Padgett Tonja M
Tonja M. Padgett, RN, DNP, ACNS-BC, Indiana University School of Nursing, Indianapolis.
J Addict Nurs. 2019 Oct/Dec;30(4):238-241. doi: 10.1097/JAN.0000000000000305.
Substance use disorder (SUD), more specifically opioid use disorder, is a national epidemic. Although there is an emphasis on treatment and increasing treatment locations, there continues to be a gap between the number of people with SUD and the number of treatment centers. To help narrow this gap, some primary care clinicians started providing medication-assisted treatment (MAT) on an outpatient basis in their offices. This option enables clinicians to provide treatment in their own communities, which increases access to treatment and decreases costs. It also enables the clinician and the person with SUD/opioid use disorder to build a relationship, which many clinicians believe is the foundation of successful treatment. The clinician, whether a doctor, a physician assistant, or an advanced practice nurse, has to obtain a Drug Addiction Treatment Act 2000 waiver to provide MAT beyond naltrexone, which has a required educational program and includes a limitation on the number of clients. Conversely, a possible drawback to this type of treatment is the potential for the disruption of continuity of care with regard to psychotherapy treatment. Federal law mandates that therapy is available and provided to people receiving MAT. The clinician may not be able to provide this service and would need to refer the person with SUD for psychotherapy treatment. It may be clinically significant for a type of follow-up communication to be implemented so that the clinician and the therapy provider can maximize SUD treatment success.
物质使用障碍（SUD），更具体地说是阿片类物质使用障碍，是一种全国性的流行病。尽管目前重点在于治疗并增加治疗场所，但患有物质使用障碍的人数与治疗中心的数量之间仍存在差距。为了帮助缩小这一差距，一些初级保健临床医生开始在其办公室门诊提供药物辅助治疗（MAT）。这种选择使临床医生能够在自己的社区提供治疗，从而增加了治疗的可及性并降低了成本。这也使临床医生与患有物质使用障碍/阿片类物质使用障碍的人建立关系，许多临床医生认为这是成功治疗的基础。临床医生，无论是医生、医师助理还是高级执业护士，若要提供除纳曲酮之外的药物辅助治疗，都必须获得2000年《药物成瘾治疗法》豁免，这需要参加一个必修教育课程，且对客户数量有限制。相反，这种治疗方式的一个可能缺点是在心理治疗方面存在护理连续性中断的可能性。联邦法律规定要为接受药物辅助治疗的人提供并给予治疗。临床医生可能无法提供这项服务，需要将患有物质使用障碍的人转介接受心理治疗。实施一种后续沟通方式可能具有临床意义，以便临床医生和治疗提供者能够最大限度地提高物质使用障碍治疗的成功率。
