Substance Use & Addiction
Q: This concept describes when substance use leads to impaired control, social problems, risky use, and pharmacologic criteria such as tolerance and withdrawal.
A: What is substance use disorder?
Q: Opioids primarily exert their analgesic effect by binding to these receptors in the central nervous system.
A: What are mu opioid receptors?
Q: This life‑threatening complication of opioid overdose is characterized by decreased level of consciousness, pinpoint pupils, and this critical respiratory problem.
A: What is respiratory depression (or respiratory arrest)?
Q: Misuse of prescribed opioids, benzodiazepines, or stimulants can include taking higher doses, using them for euphoria, or doing this with prescriptions.
A: What is doctor shopping (or obtaining prescriptions from multiple prescribers/pharmacies)?
Q: Varcarolis’ Box 18.7 highlights misuse of medications in this specific setting, where access to controlled drugs may be easier for nurses.
A: What is the workplace (or healthcare setting)?
Q: Giddens describes this as a chronic, relapsing brain disease characterized by compulsive substance use despite harmful consequences.
A: What is addiction?
Q: This class of opioids (e.g., morphine, hydromorphone, fentanyl) fully activates opioid receptors.
A: What are opioid agonists?
Q: According to Meta‑PHI ED guidance, this first‑line medication can be started in the ED to treat opioid withdrawal and OUD and reduce risk of overdose.
A: What is buprenorphine(Suboxone)?
Q: This Nova Scotia program tracks dispensing of certain medications like opioids, benzodiazepines, and stimulants to help identify inappropriate prescribing or use.
A: What is the Nova Scotia Prescription Monitoring Program (NSPMP)?
Q: According to the NSCN Practice Guideline, nurses have this professional responsibility when they suspect their own substance use is affecting their practice.
A: What is the responsibility to self‑report/seek help and to remove themselves from practice if unsafe?
Q: According to concept-based nursing, these two broad types of factors interact to influence the risk of addiction (e.g., genetics and environment/trauma).
A: What are biological (or genetic) and psychosocial (or environmental) factors?
Q: These medications (e.g., naloxone, naltrexone) bind to opioid receptors but do not activate them, reversing or blocking opioid effects.
A: What are opioid antagonists?
Q: This long‑acting full agonist can be used in OUD treatment but requires careful titration and monitoring due to risk of accumulation and overdose.
A: What is methadone?
Q: The CCSA and Justice Canada documents describe a rise in this type of opioid use, involving medications originally intended as legal pain treatment.
A: What is prescription opioid misuse (or non‑medical use of prescription opioids)?
Q: This ethical principle is violated when a nurse diverts a patient’s prescribed opioid for their own use.
A: What is nonmaleficence (or beneficence, or fidelity—any clearly ethical principle is acceptable)?
Q: This term refers to the process by which the body adapts to a drug, so that higher doses are needed to achieve the same effect.
A: What is tolerance?
Q: These drugs (e.g., buprenorphine, nalbuphine) stimulate some opioid receptors and block others, giving them a “ceiling effect” on respiratory depression.
A: What are opioid agonist‑antagonists (or partial agonists)?
Q: According to Varcarolis, assessing opioid use includes asking about route, dose, frequency, last use, and these two key areas of impact on the person’s life.
A: What are physical/health impacts and social/occupational (or functional) impacts?
Q: According to Nova Scotia guidelines for nurses and managers, an appropriate first step when problematic substance use is suspected in a colleague is to do this.
A: What is report or consult according to policy (e.g., speak with a manager, follow institutional/NSCN guidelines, not ignore it)?
Q: Name two warning signs of prescription drug misuse in a nurse, as described in practice guidelines or Varcarolis (e.g., Box 18.7).
A: What are (any two): frequent medication errors or wastage, volunteering to give narcotics for others, discrepancies in narcotic counts, deterioration in job performance, unexplained absences, mood/behaviour changes, or wearing long sleeves to hide marks?
Q: Giddens emphasizes that nursing care for people with substance use and addiction should be guided by this non‑judgmental, respectful approach focused on preserving dignity.
A: What is a trauma‑informed, person‑centred (or non‑stigmatizing) approach?
Q: Name two key nursing assessments before administering opioids for pain, as highlighted in Lilley’s Pharmacology.
A: What are (any two): respiratory rate and quality, level of consciousness/sedation, pain intensity and location, blood pressure, pulse, and history of opioid use?
Q: Name two elements of a harm reduction‑oriented nursing approach to OUD from the Meta‑PHI or Varcarolis material.
A: What are (any two): non‑judgmental communication, offering naloxone kits, discussing safer use, linking to OAT (buprenorphine or methadone), monitoring withdrawal, involving peers/supports, or helping with housing/psychosocial needs?
Q: List two examples of “monitored drugs” in Nova Scotia’s Prescription Drug Monitoring Program.
A: What are (any two): opioids (e.g., morphine, oxycodone, hydromorphone), benzodiazepines, Z‑drugs (e.g., zopiclone), stimulants (e.g., methylphenidate), or other controlled substances?
Q: The NSCN guideline and Varcarolis both emphasize that organizational responses to nurses with substance use issues should aim for this dual focus.
A: What is protecting patient safety and supporting the nurse’s recovery (or rehabilitation)?