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C55. Opioid Detoxification; Fentanyl and Nurse Observations

C55. Opioid Detoxification; Fentanyl and Nurse Observations

Learner category:

  • Intermediate Level

Learning objectives:

  • Participants will use of evidence-based protocols and instruments allow for the detection of aberrant treatment responses.

Abstract

This is a presentation of several cases that illustrate an opioid detoxification pattern in our inpatient population who had abused “illegal” fentanyl. The Background – We wanted to replace our existing opioid detoxification procedure with an evidence-based protocol using buprenorphine. The medication dosing was guided by Clinical Opiate Withdrawal Scale (COWS) scores (see reference SAMSHA). The question was to what extent and how quickly our addiction nurses would adapt to the new procedure. To answer that question, we looked at 113 patients who were treated with the individualized detoxification procedure. As expected, the patients had no issue with the individualized dosing and the addiction nurses quickly and accurately adjusted to the new procedure. These results allowed us to determine a timetable to implement individualized opioid detoxification. Our collected data revealed that several patients who initially had the predictable course of lessening opioid withdrawal symptoms then had a resurgence that appeared as a new episode of symptoms. The common feature among these patients was their prior abuse of “illegal” fentanyl. Our addiction nurses through careful observation and the use of the COWS, were able to verify that some patients actually had resurgent symptoms and were not simply medication seeking. Reference: Substance Abuse and Mental Health Services Administration. “Medications for Opioid Use Disorder.” Treatment Improvement Protocol (TIP) Series 63, Full Document. HHS Publication No. (SMA) 185063FULLDOC. Rockville, MD:Substance Abuse and Mental Health Services Administration, 2018.

Authors

Donna B Walter
RN, BSN, MS, CARN Livengrin Foundation, Inc.

Donna B Walter has been an RN for 30 + years, the last 20 years in Addictions Nursing at Livengrin Foundation Inc, a non-profit substance abuse treatment facility. Her previous career was in pharmaceutical research. Donna has held the position of Nurse Manager since 2005 and had been an active member of IntNSA since 2006.

Comments (6)

  1. suzannealunni@yahoo.com

    Donna- Great presentation. Thank you !!! I enjoyed it!

    1. Donna Walter

      Thanks Suzanne 🙂 Glad you enjoyed it!

  2. Dennis Hagarty

    Thank you for the presentation. How many of the patients required additional dosing during rehabilitation? Also did any of these patients transition to regular buprenorphine for their post detox stay?

    1. Donna Walter

      Hi Dennis,
      We found that ~20% of the opioid detox patients were stable enough to discharge from detox and complete the taper in residential rehab. We did not have any patients transition to subutex after detoxification, however several patients chose to move to suboxone maintenance after discharge from detox and transfer to outpatient services.

  3. Rachel Shuster, BSN, RN, CARN, CAAP

    Great presentation. I’m glad to see what is normally a one-size-fits-all (or two sizes in your previous case) be updated to a protocol that supports individualized, evidenced-based care. Kudos!
    I’m interested in a few of the same questions as Dennis: “How many of the patients required additional dosing during rehabilitation? Also did any of these patients transition to regular buprenorphine for their post detox stay?”
    Also, how did this affect retention rates (completing recommended length-of-stay or transitioning from detox to inpatient rehabilitation), if at all?
    Thank you again!

    1. Donna Walter

      Thanks for your comments Rachel!
      We found that ~20% of the opioid detox patients were stable enough to discharge from detox and complete the taper in residential rehab. The individualized opioid detoxification protocol had a significant impact on detox completion, transfer to residential and increased the total length of stay in inpatient treatment.

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