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After working in prisons for five years, Jason Harrison gravitated towards drug and alcohol nursing.

It seemed a logical progression, given he had helped treat many patients experiencing withdrawal on the inside and knew the vulnerable cohort needed ongoing support when released back into the community.

A Drug and Alcohol Nurse Practitioner based in Central Queensland, Jason says the specialty provides patents with access to the expert knowledge and nursing skills needed to identify and respond to complex drug and alcohol related conditions.

In his view, people who experience drug and alcohol issues are often poorly treated and misunderstood.

“I always say you’ve got to walk in a mile of a patient’s shoes in order to understand what they’ve been through,” he says.

“[Drug and alcohol nursing] is a specialised area. You really need to understand the patient group and the substances people are using, which are changing all the time.”

In his role as an NP, Jason prescribes medication to patients under the Opioid Treatment Program (OTP). It includes managing drug and alcohol withdrawal, reducing the health harms associated with opioid use, and, if required, helping general practices support patients.

Jason’s footprint covers more than 100 square kilometres. He conducts clinics in towns such as Rockhampton, Yeppoon, Blackwater, Moura, Biloela, Gladstone and Emerald.

Drug use is constantly changing, he says, determined by availability and “the population that’s chasing it”.

For example, right now, Gladstone has a higher rate of heroin and fentanyl use, while Emerald and Rockhampton has a mix of fentanyl and oxycodone. Meanwhile, in mining towns, cocaine, heroin and prescription drugs are common.

On a typical day conducting clinics across Central Queensland, Jason sees up to eight patients. They range in complexity and their journeys are at varying stages.

“I have patients that heave health issues such as diabetes, chronic pain and mental health conditions like anxiety and depression. If they’ve been injecting and have cellulitis, I will treat that. With some patients, I manage some of their health issues because general practice won’t take them because of previous behaviours or [negative] history.”

While recovery is a legitimate goal for some, Jason says every patient is unique.

Disappointingly, he says many clinicians fail to understand the journey drug and alcohol patients are on and how their backstories have contributed to ingrained behaviours. They mistakenly believe putting patients in a program or accessing drug and alcohol nurses will automatically fix them.

“I always say it’s the patient’s journey and I’m here to facilitate it and manage that to the best of my ability,” he says.

“It’s about the patient trying to manage their opiate use or alcohol use disorder. For some, they may achieve recovery, where they become abstinent. For others, it’s a harm reduction model and trying to reduce and manage their use.”

Jason says part of his role involves making sure patients who continue to use drugs and alcohol have access to harm minimisation strategies, such as needle and syringe programs, or hepatitis C treatment.

The overriding goal is to help people make informed decisions about their drug use and general healthcare.

“The big thing I work on is keeping patients engaged with us, because sometimes we’re the only key contact of healthcare for them,” he explains.

“A lot of these patients don’t want to engage with other services but when they’re accessing drug and alcohol services they’re seeing the nurses, they’re talking about their health issues. We’re those key contacts that may put them on the right path or encourage them to return to a general practitioner for some healthcare, or see one of us as a prescriber, or start sorting out some of their social issues that are going on behind the scenes.”

During the COVID-19 pandemic, the disruption to health service delivery affected many drug and alcohol nurses across Australia.

New challenges included navigating physical distancing and the use of personal protective equipment (PPE), nurses redeploying or pivoting into COVID-19 roles, a reduction in face-to-face consultations, and trying to maintain care to a vulnerable group of people who were, like the rest of the country, grappling with the burden of the pandemic.

According to recent research, many drug and alcohol nurses reported a lot of high-risk patients being given takeaway doses to counter potential lockdown impacts to supply. The reduction in face-to-face contact triggered the increased use of telehealth consultations. There were also diverse patterns of drug use, including shifts in substances used, and shortages of certain substances.

Some drug and alcohol nurses noted changes in drug and alcohol purchasing behaviours, which they attributed to government handouts and increased funds.

Up in Central Queensland, Jason was not as impacted as some drug and alcohol nurses in other states were.

The biggest change was a shift towards telehealth models of care and a reduction of face-to-face consultations.

“Some patients really loved the telehealth model and liked the convenience of it but other parts of our cohort really missed the face-to-face contact. There was also a lot of patients concerned and anxious about catching COVID-19 and the associated risks,” Jason recalls.

“Anecdotally, patients did report increases of alcohol use. The biggest thing initially, when the pandemic hit, was shortages on some drugs that used to be readily available, especially methamphetamine, for a short period. Therefore, drug use did dry up. People would often swap substances they normally use in order to alleviate some of the withdrawal they experienced.”

Jason says the COVID-19 pandemic inadvertently changed the concept of how drug and alcohol services are delivered.

“I think we realised that there is a lot of flexibility there to deliver the services in different modalities and work with the patients in new ways,” he says.

“For me, there was a lot more telehealth consultations during the pandemic, but it is surprising how much information you can get across via telephone or video with a patient.”

As Australian emerges from the pandemic in 2021, Jason is still seeing many of the same patients. Keeping them engaged with their healthcare is the number one priority.

Jason, who holds the NP sub-committee portfolio with the Drug and Alcohol Nurses of Australasia (DANA), and is the National Secretary of the Australian College of Nurse Practitioners (ACNP), remains committed to increasing the number of drug and alcohol nurses and supporting existing ones to become NPs, who have the ability to diagnose and treat patients and provide holistic patient-centred care.

Being a Nurse Practitioner in Drug and Alcohol is much more than writing prescriptions for patients, Jason says. It is also about motivating change, linking patients with other health services, and supporting them to set and achieve realistic goals.

“I think drug and alcohol use is everybody’s business,” he says matter-of-factly.

“It’s sometimes a self-medication of a bigger underlying issue within a patient. Most of the patients that have drug and alcohol issues have experienced a lot of trauma in their life and drug use is just a way to treat that trauma.”

Jason, who has now worked in the speciality for 15 years, hopes more nurses give it a chance. If clinicians can move past some of their pre-conceived beliefs about drug and alcohol use, he has no doubt they will thrive in a dynamic and rewarding environment.

“I just love talking to the patients the most,” Jason says.

“Seeing what they’re doing, hearing their story and watching them achieve the goals that they set for themselves.”