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SAMHSA’s Award-Winning Newsletter
May/June 2009, Volume 17, Number 3 

photo of (left to right) Karen Hannon, R.N.; Katie Chen, Clinician; Lexie Bergeron, Program Manager; Colleen LaBelle,  Program Director; and Daniel Alford, Medical Director

The team at Boston Medical Center’s Opioid Treatment Center includes (left to right) Karen Hannon, R.N.; Katie Chen, Clinician; Lexie Bergeron, Program Manager; Colleen LaBelle, Program Director; and Daniel Alford, Medical Director.

Buprenorphine Treatment: A Nurse’s Story

“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 in Boston, MA, 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,” Ms. LaBelle said.

Currently, at the Boston Medical Center, a total of 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.

How does this model help?

“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 Ms. LaBelle. That frees up physicians—who have received waivers from SAMHSA to prescribe buprenorphine—to manage a larger group of patients. (See box.)

Background

Approved by the Food and Drug Administration (FDA) 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. (See SAMHSA News online, “SAMHSA Helps Bring Buprenorphine to the Field, March/April 2004.)

“This was a very big deal,” said Ms. 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 goal of the pilot program 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 protocol, 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 Ms. 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 Ms. 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 daylong buprenorphine trainings, specific to nurses, modeled after the American Society of Addiction Medicine’s waiver trainings.” In addition, Ms. 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 LTJG 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 (TAP) 30,” said LTJG Azimi-Bolourian, SAMHSA’s project officer for TAP 30. (See related article.) “My co-author, Katherine Fornili, R.N., M.P.H., CARN, and Kathleen Gargano, an expert nurse reviewer, also deserve recognition for their efforts making TAP 30 such a valuable tool for nurses.”




President’s Budget

President’s Budget

FY2010 Budget sustains critical programs.


  Treatment Improvement  
   Protocols  
Addressing Suicidal Thoughts & Behaviors

Addressing Suicidal Thoughts & Behaviors

From CSAT, TIP 50 offers guidance to substance abuse counselors on how to help clients who may be in crisis.


  Medication-Assisted Treatment  
Buprenorphine: Guide for Nurses

Buprenorphine: Guide for Nurses

Specific guidance for nurses and nurse care managers.

Methadone Safety

Methadone Safety

Safe use of methadone, a medication for opioid addiction, is the focus of a new campaign.


  Data on Depression  
MDE and Youth

MDE and Youth

In 2007, 2 million adolescents had a major depressive episode.

MDE and Adults

More than 16 million adults struggle with depression.


  Focus on Children  
Mental Health Awareness Day

Mental Health Awareness Day

Eight young people take center stage in a celebration of the arts as a way to cope with mental health problems. Photo Gallery.

Data on Children, Parents, Drugs

More than 8.3 million children lived with a parent who was dependent on or abused alcohol or drugs during the past year.


  Women’s Behavioral Health  
Mental Health Publications

Mental Health Publications

“Action Steps” for professionals and “What It Means To You” for consumers are available to order.

Pregnancy & Substance Abuse

Pregnancy & Substance Abuse

How much are alcohol and drugs used during pregnancy and after childbirth?


  Recovery Month  
20th Anniversary Includes TV Spots, PSAs

20th Anniversary Includes TV Spots, PSAs

With a few months to go, the Recovery Month Web site offers flyers, banners, and more.


  Also in this Issue  
PRISM Awards

PRISM Awards

Celebrating excellence in Hollywood. Photo Gallery.

ADDERALL® & College Students

ADDERALL® & College Students

Full-time college students are twice as likely to use Adderall® nonmedically.

Real Warriors Campaign

Real Warriors Campaign

Helping service members break through stigma to ask for help.



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