Heroin addiction

Trauma Columnist · Oct 16, 2005

Hi Simon and welcome. Are you prescribing methadone? Are you an advanced practice nurse? In addition to the medication, do you also provide counseling and a rehab program? I work in a large level one trauma center (emergency dept) and unfortunately we see a lot of addictions issues here too. As a hospital, we don't prescribe methadone. However, we do refer to rehabiliation facilities that may or may not give methadone as a substitute. Do you also give clonidine and some type of anti-emetic also? Thanks...and welcome again.

Nurse Ratched, RN · Oct 16, 2005

The main problem I see here is people staying on it long term - the methadone clinics keep them coming back and the patients never truly detox.

NP (Nurse Practitioner) prescriptive authority varies somewhat from state to state in the US, so the answer to your original question is typically dependent on geography. http://www.aanp.org/default.asp has some more information.

Welcome to allnurses :).

simon greasley · Oct 16, 2005

Thanks for replying our set-up is different to yours I work in a small primary care clinic. I do prescribe methadone and Subutex, we don't prescribe clonidine but something similar with less hypotension (Lofexidine).

I do counselling, the point about people detoxing off methadone, well the american research by Drs Nyswaner and Dole said leave em on it. So at present that is my idea too as soon as you get em off the heroin they relapse quite often.

Majority of my patients are on Subutex (Buprenorphine)

So can Nurses in the US prescribe controlled drugs such as methadone?.

I am not sure what you mean by advanced practioner as we have different terms, the prescrbing course in England is at degree level.

Be interested to hear what happens over the water.

regards

Simon

Trauma Columnist · Oct 16, 2005

Hi again! Our advanced practice nurses are masters-prepared nurses. This means, they have at a minimum six years of college after high school.

Thunderwolf, MSN, RN · Oct 17, 2005

I used to work detox in the past. The unit went through a period of using Buprenex...what you call, Subutex. We gave it SQ. Other places, I know, gave it IM. The problem we saw with its use was that it never really addressed "the psychological aspect" of Herion addiction, but reinforced it. Since a "needle" was involved, it was pretty comparable to giving liquid Valium in a "shot glass" to a detoxing alcoholic. In Heroin use, much of the craving and preparatory anxiety surrounds the equipment of use...in this case, the needle. Past research that I have seen in the past sort of supported that (unable to recall where I saw that research, though). Effective detox from any substance needs to address and change all linking aspects towards use and relapse...biological, psychological, social, emotional, and spiritual. The Buprenex worked great on the biological, but did little else. In fact, we developed a waiting list JUST for the Buprenex. Eventually, we went to Ultram which worked just as good if not better, but fell out of favor by several of the addicts because it did not involve "the cold, hard needle and the reassurance it gave to them". Good thread.

simon greasley · Nov 9, 2005

Interesting you guys talk of detox?, this is a bit strange as most work now are aiming for maintanance treatment.

This comes from originally american research by nyswander and dole, this said it needed treatment for life.

We in our practice only look for detox if the patient really wants it or if they are very young.

We see a repeating pattern of reducing methadone and subutex and then the heroin use starts or increases again. if patients are left on treatment then they don't relapse to me it is same as stopping a hypertensive's treatment.

lucianne · Nov 10, 2005

I don't work in chemical dependency at all, but this is an interesting take on treatment.

simon greasley · Nov 10, 2005

Well the American research was done about 40-50 years ago I think, it is nothing new.

Brotherbob, BSN, RN · Nov 10, 2005

I used to work detox in the past. The unit went through a period of using Buprenex...what you call, Subutex. We gave it SQ. Other places, I know, gave it IM. The problem we saw with its use was that it never really addressed "the psychological aspect" of Herion addiction, but reinforced it. Since a "needle" was involved, it was pretty comparable to giving liquid Valium in a "shot glass" to a detoxing alcoholic. In Heroin use, much of the craving and preparatory anxiety surrounds the equipment of use...in this case, the needle.

We used to give Buprenex sublingual.

TMPaul · Nov 10, 2005

Hi Simon,

Nurses with an Advance Practice degree (Nurse Practitioners, Nurse Midwives, Psychiatric Nurse Practitioners, Nurse Anesthetists, etc) take advanced courses (A & P, pharmacology, diagnostic classes, etc) and sit for a national certification test. Each state differs as to what (if any drugs) advanced practice nurses can prescribe. I live in Tennessee and can prescribe any medication. I hold a DEA license that allows me to prescribe controlled substances. :)

simon greasley · Aug 12, 2006

Thanks for the info. It's great to hear wha is happening in different countries.