Suboxone use and the Boards of Nursing

[imfree]

Does anyone here know, with any degree of certainty, how the various State Boards of Nursing view the use of Buprenorphine (Suboxone/Subutex) for opiate dependence and/or addiction? Do they allow nurses who are in diversion/alternative to discipline programs for addicted nurses to use buprenorphine as part of their treatment plan? My first reaction would be that they would not approve of it and would actually state that if a nurse is using Suboxone/Subutex they would be practicing in violation of their Nurse Practice Act. But I don't know that for a fact. I believe that buprenorphine is saving many lives right now of opiate addicted individuals...giving them a much better chance at sustained recovery over the long term. It does not affect the mood, produces no euphoria and in fact, in my opinion, provides a good safety net against relapse. While on bupe, the opiate receptors are loaded and taking a full agonist opiate will provide no high to the user, thereby taking away the obsession to use. There are just so many good things about this treatment modality that I cannot believe it is not more widely accepted amongst the Boards of Nursing. I have heard that most if not all, BONs prohibit its use, but I'd like to know if anyone knows that to be a fact, either by their own experience or by reading about it somewhere. I'd appreciate any responses. Thanks a lot!

[SEDK]

No, not only in Texas. Several states are as bad or worse. My state has no alternative to discipline program of any kind for ANYONE with any addiction, so one's career is destroyed regardless of how many years, even decades of recovery are in place.

Catmom :paw:

What state do you live in?! That's awful since addiction is accepted by the federal government, the AMA, WHO, NIH, etc as a disability and a disease. It would be tantamount to telling a diabetic, or hyperthyroid nurse they cannot work because of their diagnosis.

[edmia, BSN, RN]

^^ Right? You'd think these decisions and programs would be evidenced based since that's what nursing theory is all about ... SMH ...

Sent from my iPhone -- blame all errors on spellcheck

[Guest849204]

It depends on the state. I don't have a lot of knowledge on this, but I believe MOST states will allow RN's to take suboxone provided its being prescribed by a doctor. They may also impose additional requirements like regular drug testing and/or psych evals, but for the most part you can practice as anyone else (i.e. they wont revoke you narcotics access or anything). Thankfully, the medical community (including medical facilities) are a lot more educated about addiction and drugs and don't take as much of a negative attitude toward it (like the general public), but there is still a lot of bias and outdated views. Its also a legal thing, if the RN went to court you know the other sides lawyer would emphasize how the RN was "taking a potent narcotic painkiller and is a drug addict" and 90% of the people in the room will think that's the truth.

Also....

I see a lot a negativity towards buprenorphine here and I think its misguided. First of all, it is different than methadone and different than street opiates and narcotic painkillers like oxycodone. It is a partial agonist, meaning its like a cross between nalxone (opiate overdose antidote) and a regular painkilling opiate. Methadone is a full agonist just like morphine and is actually used quite a lot for pain, its used for detox and maitence because its long lasting and also has a high receptor affinity, so it will block things like heroin and oxycodone at moderate and high doses. Since its a full agonist, it has the traditional opiate affects that buprenorphine lacks so nursing on methadone is probably not safe, but buprenorpine can be safely taken by nurses under the care of their psychiatrist.

People taking buprenorphine do not experience any euphoria (after the first few doses), it simply stimulates those opiate receptors just enough to prevent withdrawal. An opiate addicts brain is rewired in a way to need opiates to function normally, and suboxone provides just enough stimulation to allow addicts to function normally without being impaired in any way. It also has a high affininty for the mu opiate receptor, which allows it to acts as a "blocker" so if the nurse was to, say, slip up one day and take a few painkillers from the narcotics drawer, she would not get any affect from taking them nor would she get any effect from buying a bag of heroin on the way back. The blocking effect can last for about 3 days (or more in some people) so that gives the patient plenty of time to rethink their desire to use again, whihc is great because most relapses are quite impulsive and almost always regretted.

So there it is. I've done a TON of research on addiction treatments so I know a lot about this stuff.

To summarize, suboxone/subutex/buprenorphone is a very beneficial drug (even if you are on it for your entire life) that does not cause any impairment that would make it unsafe for a nurse to be taking it on the job. Statistically, I would bet my life that a nurse who simply got clean and is trying to stay clear is a far greater risk than one on suboxone, the suboxone gives them that saftey net so they can fall victim to a momentary lapse of judgment that accompanies so many relapses.

P.S. There is also long acting forms of the opiate blocker naltrexone which can be used to really restore the brain to its normal state, but its can take 1-3 years, requires detox, and has a number of side effects that most patients don't like. All the research we have thus far says patients can function very well on long term suboxone Tx so I don't see a need to have so much regulation and controversy over it (prescribing docs even need a special cert and they have a patient cap of 100, which only drives up the cost of treatment and makes finding a doctor that much harder). Again, this is all do to socio-political misunderstanding about drugs and addiction, but I'll save that for my ethics class :)

[Magsulfate, BSN, RN]

Responding to the op, suboxone is a safe way to get rid of an opiod addiction. Whether the BON approves it or not, I personally would not recommend it. The withdrawal from suboxone is BAD. I can't explain that in any better word, it's just BAD. Some say a worse experience than the original drug of choice. It is considered a narcotic, so that wouldn't be coming "clean".

[Magsulfate, BSN, RN]

I just realized I commented 5 years ago on this thread lol

[Guest849204]

Also, im going to be doing a research review on impaired professional programs for a research class so if I learn anything new there I'll be sure to post it here.

[Brandi Kemp RN, BSN]

Taking a med like suboxone is still an active addiction imo. If anything were to prevent the person from getting their med they would suffer withdrawals and be more likely to abuse their previous drug of choice. With sustained abstinence withdrawals have already been dealt with.

[Guest849204]

You are absolutely correct that taking buprenorphine based drugs like Suboxone does not by itself address the addiction, but that's not what its for.

The short version is:

1. Addiction is a disease of which drug use is a symptom, its unethical to blame addicts for their use.

2. Further research is required, however ancedotal reports and some reseach suggests that suboxone does not cause impairments after a stable dose is maintained.

3. In certain cases, patient safety is greatly increased when the RN is on Suboxone compared to the same RN expected to remain abstinent.

And now for the long version:

Suboxone and similar drugs (buprenorphine is the generic name) are partial opiate agonists with high receptor affinities and slow dissociation rates. Basically, the drug clings tightly to opiate receptors knocking off any other drug in its way and then holds on tightly for a very long time (up to a 72 hour theraputic half life). It does this while only stimulating the receptor a tiny amount (intrinsic activity of around 0.5).

That's the pharmacology, but for the addict it means a suppression of withdrawal and cravings as well as an inability to "get high" off painkillers and street drugs and it does this without making the user "high" or causing impairments (further research is required, but it appears that people become tolerant quickly to any impairing effects). People should know however that those without a high opiate tolerance do report "getting high" with Suboxone and there is a black market diversion risk for people who can't afford doctor visits or who use the drug to suppress withdrawal when they are unable to get their drug of choice, so it should eb treated like any other narcotic in terms of safe storage.

Therapeutically, this allows the addict to feel normal and deal with their psychological problems without trying to deal with the physical and psychological affects of acute and long term withdrawal at the same time. This allows the RN to practice safely while completing treatment, which can take 1-3 years to reach the point where he/she is abstinent, free of significant cravings, and able to cope with problems without drugs.

Unfortunately, Suboxone is often over-prescribed and some people take it for years and years. That said, its this far been shown to be safe to take long term and is quite effective in reducing mortality rates in people with substance abuse disorders. The downside of course is that they are dependent on a medication and if they don't deal with the issues causing them to use opiates, they are at risk for adopting another ineffective coping mechanism such as addiction to another type of drug, sex, gambling, etc...

In the end it all comes down to the patient. If the RN can't reliably remain abstinent around narcotics, then its better to use suboxone. When state BON's don't allow suboxone, they put patients at risk by incentivizing RN's to attempt to remain abstinent when they are likely to slip and work impaired. In terms of patient saftey, BON's should either allow suboxone use or require a multi year sobriety period and clearance from an addiction specialist before allowing the RN to return to direct patient care. Since suboxone is safe for a nurse to take while providing patient care, there's no reason to put an RN out of the job for years.

They also need to make treatment programs more accessible and confidential. Most RN's who avoid treatment are simply afraid of the stigma and risk to their license. If they were ensure that they would have the opportunity to keep their license and have their treatment kept confidential, we would have a lot less impaired RN's.

That's about all I can say, I'm in the middle of writing a paper on this very topic so I need to stop procrastinating and get to it! Fell free to PM me with any questions. I was a psych undergrad with a focus on psychopharmacology and addiction so I have a lot to share and I always guarantee confidentiality and no judgement when people ask me about this stuff.

[Guest849204]

I've seen multiple anecdotal reports of how bad withdrawal from suboxone is. Are you aware of any studies? I believe the reports but for paper writing purposes it would be nice to have peer reviewed studies.

[reggaemuffin, MSN, NP, CNS]

"Taking a med like suboxone is still an active addiction imo. If anything were to prevent the person from getting their med they would suffer withdrawals and be more likely to abuse their previous drug of choice. With sustained abstinence withdrawals have already been dealt with."

What you are describing is the definition of physical dependence, not active addiction. Your opinion is uninformed and actually offensive.

[domenicon]

Hi,

I am currently in a Nursing Program at Nassau Community college. I am on Suboxone and Valium, will they still give me a job when I get my R.N...?? Or do you think they will discriminate me? I am from NY.

[Throwaway2022, ADN, RN]

Drug screen on Monday for new job at hospital. Really concerned about disclosing subutex maintenance. Can I ask what substances are included on the drug screen prior to submitting my specimen? I have a temporary license at this time. I am terrified that if I disclose this information, I will automatically be flagged. If I take the risk of not disclosing it, I have chance of it not being on the drug screen. Any advice?