The US Department of Justice (DOJ) says the Indiana State Nursing Board discriminates against nurses with opioid use disorder (OUD), according to findings of a recently released investigation. Specifically, the board “violated 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].”
ISNAP rehabilitates and monitors nurses with substance abuse disorders, and the nursing board contracts with vendors to administer the program. Nurses seeking recovery must typically enroll in ISNAP and complete the 1-year program to maintain an active nursing license or have one reinstated.
The state’s professional organization for nurses said the DOJ’s suggested remediation efforts will help nurses struggling with OUD.
Katherine Feley, DNP, RN, chief executive officer of the Indiana State Nurses Association, told Medscape Medical News that “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.”
The DOJ opened an investigation after receiving a complaint from a nurse alleging she was denied participation in ISNAP because of her use of prescription medication for OUD.
According to the detailed findings released by the DOJ, after the complainant became a licensed registered nurse in Indiana in 2011, she tried several treatment methods to curb a previously developed dependency on prescription opoids, including total abstinence, therapy, and methadone, though none were successful long-term.
In 2013, while enrolled in a methadone maintenance program, the nurse self-reported her opioid abuse to ISNAP. She was informed she would need to taper off the methadone since the program utilizes an “abstinence-based” model. The nurse “was required to agree to ‘total abstinence’ from controlled substances…defined as ‘no use, whatsoever, of any amount or kind of alcohol, any illicit drug, any narcotics, and controlled substances (Schedule IV drugs), some prescription” Medications and other mood-altering substances,” says the DOJ.
Ultimately, she could not complete the program, and her nursing license was suspended in late 2014. In 2016, her physician prescribed a new treatment for OUD — buprenorphine — a medication she described in her DOJ filing as “lifesaving, allowing her to function completely normally [with] no impairment” and avoid “illegally used opioids.”
After remaining in recovery for a year while on buprenorphine, the complainant sought to enroll in ISNAP again. The vendor administering the program at the time, ISNA, instructed her to taper off the buprenorphine within 3 months of enrollment.
Because the nurse and her physician believed that “tapering…would come with a significant risk of relapse [and possibly] death,” says the DOJ, she could not comply and, to date, has been unable to qualify for reinstatement of her license.
OUD Abstinence Policy Violates Individuals’ Civil Rights
The DOJ says ISNAP’s OUD abstinence policy does not align with the state’s statute, which mandates the provision of substance abuse rehabilitation services for nurses and “does not prohibit the use of medications for OUD” in such programs.
Recovery and monitoring programs must allow individuals to use proven medications that support their recovery, including prescribed medications that treat [OUD],” Assistant General Kristen Clarke of the Justice Department’s Civil Rights Division said of the findings. “Refusing to allow individuals to participate in a required support program because their disabilities violates the ADA and makes it harder for individuals to secure and maintain jobs and livelihoods.”
Now, the nursing board and current ISNAP vendor, Parkdale Aftercare LLC, which also requires participants to abstain from all controlled substances, must revamp the program “to protect the civil rights of individuals with OUD going forward,” says the DOJ.
Corrective measures include:
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.
Medscape Medical News reached out to the Indiana State Nursing Board for comment but did not receive a response at press time.
Steph Weber is a Midwest-based freelance journalist specializing in healthcare and law.
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