Buprenorphine treatment: a nurse’s story
From the Massachusetts Nurse Newsletter
September 2009 Edition
By Meredith Hogan Pond
“The greatest day of my life was when we were able to get rid of our waiting list,” said Colleen LaBelle, R.N., CARN, program director for the Boston Medical Center’s Office-Based Opioid Treatment (OBOT) program and state director for the Department of Public Health’s OBOT sites.
“People shouldn’t be waiting for buprenorphine treatment. If patients are ready to start their recovery from addiction to heroin or other opiates, we want to be ready to help,” LaBelle said.
Currently, at the Boston Medical Center, 375 patients are managed through their varying levels of opioid addiction treatment with the medication buprenorphine. The “nurse care management model” is an important part of this expanded availability of treatment services at the center.
“This model has allowed us to provide buprenorphine treatment to a large number of patients without adding more work for the physicians. The nurse does the majority of the upfront assessment, education management, and paperwork to get a patient into care,” said LaBelle. That frees up physicians—who have received waivers from the federal Substance Abuse and Mental Health Services Administration to prescribe buprenorphine—to manage a larger group of patients.
Approved by the Food and Drug Administration in 2002 and available in pharmacies in 2003, buprenorphine allows opioid-dependent patients to bypass specialized methadone clinics and seek treatment in the privacy of their own doctor’s office or local clinic. The medication alleviates drug cravings and eases the withdrawal of patients addicted to heroin, prescription narcotics and other opioid drugs.
Each specially trained physician received a waiver and was allowed to serve no more than 30 patients at a time.
“This was a very big deal,” said LaBelle. “We were getting calls for treatment information from across the state, from politicians, from nurses, from lawyers, from CEOs, from people from all walks of life, she said. The Boston pilot program was funded by the Massachusetts Bureau of Substance Abuse Services to see if using this model in an academic-medical setting would allow for the expansion of treatment for patients with opioid dependence.
The pilot program’s goal was to get more patients into care for their opioid addiction by using the nurse care management model with waivered physicians ready to see patients, to identify the patients appropriate for this treatment and to be their prescriber of record.
“Even with that program, we had a waiting list of more than 300 people. People were literally dying on our waiting list because there wasn’t enough treatment,” said LaBelle. “Imagine asking for someone who has come up on your waiting list and hearing from her mother on the other end of the phone that she recently died from a heroin overdose.”
In December 2006, the situation improved. At that time, the FDA approved certain physicians who met the criteria to serve 100 patients at a time.
“In August 2007, we had two full-time nurses, and I oversaw that project, along with another grant award from the state to provide training and technical support for 19 health centers modeled after our pilot program,” said LaBelle. The goal of the 19 sites was again to expand treatment, provide training and support, and build a network for nurses across the state who were doing addiction work.
“I provided day-long buprenorphine trainings, specific to nurses, modeled after the American Society of Addiction Medicine’s waiver trainings.” In addition, LaBelle provided quarterly training on topics of interest related to addiction, along with conference calls, site visits, networking, and more.
“Ms. LaBelle is a pioneer in the nurse care management model for buprenorphine treatment,” said Sara Azimi-Bolourian, M.S.N., M.H.A., M.B.A., a public health advisor in SAMHSA’s Division of Pharmacologic Therapies, Center for Substance Abuse Treatment. “Her knowledge made her a key person to provide expert nurse review for SAMHSA’s Technical Assistance Publication 30.”