Nurse prescribing practices across the globe for medication-assisted treatment of the opioid use disorder (MOUD): a scoping review

Abstract Background Despite the dramatic increase in opioid-related deaths in recent years, global access to treatment remains poor. A major barrier to people accessing Medication-assisted treatment of the opioid use disorder (MOUD) is the lack of providers who can prescribe and monitor MOUD. According to the World Drug Report, more young people are using drugs compared with previous generations and people in need of treatment cannot get it, women most of all. Nurse prescribers have the potential to enhance both access and treatment outcomes. Nurse prescribing practices do, however, vary greatly internationally. The aim of this scoping review is to explore nurse prescribing practices for MOUD globally with a view to informing equitable access and policies for people seeking MOUD. Methods This scoping review was informed by the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews (PRISMA-ScR). Electronic searches from 2010 to date were conducted on the following databases: PsycInfo, PubMed, Embase, and CINAHL. Only studies that met the eligibility criteria and described nurse prescribing policies and/or behaviours for MOUD were included. Results A total of 22 articles were included in the review which found several barriers and enablers to nurse prescribing of MOUD. Barriers included legislation constraints, lack of professional education and training and the presence of stigmatizing attitudes. Enablers included the presence of existing supportive services, prosocial messaging, and nurse prescriber autonomy. Conclusion The safety and efficacy of nurse prescribing of MOUD is well established, and its expansion can provide a range of advantages to people who are dependent on opiates. This includes increasing access to treatment. Nurse prescribing of MOUD can increase the numbers of people in treatment from ‘hard to reach’ cohorts such as rural settings, or those with less financial means. It holds significant potential to reduce a wide range of harms and costs associated with high-risk opiate use. To reduce drug-related death and the global burden of harm to individuals, families, and communities, there is an urgent need to address the two key priorities of nurse prescriber legislation and education. Both of which are possible given political and educational commitment

Opioid agonist maintenance treatment outcomes : the OPTIMUS international consensus towards evidence-based and patient-centred care, an interim report

Abstract: Non-medical opioid use is a major public health concern causing high mortality. While opioid agonist maintenance treatment (OMT) is a key life-saving intervention, there is (a) no international consensus on opioid treatment outcomes and (b) few opioid treatment outcome studies include key (public) health outcomes, such as overdose or HIV/hepatitis C. We report the rationale and study protocol for, and preliminary results of, an on-going international OMT outcomes consensus study that aims to address this double gap (n= 110 collaborating experts from 32 countries, plus a n = 477 Delphi evaluation panel from 26 of those countries: 58% male, 41% female; 47% OMT patients, 53% OMT professionals). We present a first draft of a patient interview guide (including a \u2018clinical form\u2019) to monitor OMT outcomes in six domains. The form appears to be well accepted and feasible in early testing. Through this, we aim to enhance the quality of and access to OMT and improve the survival, health, and quality of life of people who use opioids, while promoting nonstigmatising patient-physician relationships