In opioid crisis, a call to action for advanced practice nurses

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A packet of sublingual Suboxone(Buprenorphine/Naloxone 8mg/2mg) ablets and both sides of one Suboxone tablet.

Rates of opioid abuse and heroin use have reached epidemic proportions in Connecticut.  According to government statistics, accidental deaths rose from 357 in 2012 to 723 in 2015 — 53 percent of those involving heroin.  That is a 102 percent increase in lives lost in a three-year period.  Not only do individuals and families suffer but the financial implications are also substantial.

Connecticut spends a significant amount of tax revenue on emergency room visits, incarcerations, and the medical care/services needed to treat opioid abuse.  To further compound the problem, access to opioid treatment is difficult to obtain in Connecticut due to the limited number of providers, leaving many affected individuals without treatment and feeling hopeless.

Treatment consists of specific medications that help suppress withdrawal symptoms and reduce cravings, along with counseling and psycho-social support.  At the forefront of treatment is a medication called Suboxone.

Suboxone is a controlled prescription medication that has shown to be effective and safe in treating opioid addiction.  It contains an additive called Naxolone, also known as Narcan, which blocks the effects of the opioid preventing a euphoric high and accidental overdose.

Up until June of 2016, only physicians could prescribe this potential lifesaving medication and in Connecticut there are only ten physicians authorized to prescribe Suboxone. Hopefully this will all change with the Comprehensive Addiction and Recovery Act (CARA) that was passed into law July 2016. Section 303 of CARA extends the right for Advance Practice Registered Nurses (APRNs) to become certified and prescribe Suboxone up until October 1, 2021, in a pilot study.

To become certified to prescribe Suboxone, APRNs will be required to complete 24 hours of training to broaden their knowledge of opioid abuse, maintenance and detoxification, patient assessment, psycho-social services, drug management, treatment plans and staff roles. Ongoing education is also recommended.  Once completed, APRNs can apply for a Suboxone waiver certificate.  On-line training is available at  www.buppractice.com.

It is critical that APRNs sustain and support the changes within the CARA law that healthcare professionals and legislators worked to enact.  If APRNs do not use CARA to become certified Suboxone prescribers, their failure to act will be viewed by Congress and state legislatures as a sign of unwillingness to aid in the recovery of addiction, and the pilot could fail.

This call to action for APRNs to become certified under CARA and achieve the privilege to prescribe Suboxone aims to improve treatment of opioid addiction.  Opioid abuse is a public health crisis and APRNs should be in the forefront, helping the state of Connecticut and local communities eliminate this disease.

APRN’s involvement is critical by increasing access to Suboxone treatment for those afflicted with addiction. Opioid addiction is a life-threating and chronic disease state that should be viewed no differently than the management of diabetes, cancer or heart disease.  Individuals and families affected with opioid addiction are depending on Connecticut’s APRNs to help them recover their lives.

Joy Elwell, DNP, APRN, FAANP, FAAN is an associate professor and Director of the Doctor of Nursing Practice Program at the University of Connecticut. She is a board-certified family nurse practitioner practicing in primary care at UConn Health, Storrs,

Aimee Eaton works as an emergency room nurse in her home town of Woodstock.  She has been a registered nurse for 16 years and currently a student at the University of Connecticut completing her master’s degree in nursing as a family nurse practitioner.

 

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