Christine Murphy, fourth from left, rounds on Shapiro 7 East to review the specialized care approach for patients with substance use disorder who undergo cardiac surgery.

If there’s one thing Christine Murphy, MS, PMHCNS-BC, CARN-AP, wants people to know about substance use disorder, it’s that the disorder is a disease just like any other illness.

“There was a time when society taught us addiction was a choice within the individual’s control. We have to put that part of history behind us and help patients recover from this devastating disease,” said Murphy, of the Psychiatric Nursing Resource Service. “With the right care and support, people do get better.”

Murphy and advanced practice nurses throughout the Brigham are working on numerous efforts to help overcome the stigma surrounding substance use disorder and improve the care of patients and their loved ones. These are priorities for the Department of Nursing and the entire institution.

Understanding the Issues

This spring, the Advanced Practice Registered Nurse (APRN) Council partnered with the Psychiatric Nursing Resource Service to organize a full-day conference for advanced practice nurses in diverse settings.

“No matter what area you practice in, you will be caring for patients with substance use disorders — inpatient, outpatient, primary care and procedural areas,” said Caitlin Sachs, MSN, NP, of Plastic Surgery and chair of the APRN Council. “Our goal was to cover a broad range of topics related to substance use disorder to help us provide the best care for patients and recognize biases.”

Murphy opened the conference with a discussion about the disease model of addiction. The lineup of speakers, most of whom were Brigham nurse experts, covered barriers patients face in receiving care, harm reduction, recovery-oriented care, pain management and trauma-informed care.

The keynote speaker, Monica Bharel, MD, MPH, commissioner of the Massachusetts Department of Public Health, provided an update on the progress Massachusetts has made in reducing fatal opioid-related overdoses. <

The conference concluded with reflections from a patient in recovery. “The patient was really brave, and his talk solidified for everyone what the conference was all about,” said Barbara Lakatos, DNP, PMHCNS-BC, APN, of the Psychiatric Nursing Resource Service. “He talked about his journey through health care, the stigma he experienced and its negative effect on him. He described what clinicians did that was helpful or not helpful throughout the process. He provided tips on what he found most useful, including receiving outpatient care through the Bridge Clinic.”

Increasing Access to Treatment

One of the topics that emerged at the conference was how nurse practitioners can receive training to prescribe medication-assisted therapy, such as buprenorphine. The state requires an eight-hour training for physicians and 24 hours of training for nurse practitioners and physician assistants, plus an online training component, to receive a waiver to prescribe. A few weeks after the conference, Elizabeth Donahue, MSN, RN, NP-C, of Primary Care, helped to organize a training for more than 60 nurse practitioners and physicians from multiple specialties at the Brigham and other local institutions.

Currently, providers volunteer to complete training to prescribe. The more providers who do so, the more access to treatment patients have.

“Right now, the education and training are optional for providers, which perpetuates the stigma of the disease,” said Donahue. “We need to shift to acceptance and recognition of substance use disorders as chronic disease and ensure that no patient is left to suffer. We need everyone to take up this mantle if we hope to adequately address this epidemic.”

Elevating the Level of Care

At the Brigham, behavioral health is integrated throughout all services. The hospital doesn’t have a dedicated behavioral or mental health unit on campus, although patients may be referred to other Partners inpatient care units. “That has allowed us to advance the care for substance use disorder in all areas; it is part of the care we provide to our patients,” said Lakatos.

That means that staff in inpatient, outpatient and procedural areas must have support, education and resources to ensure they tailor care to meet the needs of patients with substance use disorder. Nurses identified education related to substance use disorder as their highest priority via the department’s recent Learning Needs Assessment.

Murphy, who participated with interprofessional colleagues on the Brigham Comprehensive Opioid Response and Education (B-CORE) Program Education Taskforce, helped to develop resources for Brigham staff. “Our nursing contribution was offering tips on how to care for these patients, with a focus on communication, withdrawal, safe environment of care, pain and the disease model of addiction.”

Currently, Murphy, Lakatos and colleague Monique Mitchell, MS, PMHCNS-BC, are leading an effort to develop simulation training. “Patients with substance use disorder come in with medical co-morbidities, and they may be in the hospital for an extended length of stay,” Murphy said. “They may have challenging behaviors, and nurses need to feel comfortable assessing them for pain and talking with them about their disease so that we can continue to elevate the level of care they receive.”

Murphy and Donahue were recently appointed to the Partners Substance Use Disorder Steering Committee, which makes recommendations and provides guidance for system-wide changes related to substance use disorder.

“It’s meaningful to have acknowledgement at the Partners level that we need to do more in terms of standardizing tools, providing evidence-based care and focusing on harm reduction,” said Murphy. “We need to teach patients to care for themselves and offer them a compassionate, stigma-free environment that says, ‘We care about you.’”

Resources for staff are available at bcore.brighamandwomens.org.

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