Nurse prescribing in substance abuse

[Alan Long]

dear colleagues

i am a uk based nurse who has been asked by the national treatment agency (nta) to undertake a review of the possible risks and benefits in nurse (and pharmacist) prescribing in substance misuse in order to fully assess the impact on future clinical practice.

based upon the gathered evidence, the proposed review will conclude with an option appraisal of all available and potential models of nurse prescribing, the positive and negative benefits to service users, and the likely impact on the nurse prescribers, their clients and substance abuse services.

i am very anxious to garner all opinions from colleagues around the uk and other countries with respect to nurse prescribing within the substance abuse field and would welcome any views on this subject. all views, positive and negative, will be considered within the review and the final conclusions. please let me know what you think.

alan long

i am happy to discuss this via the forum or you can contact me at...

[email protected]

leicestershire nhs drugs and alcohol service

drury house

50 leicester road

leicester

uk

le19 2df

[CharlieRN]

Alan

I fully appreciate that you want a much more statisticly significant answer than this.

But anyway, how much worse can they do than MD presciption? A good precentage of the heroin addicts I have treated say that their addiction began with the meds they were prescribed for pain relief.

Somehow the potent tool of "enlightened self interest" needs to be harnessed to the problem of giving the medication that is needed, when it is needed, and not giving it when it is only wanted, not needed.

Does preventing withdrawal sx count as "need" or "want"?

Welcome to medical ethics.

[Alan Long]

Hi CharlieRN

Thankyou for your observations.

As we do not have a precedent, in the UK, for nurse prescribing in the substance abuse field I do need the views of you folks that are already engaged in it. The experience in the UK is that by far the majority of dependent opiate users have a recreational aetilogy, iatrogenic users are the exception.

The "English" model is recommending early engagement, intervention and replacement therapy based around the "risk reduction" model... an ethical minefield. The replacement therapy commonly used in the UK is Methadone, and very occassionally Diamorphine Hydrochloride. The increasing numbers of presenting opiate users and saturation of health service resources, including the increasing shortage of specialist medical staff, has brought about the discussion in nurse prescribing.

The reality is that nurse prescribing will happen, my review aims to bring this about safely to the benefit of the patients and to my nursing colleagues.

In your experience, do you see any distinct advantages or disadvantages to yourself or to your clients for nurses to prescribe within the substance abuse field?

Thanks again for replying

Alan