DNP Scholarly Projects

Abstract

Background: The gold standard treatment for opioid use disorder (OUD) is medication-assisted treatment (MAT), such as methadone. Although evidence suggests that discontinuing MAT through tapering increases the risk of relapse and overdose, some individuals may still desire to taper off methadone. Additionally, legislation in certain states mandates that MAT providers offer discontinuation options to patients. Providers must engage with patients in the tapering process through shared decision-making to anticipate challenges in the patients’ tapering experience. Determining the factors influencing a patient’s tapering experience will allow providers to identify risks and offer supportive measures to help patients successfully taper while avoiding relapse, overdose, and death. However, limited evidence is available regarding the experiences of individuals tapering off methadone. Purpose: This study aimed to explore the barriers, facilitators, and experiences of individuals tapering off of MAT in Middle Tennessee. Methods: A cross-sectional, mixed-methods, and descriptive design was used to explore the experiences of individuals tapering off methadone. Semi-structured interviews were conducted in three outpatient opioid treatment centers in Middle Tennessee. Semi-structured interviews were used to survey individuals contemplating tapering (n = 6) or actively tapering off methadone (n = 6). Quantitative data were analyzed using descriptive statistics. Qualitative data were managed using the Nvivo software for open coding to develop themes. Results: 16 major themes were identified between both groups of participants. Results emphasized environmental, personal, and logistical factors that influenced patients’ tapering experience. Key factors included clinic experience, shared decision-making, stigma, knowledge, fears, triggers, mental health management, finances, and liquid methadone. Conclusion: Providers and patients should acknowledge the risks, triggers, and stressors of tapering so that certain supportive measures can be offered. MAT guidelines highlighting patient education, shared decision-making, patient assessment, and take-home naloxone distribution should be developed to ensure safe and effective care. Providers and staff should receive education on OUD, MAT, and tapering. This process may strengthen their ability to support patients’ individual needs and prevent relapse. Lastly, the project site could improve its clinic efficiency by hiring more staff and offering liquid methadone.

Date

Spring 4-20-2023

First Advisor

Dr. Kathryn Dambrino

Scholarly Project Team Member

Dr. Steven Busby

Scholarly Project Team Member

Dr. David Phillippi

Scholarly Project Team Member

Dr. Jennifer Hicks

Department

Nursing, School of

College

Health Sciences & Nursing, Gordon E. Inman College of

Document Type

Scholarly Project

Degree

Doctorate of Nursing Practice (DNP)

Degree Level

Doctoral

Degree Grantor

Belmont University

Keywords

opioid use disorder, medication-assisted treatment, methadone tapering, tapering experience, harm reduction strategy

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