse followed her.

An encouraging force

A Nurse of the Week who didn’t miraculously save lives? As nurses know well, caring doesn’t end with a patient’s passing. Nursing care extends to relatives as well, and nurses often have a very special gift for connecting with and supporting families in the throes of loss. It was Bercasio’s strong and reassuring presence after that loss that inspired Roland Bueno to nominate her as a “healthcare hero” of Hawaii’s health system.

“My mom and dad had passed very close to each other, just unexpectedly, and she was so integral to that process of accommodating us — not just the health things, but she was just really an encouraging force in our family,” Bueno declared. He told Hawaii News Now, “I’ve heard you can’t change the world, but you can change the world for one person, and I’ve been on the giving end of it, but I have not been on the receiving end. So she really changed the world for our family, too.”

To see a video interview, visit Hawaii News Now.

NP Introduces New Addiction Competencies Toolkit for Nursing Curriculum

NP Introduces New Addiction Competencies Toolkit for Nursing Curriculum

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.


Article republished courtesy of Boston Medical Center’s HealthCity. To sign up for regular updates, register here.


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, Boston Medical Center

Addiction specialist Kristin F. Wason, NP, Boston Medical Center

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.

Listen to the Chapter Podcasts for Jonas and Kovner's Health Care Delivery in the United States


Gain a better understanding of the current state of the US health care system and how it might impact your work and life.

You have Successfully Subscribed!