Caring for MAT Patients
Addiction to opioids is currently in the news. Over the years in my experience, most nurses have never ventured into the treatment of this addiction other than what they see in the ER or patients in an office or hospital asking for pain meds.
Below is some general information that might be of use for those interested in MAT from the trenches. Let me know what you think....
What is a MAT (Methadone Assisted Treatment) Program? MAT Programs include people who have/had additions to street and opiate prescription drugs. MAT Programs follow specific guidelines on dosing of methadone or buprenorphine. MAT Facilities have to manage/track drug intake and dosing records to DEA standards/regulations. MAT Programs see people from all walks of life, all colors, creeds and orientations. Clients in a MAT program are private pay, covered by private insurance and Medicaid that covers treatment programs. Nationally 55% of clients in a treatment program will be successful. MAT Programs include long-time and short-time (less than 60 days) users. To be admitted to a MAT program a client must see a physician, a counselor and a nurse and have a history of a substance use disorder.
What is your perception of patients with substance abuse based on?
- For the most part, these are good people who made an uninformed decision resulting in a negative outcome.
- Many were placed on pain meds for chronic pain. Over time, many were unable to get pain relieve requiring more med and then doctors and insurance became worried about abuse and stopped the Rx. (Note: Ask most people with "nerve pain" if ask if the meds helped the pain ... most who are honest will tell not much helps, just let's them sleep.)
- Some people have been addicted to street drugs for years or turned to these options when prescriptions were no longer available.
- Different groups use street drugs to self medicate for anxiety, hyperactivity, depression, etc.
- Some people are functional users meaning they hold down a job that pays enough to supply their habit.
- Some people are now financially stable and use any means (lie, cheat, steal, intimidate, illegal prostitution, etc.) to acquire the means to afford their drugs.
- Drug abuse/use is often generational.
Other things to know:
- MAT treatment makes lives safer, decreases criminal activity, and allows people to have productive lives including work, families and communities.
- Pregnancy outcomes are better with less postnatal problems when on methadone than other drugs.
- MAT clinics and obstetricians work cooperatively to manage treatment.
- After birth, MAT treatment for new moms is more successful.
- MAT clinics offer support groups that improve successful treatment.
- Some people can get off drugs completely over time. The time it takes depends on the time and amount used.
- Just like an alcoholic, obesity, smoking...drug use cannot really be changed unless the user decides not to use. Incarcerations often are temporary breaks but doesn't stop cravings for the drug.
- MAT clinics do frequent drug screening depending the length at that clinic in treatment; success in program; and visual appearance or symptoms. Drug screening that is refused is counted as a dirty result.
- Responsible emotional, physical, financial support improves the success outcomes.
- Counseling and "working your program" will help improve the chances of success.
- "Working your program" requires clients to show up and work through reasons and choices on why they use and interventions to manage their decisions. There is no timeline on how long it will take.
- Quickly going decreasing doses to "wean you off" without regarding whether a client does or doesn't have withdrawal symptoms, often increases use. It is seldom successful.
- Clients may be on daily does or split (divided into 2x/d to manage sx) dosing to control cravings/symptoms.
- Peak and trough levels can be done to determine if dosing is adequate in pregnancy and users requiring higher levels. Physical versus psychological need.
- There is no one-size-fits-all dose for everyone. Doses can range from 10mg to 300mg.
- If a client is on daily methadone, they may start having symptoms of withdrawal in 48 to 72 hours of last dose.
- Most MAT centers dispense liquid methadone to find the most accurate dose for an individual patient.
- When admitted to the hospital, MAT patients should receive their regular dose to control their addiction and symptoms.
- Special care should be given on MAT patients and anesthesia since both are respiratory depressants.
- For a planned admission a MAT patient, the patient will have a take home labeled bottle with their current dose or clinic documentation.
- MAT clinics are usually open at 0600 to early afternoon to accommodate work schedules.
- Nurses should try to document/verify the dose by calling the local MAT clinic and advise patient is in ER or unplanned admission.
- When discharging a MAT patient, patient should be given a copy of their MAR to take back to the clinic to show no break in service on methadone or buprenorphine dosing.
- Most MAT clinics will decrease the patient dose for breaks in service over 3 days and use of certain med that interact with methadone.
- If patient has a surgical procedure, that patient needs pain meds to manage the pain. The methadone will have little if any effect on the current pain.
- Successful progressive MAT patients usually are more likely to refuse pain meds and attempt to tolerate pain rather than take the possibility of regressing.
- Clients are encouraged to bring in all medications, monthly routine and new, to be reviewed by their counselor or nurse.
- MAT clinics have policies regarding abuse, physical and verbal actions, use of medications on site, sale of drugs or paraphernalia on site.
- Some sites require take home doses be locked in boxes on leaving.
- Initially clients are required to come to the clinic daily for at least 30 days or more. With clean urines and working their program, visits can become less frequent.
It is my hope that this information is helpful and gives nurses another perspective of life and addition therapy. As nurses we should be looking at these individuals as people with an illness. We should advocate for them with honesty, education and humor. At times they may try to use your naivety to get around the rules or they may be thankful for your kindness and understanding. Like anything we do, it all makes us who we are as nurses.Last edit by traumaRUs on Oct 16, '17
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