The Prescribing of Buprenorphine by Advanced Practice Addictions Nurses
Stephen Strobbe, PhD, RN, NP, PMHCNS-BC, CARN-AP
University of Michigan, Ann Arbor, Michigan, USA
Debra Hobbins, DNP, APRN, LSAC, CARN-AP
Utah Board of Nursing, Lifetree Clinical Research, Salt Lake City, UT, USA
In order to increase safe access to buprenorphine treatment for patients with opioid dependence, it is the position of the In-ternational Nurses Society on Addictions (IntNSA) that the Drug Addiction Treatment Act of 2000 (DATA 2000) be amended to al-low for the prescribing of buprenorphine by qualified advanced practice nurses who have both prescriptive authority and specialty certification in addictions nursing.
Misuse of opioids, including prescription opioid medica-tions, has become an increasingly important public health prob-lem, from adolescence through older adulthood (SAMHSA, 2007). The prevalence of prescription opioid abuse now greatly exceeds that of illicit opioids such as heroin, and prescription opioid dependence has come to dominate the profile of opioid dependence in the United States (Sullivan & Fiellin, 2008).
Buprenorphine (Suboxone, Subutex), a medication devel-oped by the National Institute on Drug Abuse (NIDA) and ap-proved by the U.S. Food and Drug Administration (FDA), has been shown to be a safe and effective form of pharmacother-apy for the treatment of opioid dependence (Orman & Keating, 2009), including detoxification and maintenance therapy. How- See More
TIME FOR CHANGE – a fundamental description of a recovery process
"All great changes are preceded by chaos." — Deepak Chopra
If the process of addiction recovery could be summed up in one word, it would be change. After all, it is changes to the brain which produce addiction's cravings, and recovery is essentially reversing those changes through changes in behavior. Without change, there is no recovery.
"You could not step in the same river twice." — Greek Philosopher Heraclitus
The changing brain.
The brain is a fluid network of connected cells. With every thought and experience new connections form as others dissolve, some strengthen while others weaken. As with a river, the brain is always changing, it is not the same brain today as it was yesterday, nor will be tomorrow. Navigating this brain evolution with deliberate changes in behavior, thinking, and environment, is what a successful recovery is all about. Treatment medications, support, counseling and therapy are simply tools for realizing these changes.
Before we can fix the problem, we need to understand it.
The slow, sinister change which leads to addiction. When we are hungry or thirsty, we naturally crave food or water. These cravings motivate us to eat or drink to ensure our survival. This behavior is reinforced with a reward of feel-good brain chemicals which associate pleasure with a good meal or refreshing gulp of water. A memory is created relating the satisfaction of hunger and thirst with pleasure. The memory is triggered the next time we become hungry or thirsty which prompts us to satisfy the cravings in the same way. This learning process helps us prioritize essential needs crucial for survival. See More
A Treatment For Opioid Addiction in the privacy of a docrtor’s Office
How opioids work in the brain: Specialized receptors in the brain accept opioid molecules and, through a biochemical process, release dopamine — a chemical that makes people feel good. Dopamine is also released naturally through exercise, sex, or eating a good meal. To feel 'normal', a certain amount of opioid receptors always need to be occupied. In a normal healthy person, the body regulates this naturally by manufacturing the right amount of opioid-like chemicals. Endorphins are one example. The body strives for a state of balance to avoid feeling too good or too bad. High doses of opioid drugs, however, can flood the receptors causing a very high release of dopamine, much more than could ever be released naturally, causing feelings of extreme euphoria. The body responds with a decreased sensitivity to opioids.
Tolerance, physical dependence, addiction: As a person takes opioids for an extended period of time, the opioid receptors become less sensitive as the body tries to maintain normal dopamine levels. This is called tolerance. As a result, the person needs to continually increase the amount of opioids to get the same level of opioid effect.See More
Long-Term Follow-Up of Medication-Assisted Treatment for Addiction to Pain Relievers Yields “Cause for Optimism”
By Eric Sarlin, M.Ed., M.A., November 30, 2015
In the first long-term follow-up of patients treated with buprenorphine/naloxone (Bp/Nx) for addiction to opioid pain relievers, half reported that they were abstinent from the drugs 18 months after starting the therapy. After 3.5 years, the portion who reported being abstinent had risen further, to 61 percent, and fewer than 10 percent met diagnostic criteria for dependence on the drugs.
“Our findings are cause for optimism for these specific patients,” says Dr. Roger Weiss, of McLean Hospital and Harvard Medical School, who co-led the study. The findings indicate that two factors strongly influence patients’ chances for recovery from addiction to pain relievers: See More
Pain Management Conditions:
Menta Health Conditions:
Dr. Ahmed along with APNNA executive members
Christina, Tonya, Dr Ahmad, Richard, Debra