Development and Implementation of an Evidence-Based Buprenorphine-Naloxone Medication Assisted Treatment Program in a Primary Care Setting

Opioid abuse is one of the most significant drug-related public health threats in the United States (U.S. Drug Enforcement Agency, 2016). Approximately 115 Americans die every day from an opioid overdose in the United States (Center for Disease Control and Prevention, 2017). Coupled with counseling, medication assisted treatment (MAT) can successfully treat opioid use disorder and sustain recovery by providing a more individualized approach to therapy (Substance Abuse and Mental Health Services Administration, 2016). The purpose of this project was to assist a primary care clinic (PCC) in Fargo, ND with the development, implementation, and evaluation of a buprenorphine-naloxone MAT option for opioid use disorder (OUD) patients in collaboration with a chemical dependency residential center (CDRC). This was accomplished through the development of evidence-based guidelines, consent for treatment forms, and a provider order-set, and educating nurses at the primary care clinic on the use of the Clinical Opiate Withdrawal Scale. Additionally, nurse practitioner confidence in utilizing medication-assisted treatment was evaluated two months post-project implementation using a 5-point Likert Scale, while nurse practitioners also identified strengths and weaknesses of the project via free hand data entry. The analysis at the conclusion of this project included the overall results of the pre and posts implementation Likert Scale surveys and qualitative questionnaires. Nurse Practitioner confidence in treating OUD patients, knowledge of community resources for addiction resources, understanding the pathophysiology of opioid addiction, and willingness to provide medication assisted treatment improved post-implementation. Through analysis of the qualitative questionnaire, nurse practitioners indicated positive feelings about the program and the working relationship within the PCC and with the CDRC. Lack of experience working with OUD patients was indicated in nurse practitioner responses as a weakness. Results generalized within the confines of the PCC may indicate more experience working with OUD patients could lead to increased nurse practitioner confidence in treating the patient population