Peer Facilitator Training for Diabetes Prevention in a Nigerian Drug Treatment Center.

INTRODUCTION AND BACKGROUND: Individuals with substance use disorders (SUDs) are at an increased risk of developing comorbid medical conditions, including Type 2 diabetes. Although the diabetes prevention program (DPP) is efficacious and cost-effective, there is no published evidence to support its implementation in Nigeria or within SUD treatment settings. In this first known DPP within an SUD treatment program, we implemented a multiphased, nurse-led DPP at a small outpatient drug treatment center in Nigeria. The aim of this article was to describe only the processes utilized for the initial peer facilitator (PF) training (Phase 1). METHODS: In Phase 1, a diabetes prevention master trainer delivered a virtual DPP training to the facility's lead nurse, who return-demonstrated the DPP workshop skills and competencies over four 4-hour sessions. The lead nurse then independently delivered four 8-hour training sessions to a small number of client volunteers (n = 4) who subsequently delivered the DPP lifestyle interventions to their peers in the outpatient treatment program. RESULTS: The client volunteers attended all PF workshop sessions and were observed to be proficient in all aspects of implementation. They indicated that the training objectives were easily achieved and expressed enthusiasm for delivering DPP content to their peers. The need to better contextualize the DPP curriculum specific to Nigerian food preferences was identified. CONCLUSION: The Phase 1 training process appears to be an appropriate and effective approach for preparing PFs to deliver health programs, like the DPP, in environments with limited resources for populations facing numerous challenges.

Socialized Risk and Privatized Profit: What Addictions Nurses Need to Know About the Potential Repeal of the Affordable Care Act.

The aim of this column is to provide an overview of the positive impacts of the Patient Protection and Affordable Care Act of 2010 (ACA) on improved health care access, quality, and outcomes for individuals with substance use disorders (SUDs), including opioid use disorders and opioid overdose deaths. Addictions nurses should be alerted to the serious, often lethal consequences that individuals with SUDs will experience if the ACA is repealed. Proposed legislation to reverse major provisions of the ACA include the American Health Care Act of 2017 (H. R. 1628), passed by the U.S. House of Representatives on May 4, 2017, and the Better Care Reconciliation Act of 2017 (H. R. 1628, Senate Amendment, June 26, 2017), which was made public just before this writing, amid much secrecy and lack of transparency. This column focuses on ACA-related Medicaid expansion and the impact that future cuts to Medicaid and other insurance coverage would have on individuals in need of SUD treatment. Finally, this column addresses the moral, ethical, and professional obligations of nurses and others involved in health care and health policy. Intensified advocacy efforts are required to ensure that recent ACA-related gains in insurance coverage and access to quality behavioral health treatment are not only preserved but also expanded. Access to health insurance coverage and health care, especially among vulnerable, high-risk populations, including those at elevated risk for opioid overdose and other SUD-related morbidity and mortality risks, is one of the most important social justice issues of our time.

Nurse Practitioner Prescriptive Authority for Buprenorphine: From DATA 2000 to CARA 2016.

The aim of this Policy Watch column is to provide an update on a much anticipated legislation, enacted in 2016, which enabled office-based opioid treatment (OBOT) with buprenorphine prescribing for the treatment of opioid addiction by nurse practitioners (as well as physician assistants). First, an overview of the Drug Addiction Treatment Act of 2000, which only permitted OBOT prescribing by physicians, will be described. It will be followed by a summary of the Recovery Enhancement for Addiction Treatment Act of 2015-2016. Finally, a review of the Comprehensive Addiction Recovery Act of 2016 will be provided, which includes information about important changes to OBOT regulations that enable NP prescribing of buprenorphine for the treatment of opioid addiction.

Part 1: The Theoretical Basis for Recovery-Oriented Management of Substance Use Disorders in Primary Care.

There is strong evidence in the literature that screening and brief counseling interventions are effective in detecting alcohol problems and decreasing alcohol consumption among patients in primary care settings but somewhat weaker evidence regarding screening and brief intervention for drug problems. In 2014, two published studies made news and caused concern among proponents of substance Screening, Brief Intervention and Referral to Treatment (SBIRT) programs, when their authors concluded that brief interventions were not effective for decreasing drug use among primary care patients identified through screening, and advised that widespread adoption of screening and brief intervention for drug use was not warranted.An evaluation of the theoretical foundations for evidence-based SBIRT services was conducted to produce possible explanations for why traditional SBIRT works well for individuals with unhealthy alcohol use but not as well for those with more serious substance use disorders, including drug use and alcohol/drug dependence. Smith and Liehr's evaluation framework for middle-range theory was utilized to analyze the Chronic Care Model, which was featured prominently in early SBIRT literature, and the newer Recovery Management model, which provides a philosophical framework for organizing modern addictions services and quality-of-life enhancements (Part 1 of this two-part series).Programs are more likely to succeed if guided by theory, and examination of relevant components of theory-based interventions can be useful in developing practical strategies for meeting program objectives. A new, theory-based, recovery-oriented framework for primary care SBIRT is introduced in Part 2 ("SBIRT+RM(C): A Proposed Model for Recovery-Oriented Primary Care").

Part 2: Screening, Brief Intervention and Referral to Treatment Plus Recovery Management: A Proposed Model for Recovery-Oriented Primary Care.

Part 1 of this two-part series (The Theoretical Basis for Recovery-Oriented Management of Substance Use Disorders in the Primary Care) explored the theoretical foundations for evidence-based substance Screening, Brief Intervention and Referral to Treatment (SBIRT) services. The aim was to produce possible explanations for why traditional SBIRT works well for individuals with unhealthy alcohol use but not as well for individuals who have more serious substance use disorders, including drug use and alcohol/drug dependence. Building on that analysis, through meaningful application of recovery management (RM) concepts within an integrated primary care/behavioral health context, a new, theory-based, recovery-oriented framework for primary care SBIRT is now introduced in Part 2. The proposed SBIRT Plus Recovery Management (SBIRT + RM) model moves traditional SBIRT from its original, limited, and narrow focus only on substance detection, brief intervention, and referral to its rightful, structured placement within a comprehensive, multidimensional, recovery-oriented system of care clinical practice environment. SBIRT+RM describes relevant strategies for improving recovery outcomes for individuals identified through primary care substance screening and defines primary care provider roles and responsibilities for sustained recovery support and long-term recovery maintenance.

Managing pain in opioid-dependent patients in general hospital settings.

Opioid-dependent patients have unique pain management and psychosocial needs. Inadequate staff training, the absence of addiction screening and intervention protocols, and stigma related to opioid use can impact outcomes negatively for these patients in general hospital settings.