A pregnant woman walks into a hospital in early labour. She feels nauseated and achy; her contractions are 20 minutes apart. There is more to her story than meets the eye. She is on methadone maintenance therapy (MMT) and wasn't able to pick up her daily dose at the pharmacy this morning. Although her story may be hard to believe she is one of the estimated 17,000 clients in Ontario currently receiving MMT. Methadone is a legal substitute therapy for patients addicted to opioids, such as heroin, and prescription narcotics like OxyContin.
For nurses who encounter MMT clients during the course of their work, the recently published Registered Nurses' Association of Ontario (RNAO) MMT guideline is a welcome resource. The guideline ensures that nurses have the latest evidence-based information to enhance their practice and strengthen and improve care for MMT clients.
The costs of untreated opioid addiction include health care, law enforcement, social assistance and loss of economic productivity. In the past, heroin has been the most commonly misused opioid in Canada however, that pattern is changing due to the increased availability of prescription opioids. "A lot of people think it's only street drug users who take methadone but that's simply not true. I've had clients... addicted to opiates after dental or back surgery," explains Janice Price, a public health nurse who contributed her expertise to this guideline.
Nurses are an integral part of the health-care system and in a unique position to address stigmas and to reduce barriers to care. They are often the first contact that people have with the health-care system and - even if they do not work directly in addiction areas, they do encounter MMT clients especially in the Emergency and Maternity departments. This guideline allows them to recognize the signs and symptoms of substance abuse, understand treatment options and have an appreciation for the stigmas and biases often associated with this population. Irmajean Bajnok, director of the International Affairs and Best Practice Guideline Program at RNAO, says the guideline recommends that nurses consider social determinants of health when carrying out assessments and interventions. She says, "factors such as housing, income, social status and stress impact the health of all people, but their influence can be more pronounced in this group."
According to Margaret Dykeman, manager of a primary care clinic and leader of the panel who developed the guideline, "People on methadone can live a normal life. Our goal is to get them feeling like a human being again, getting them back to work, getting their kids from social services and for new mothers improving the odds that they have a normal baby that's not addicted or damaged by drugs." The MMT follows the principles of the harm reduction model, which essentially says a practical and compassionate approach towards addiction is the most effective way of treating people.
The development of this guideline started in January 2008 with a multi-disciplinary panel made up of nurses and other health-care professionals from various settings including hospitals, community, corrections and academic universities.
REGISTERED NURSES' ASSOCIATION OF ONTARIO