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Discussion

suboxone taper

When a patient comes in for opiate addiction and wants suboxone, we have them sign a consent and agreement to stay until the taper is done. Still, some patient sign on AMA before the taper is completed and the Docs let them go. My question is, if a patient is on a suboxone taper and they signed an AMA and are leaving, but the morning they are leaving they either a)happen to be due for a dose of suboxone from the taper or b)request one of the PRN doses of suboxone, is it ok to administer a dose? Some nurses say no, they can't get the suboxone the day of AMA discharge. But my thinking is, if you give them some suboxone, maybe they wont feel so crappy and run out and try to find heroin to feel better. And even if they do go and get heroin, the suboxone will block the effect? What is the harm in giving them a "last dose" of suboxone as long as it is currently on their inpatient MAR at the time of discharge and the med order wasn't discontinued?

Thanks for any input! I am new to this...

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    • Experts

    In my experience, people who are signing out AMA don't get any further medications. They are declining/refusing treatment ...

    The people are choosing to leave against medical advice. Whether or not they're going to go out and use again (which is most likely what they're going to do) isn't your problem.

    However, your particular facility should have a policy/procedure on this, and all the nurses should consistently be following the established policy. If there isn't a policy, you should bring the lack of a policy on this to the attention of your administration, so one can be developed.

    This kind of situation is always tough. Best wishes!

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    • Experts

    I should have said earlier that, in my experience, people signing out AMA don't get any further medications unless the medications are really medically necessary and withholding them would endanger the individual. Opioid withdrawal is not life-threatening and the medications are given basically for comfort, so someone going AMA would not get any more of those medications, specifically. Also, in my experience, someone who signs out AMA is walking out the door shortly after signing the AMA form, so there wouldn't really be any opportunity to give additional medication. Do people in your program sign out AMA, or announce their intention to sign out AMA, and then continue to hang around and get treatment?

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    • Experts

    IMO, they should get any scheduled medications until they are discharged and have left the premises.

    The patient should also be made aware that by going AMA, they might NOT be getting a prescription to take with them. A lot of the docs I work with will not write discharge prescriptions for AMAs unless it's a critical medical necessity. So this means no suboxone script to carry them after they're released.

    Stopping suboxone isn't going to kill them. And as for the "but they'll run out and get heroin" argument...well, IMO, it's their addiction and they need to decide for themselves if they truly want recovery.

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    In my facility we require patients to submit a 3 day note if they want to leave early. There should definitely be a policy on this in your facility... But if the pt is leaving AMA, they are refusing treatment which includes medications.

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    Do what you think as nurse is best. Why are they leaving? Is it to score dope? Unhappy with staff? Let them know what will happen by taking Suboxone and attempting to get high from heroin. If it is not a policy than it is a nursing judgement (dont you love that???). Be there to help and facilitate recovery not another person that says no or I cant help you!

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    I question the use of Suboxone in a short term detox period. Suboxone is more of a long term medication, since it hangs on the receptor cells longer a taper in detox makes no sense IMHO and experience with suboxone patients. In the outpatient setting, suboxone is tapered on a longer time frame. The suboxone will keep the addict from getting dope sick, and many times that's why they use it on the street in place of other opioids, but the studies have shown that the best results have been long term with counseling, avg. success is around 2 years.

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