PhD, MS, MSN, RN, APRN-BC, CCRN, CDCES, CNE
Imagine you have a brother who had been in a serious car accident with multiple fractured bones requiring weeks of physical therapy and pain medication. Unfortunately, that became his introduction to opioids, and he has now become addicted to them.
Doing whatever it takes to obtain more opioids, your brother ends up in jail and then drug rehab, multiple times. He now has a criminal record and is still no closer to weaning off the physical and psychological need for opioids. Without hope or help, he ends up committing suicide.
Tragically, that story isn’t fictitious for many families who mourn the loss of a loved one due to substance use disorder.
Medication administration is an activity that occupies a large part of a nurse’s workday. A large component of nursing knowledge is pharmacology and the safe administration of medications. An important safety topic for nurses within medication treatment is using controlled substances for the treatment of known substance use disorder, also known as Medication Assisted Treatment.
Ever since the narcotic epidemic began, there has been much debate attempting to solve the serious issue. The early 1990s saw the first wave of increased opioid prescriptions, with the emphasis on nurses treating pain quickly as the fifth vital sign.
Then in the 2010’s a second wave introduced the heroin epidemic. Drug overdose increased from 31% across all races between 2019 and 2021 to 40% among ages 35-45. In the same time period of data collection, opioid-related deaths increased 56% and cocaine deaths increased 22%.
Clearly, better action needs to be taken. When policymakers proposed Medication Assisted Treatment by using tax dollars to give narcotics in a controlled setting to those who have narcotic addictions, the public became confused, alarmed, and even outraged.
In general, medications are used in the treatment of many disorders. So how is the term mediation assisted treatment different from taking any medication to treat symptoms?
Medication Assisted Treatment (MAT) involves the use of medications, in combination with counseling and behavioral therapies, to treat drug or substance abuse or addiction with the objective of facilitating recovery.
The difference involves administering the very medication that someone may be addicted to, carefully by medical professionals to help a patient avoid dangerous withdrawal and potentially fatal overdosing.
For example, if a patient was addicted to a narcotic, then the strategy for recovery is the careful administration of that same narcotic in a controlled setting by a nurse who can confirm the correct dosage, monitor for side effects, and provide support for guided weaning.
Synthetic and controlled narcotics are given in narcotic clinics to those with substance use disorder to help them avoid overdosing on the streets. The concept is that it will actually cost taxpayers less to carefully provide the drug with medically guided weaning, than the expensive emergency room visits and possible intensive care for those who overdose on their own.
To understand the issues of Medication Assisted Treatment, it’s important to review the terms of drug addiction, substance abuse, and tolerance.
Drug addiction, also known as substance dependence, is a chronic and relapsing brain disorder characterized by compulsive drug-seeking behavior and use despite harmful consequences. It is considered a mental health condition that affects an individual’s ability to control their drug use. Addiction involves changes in the brain’s reward and motivation circuits, leading to an overwhelming desire to seek and use drugs. This persistent craving for drugs can dominate an individual’s life, leading to detrimental effects on their physical, mental, and social well-being.
Substance abuse refers to the excessive and inappropriate use of drugs or other substances that have mind-altering effects, leading to negative consequences for the individual and those around them (APA, 2013). This term encompasses the misuse of both legal and illegal substances, such as alcohol, prescription medications, opioids, stimulants, hallucinogens, and illicit drugs. Substance abuse can lead to impaired judgment, physical and psychological health issues, relationship problems, legal troubles, and difficulty functioning in daily life.
Tolerance is a condition in which an individual’s response to a drug diminishes with continued use, requiring higher doses of the substance to achieve the same effect that was previously achieved at lower doses. This occurs due to neuroadaptations in the brain in response to repeated exposure to the drug. As tolerance develops, people may increase their drug intake, which can contribute to the development of addiction and increase the risk of overdose.
According to the National Institute on Drug Abuse (NIDA) or the Substance Abuse and Mental Health Services Administration, the following are statistics demonstrating how prevalent substance use disorder is. Nurses play a large role in helping these people with recovery, patient education, and safe medication administration.
Opioid Epidemic:
In 2021, an estimated 10.1 million Americans aged 12 or older misused opioids in the past year, including prescription pain relievers and heroin. On average, 130 Americans died every day from an opioid overdose in 2019 and mental health disorders increased during Covid-19.
Alcohol Use:
In 2021, approximately 85.6% of people aged 18 or older reported that they had consumed alcohol at some point in their lifetime. About 25.8% of people aged 18 or older reported binge drinking in the past month in the same year.
Marijuana Use:
In 2021, approximately 43.5 million Americans aged 12 or older reported using marijuana in the past year. With the legalization of medical marijuana in almost all states, the numbers have risen substantially in adult populations. Although marijuana remains a federal crime, many states still allow medical marijuana use.
Cocaine Use:
In 2021, around 2.0 million Americans aged 12 or older reported using cocaine in the past year.
Methamphetamine Use:
In 2021, approximately 1.9 million Americans aged 12 or older reported using methamphetamine in the past year.
Prescription Drug Misuse:
In 2021, an estimated 9.7 million Americans aged 12 or older reported misusing prescription psychotherapeutic drugs in the past year.
Tobacco Use:
In 2021, about 14.0% of adults (age 18 and older) in the U.S. were current cigarette smokers.
It’s important to remember that substance abuse is a complex issue, and these statistics represent only a portion of the overall problem. If you or someone you know is struggling with substance abuse, it’s essential to seek help and support from healthcare professionals and addiction treatment services.
Nurses need to have a thorough understanding of the medications used in Medication Assisted Treatment to be better informed and effectively assist those who qualify for MAT. It depends on the substance use disorder for which medication is given.
Currently, to deliver similar pharmacodynamic properties that opioids deliver, the three typical medications being used currently for opioid use disorders (OUD) include the following:
Methadone: A long-acting opioid agonist that helps reduce cravings and withdrawal symptoms in people addicted to opioids like heroin or prescription painkillers.
Buprenorphine: A partial opioid agonist that also helps with opioid addiction, but with a lower risk of misuse and overdose compared to full agonists like methadone.
Naltrexone: An opioid antagonist that blocks the effects of opioids and alcohol, reducing their reinforcing effects.
As always, using the nursing process, nurses must complete a thorough patient assessment, and create a plan of care collaborating with other health professionals.
Nurses must conduct comprehensive assessments of patients to determine their eligibility for Medication Assisted Treatment. This assessment should include a thorough medical history, substance use history, mental health evaluation, and physical examination.
Nurses should collaborate with other healthcare professionals to create individualized treatment plans for patients undergoing MAT. The plan should include medication management, counseling, and other support services.
Additional responsibilities for nurses include administering MAT medications as prescribed and ensuring proper dosing, and monitoring for any adverse effects or drug interactions. Nurses should provide education to patients about MAT medications, potential side effects, and the importance of medication adherence.
It’s also crucial to address any misconceptions or stigma related to Medication Assisted Treatment. The goal of MAT is to carefully help an individual wean off their physical and psychological need for the scheduled drug, and not to just deliver free narcotics. Regular monitoring of a patient’s progress, including drug screening, is essential to evaluate the effectiveness of MAT and identify any potential relapse or non-compliance.
Nurses should be aware of the high prevalence of co-occurring mental health disorders in individuals with substance use disorders. Addressing both substance use and mental health issues is critical for successful treatment outcomes.
Emphasizing harm reduction principles, such as needle exchange programs and safe injection sites, can improve patient safety and reduce the risk of infectious diseases. Nurses must be familiar with the legal and ethical aspects of Medication Assisted Treatment, including patient confidentiality and informed consent.
Nurses need to be aware of the legal and ethical issues, of MAT especially if they’re involved firsthand in a Medication Assisted Treatment clinic. The general public relies on patient education by nurses, so nurses must be well-informed about these issues.
One of the primary ethical concerns surrounding MAT is ensuring equitable access to treatment for all individuals with substance use disorders. Limited availability or high costs of medications and treatment programs may result in health disparities, preventing some individuals from receiving the help they need.
There is a stigma associated with MAT for substance use disorders, particularly for medications like methadone and buprenorphine used in opioid addiction treatment. This stigma can lead to discrimination against individuals seeking MAT, potentially hindering their recovery and reintegration into society.
Ethical practice requires that individuals provide informed consent before starting MAT. This includes a clear understanding of the benefits, potential risks, and alternative treatment options available. Sometimes, individuals with a substance abuse disorder may be in vulnerable states, and it is essential to ensure they are fully aware of their treatment choices.
Respecting patient autonomy is crucial. Some people may prefer non-medication-based treatment approaches or may wish to discontinue MAT at a certain point. Balancing autonomy with the best interests of the patient can be challenging.
There may be concerns about the long-term use of medications in MAT, particularly when it comes to opioid agonist medications like methadone. Some critics argue that using medications to treat addiction is merely replacing one addiction with another.
Medications used in MAT, such as methadone and buprenorphine, have the potential for diversion and misuse. If not adequately monitored and controlled, these medications can end up on the black market, exacerbating the opioid crisis.
MAT programs are subject to various regulations, licensing requirements, and oversight. Legal issues can arise concerning the appropriate use, prescribing practices, and documentation related to MAT.
In some situations, MAT may be mandated as part of a court order or as a condition for parole or probation. The ethics of coerced treatment can be complex and raises questions about whether such approaches are truly effective.
Medication Assisted Treatment raises ethical considerations when pregnant individuals with a substance abuse disorder are involved. Decisions about medication use during pregnancy must balance the potential benefits for the patient with the potential risks to the fetus.
There could also be potential conflicts of interest if the provider of MAT also has a financial interest in the medication being prescribed.
Addressing these legal and ethical issues requires collaboration among policymakers, healthcare providers, researchers, and individuals with lived experiences of addiction. By ensuring that MAT programs are evidence-based, patient-centered, and sensitive to the ethical complexities involved, we can improve the quality and accessibility of treatment for substance use disorders.
There are many online resources to help nurses become better informed about MAT including the following:
SAMHSA’s Treatment Improvement Protocols (TIPs): The Substance Abuse and Mental Health Services Administration (SAMHSA) provides comprehensive TIPs that offer evidence-based guidelines and best practices for the treatment of substance use disorders, including MAT. These resources are free to access and can be beneficial for nurses seeking in-depth knowledge.
SAMHSA’s Medication-Assisted Treatment Webpage: SAMHSA maintains a dedicated webpage focused on MAT, providing essential information, guidelines, and resources for healthcare professionals, including nurses. It covers various medications used in MAT, clinical practices, and implementation considerations.
National Institute on Drug Abuse (NIDA): NIDA offers educational materials, research findings, and resources related to substance use disorders and treatment options, including MAT. Their website is an excellent source of up-to-date information and training opportunities.
American Society of Addiction Medicine (ASAM): ASAM is a professional organization that provides resources, educational programs, and clinical guidelines related to addiction medicine, including MAT. Nurses can access webinars, publications, and training through ASAM.
Continuing Education Courses: Many nursing associations and organizations offer continuing education courses specifically focused on addiction and MAT. These courses can be a valuable way for nurses to deepen their understanding and earn continuing education credits.
Nurse Training Programs: Some organizations and institutions develop specialized training programs for nurses and other healthcare providers to enhance their knowledge and skills in addiction treatment, including MAT. These programs may be available online or through in-person workshops.
Peer Support and Networking: Connecting with other nurses and healthcare professionals who have experience in MAT can be invaluable. Nurses can join online forums, discussion groups, or attend conferences related to addiction medicine to learn from others’ experiences.
Publications and Journals: There are several medical journals and publications that focus on addiction medicine and MAT. Subscribing to these journals or accessing their online archives can keep nurses informed about the latest research and developments in the field.
MAT Clinic or Program Visits: Nurses can consider visiting MAT clinics or treatment programs in their area to gain firsthand experience and observe how MAT is implemented in practice. This can provide valuable insights and practical knowledge.
State and Local Health Departments: State and local health departments often have resources, guidelines, and training materials related to addiction treatment and MAT. Nurses can reach out to these departments for relevant information.
Patients considering or undergoing Medication Assisted Treatment (MAT) for a substance use disorder should be well-informed about various aspects of the treatment to make informed decisions and enhance their chances of successful recovery. Educating patients about these aspects of MAT can help them make informed decisions, stay engaged in their treatment, and increase their chances of successful recovery from substance use disorder.
Patients should have a clear understanding of what MAT entails. They should know that MAT combines FDA-approved medications with counseling and behavioral therapies to treat substance use disorders effectively. Patients should be aware of the goals of MAT, which typically include reducing cravings and withdrawal symptoms, preventing relapse, and supporting long-term recovery.
Patients should know about the medications used in MAT for their specific substance use disorder. For example, an opioid use disorder may involve medications like methadone, buprenorphine, or naltrexone, while alcohol use disorders may involve acamprosate or disulfiram.
Patients need to understand the potential benefits of MAT, such as improved treatment outcomes, reduced risk of overdose, and better social functioning. It’s also important to be aware of potential side effects and risks associated with medications.
Patients should be informed that their treatment plan will be personalized. Patients should know that the duration of their treatment may vary, and it could be short-term or long-term, depending on their progress and individual circumstances.
Counseling and behavioral therapies are integral components of MAT. Patients should understand that active participation in counseling sessions is crucial for the best treatment outcomes.
Patients have the right to confidentiality and privacy regarding their treatment. They should be informed about the rules and regulations governing the disclosure of their treatment information. Patients should inform their healthcare provider about all the medications they are taking, including over-the-counter drugs and supplements, to avoid potential interactions with MAT medications.
For patients who may become pregnant, it is crucial to discuss potential pregnancy considerations when starting MAT. Some medications may require special precautions during pregnancy. Patients should be encouraged to build a strong support system involving family, friends, or support groups to help them through the recovery process.
It’s essential for patients to understand that relapse is not uncommon in recovery. They should be aware of strategies for managing relapse and seeking help when needed. Patients should know that recovery is an ongoing process, and MAT may be just one part of their overall treatment journey. Aftercare and ongoing support are vital for maintaining long-term sobriety.
Patients should be empowered to take an active role in their treatment and advocate for their needs throughout the process. Patients should feel comfortable asking questions and expressing their concerns about MAT at any point during their treatment.
Nurses play a vital role in reducing the stigma associated with addiction and Medication Assisted Treatment. They can help create a compassionate and supportive environment for patients seeking treatment.
Nurses should collaborate with other healthcare providers, counselors, and social workers to ensure holistic care for patients. They should also be prepared to refer patients to appropriate resources and support services.
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