Indiana Reverses Rehab Policy After Nurse Wrongfully Denied Treatment for Opioid Addiction

Nurses play a central role in combating the opioid epidemic by helping patients find alternative ways of managing chronic pain. But nurses are not immune to the addictive properties of prescription painkillers. Providers struggling with addiction may have their licenses temporarily suspended or revoked while they participate in rehabilitation programs, as required by state nursing boards.

But the U.S. Department of Justice says the Indiana Nursing Board discriminates against nurses with opioid use disorder (OUD) by prohibiting those who take medication for OUD from participating in the Indiana State Nursing Assistance Program (ISNAP), which rehabilitates and monitors nurses with substance abuse disorders. 

The DOJ determined that a nurse taking a prescribed narcotic for OUD was wrongfully denied access to the ISNAP. Prosecutors entered a settlement agreement with the Indiana State Board of Nursing that allows nurses to remain on medication for OUD while enrolled in the rehabilitation program.

ISNAP was created in 2006 in the wake of the opioid epidemic. Nurses can enroll in the program voluntarily, but in most cases, they are required to join to maintain their licenses or have one reinstated. The nursing board contracts with local vendors to administer the program.

The nurse at the center of the case sought treatment for her OUD in order to have her license reinstated. She had been prescribed buprenorphine, which is a Schedule III narcotic analgesic.

According to the FDA, Buprenorphine helps diminish the effects of physical dependence, such as withdrawal symptoms and cravings. The drug activates the same opioid receptors in the brain targeted by prescription or illicit opioids, but without producing euphoria.

However, she was told she couldn’t enroll because the policy requires participants to “demonstrate full abstinence from all mood-altering chemicals,” including buprenorphine, according to DOJ officials.

The nurse told the board that she believes nursing is her calling in life but remaining on her medication is “a life-or-death decision.” Unable to join the program, she was unable to reinstate her license.

But the DOJ says that amounts to discrimination under the Americans with Disabilities Act (ADA) “by prohibiting nurses who take medication to treat OUD from participating in the Indiana State Nursing Assistance Program [ISNAP].”

“Recovery and monitoring programs must allow individuals to use proven medications that support their recovery, including prescribed medications that treat [OUD],” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “Refusing to allow individuals to participate in a required support program because of their disabilities violates the ADA and makes it harder for individuals to secure and maintain jobs and livelihoods.” 

The Indiana Board of Nursing says it will now reverse its rehab policy to expand eligibility. The settlement will ultimately help more nurses participate in the rehabilitation program, so they can get their licenses back.

Katherine Feley, DNP, RN, chief executive officer of the Indiana State Nurses Association, said, “Expanding nurse assistance program eligibility will enable additional nurses to access necessary support for their health and their profession, instead of having to choose between the two.”

“This improvement will increase access to treatment resources, enabling more nurses to complete treatment and progress toward a safe return to work,” she said.

Under the settlement, the board must pay the nurse $70,000 in damages. It is also required to report regularly on its compliance with the new eligibility standard.

Up to 6% of nurses are engaged in active drug or alcohol use and addiction, according to The American Journal of Nursing. Providers that participate in state rehabilitation programs have an 80% success rate of having their licenses reinstated. They are also much less likely to experience a relapse.

The move should also help Indiana retain more nurses during the ongoing staff shortage. Providers struggling with addiction can get back to work instead of sitting on the sidelines. It will also help the healthcare industry recover from the opioid epidemic.

Nurses that have struggled with addiction in the past can use this knowledge and experience to better care for patients dealing with chronic pain.

According to Zachary Myers, U.S. Attorney for the Southern District of Indiana, the opioid epidemic has impacted professionals in all walks of life and requiring the state to allow nurses seeking treatment to stay on their prescribed medication will help combat that crisis.

“Indiana must now enact policies to ensure that Hoosier nurses will not be forced to choose between their recovery and their livelihoods,” he said.

The DOJ has reached settlements with state nursing boards in Massachusetts and Colorado over similar issues. To comply with the new standard, the state nursing board must:

• Revising policies and handbooks “to eliminate the ban on ISNAP participants using medication to treat OUD”
• Training nursing board staff and vendors on ADA guidelines and nondiscriminatory practices
• Compensating the complainant and other affected individuals for damages incurred
• Reporting to the DOJ all steps taken to meet the above requirements.