Indiana State BON Guilty of Discriminating Against Nurses With Opioid Use Disorder

A recent decision from the Justice Department that the Indiana State Nursing Board was discriminating against nurses being treated for opioid use disorder has shined a spotlight on what the condition is, how medication management is part of treatment, and how opioid rehabilitation programs affect nurses. 

According to a local news outlet, the U.S. Justice Department ruled that the Indiana State Board of Nursing violated the Americans with Disabilities Act (ADA), because the state board barred nurses who take medication to treat opioid use disorder from being part of the Indiana State Nursing Assistance Program.

The Indiana State Nursing Assistance Program (ISNAP), is a program designed to support nurses struggling with substance abuse disorder. It’s also known as the Indiana Professionals Recovery Program. 

What is ISNAP? 

ISNAP is a form of substance abuse rehabilitation that nurses can go through in order to make a plan to be allowed to return to work or continue to work. According to the ISNAP’s website, the program can:

• Allow nurses to continue to work.
• Provide support and encouragement to nurses in locating resources for recovery.
• Equips nurses with the “skills” they need to return to work and “remain abstinent from substance abuse.”
• Be completely confidential, if the nurse completes the program. 

 Nurses can voluntarily enroll in the ISNAP program, or they may be required to enter into it by an employer if the nurse has been found to be impaired at work, fails a drug screen, is accused of taking medication at work or has a complaint made against them by a patient. 

 Through ISNAP, nurses make a Recovery Monitoring Agreement (RMA), which the organization explains, is a written agreement that outlines what is required of the nurse through the program. The nurse must stick to the RMA in order to successfully “pass” the program. An RMA can be made from 1 to 3 years. 

What Happened in Indiana

The Indiana case was made after a nurse made a complaint that she was denied from participating in the State Nursing Assistance Program because she was taking prescribed medication for opioid use disorder. 

According to the Substance Abuse and Mental Health Services Administration (SAMHS), medication management that includes acamprosate, disulfiram, and naltrexone can be used alongside other treatments, such as counseling and behavioral therapies, to help treat opioid use disorder. The SAMHS explains that these medications are approved by the FDA for the treatment of alcohol and opioid use disorders and work to relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body.  

Buprenorphine, methadone, and naltrexone specifically are used for opioid use disorders that include heroin, morphine, codeine, oxycodone, and hydrocodone. According to the SAMHS, medication management meds can be safely used as needed, from as little as a few months to over the course of a lifetime.  

So how exactly does this all come into play with nurses using approved medication for opioid use disorder? 

Well, people who are being treated for opioid use disorder are actually protected under the Americans with Disabilities Act (ADA). Unless the individual being treated is using illegal drugs, they are considered to have a disability and thus, are protected under the ADA. 

Because of this protection, the nurse who made the complaint was able to have a state investigation opened up into her case and the Justice Department ultimately decided that the Indiana State Board was violating the ADA by denying her entry into the program based on her medication treatment. 

The official statement from the U.S. Justice Department explained that their investigation confirmed the nurse was denied participation in the program and also noted that the program bans participants from using medication management. The Justice Department stated that tapering the nurse off her medications could come “with a significant risk of relapse and harm.” In fact, the Justice Department even referend SAMHS data, which notes that individuals who discontinue the use of the medication before appropriate run a higher risk of using substances again. 

What This Means for Nurses

This case is an important one for any nurse who is currently seeking treatment for opioid use disorder or who is considering taking the step towards getting help, because it reinforces that nurses struggling with substance abuse,

1) deserve help 

2) should have access to full treatments available, including medication as appropriate and,

3) have legal protections. 

The exact rules for nursing licensure vary by state, but in most states, healthcare professionals who voluntarily enter a substance abuse recovery program and complete the program are able to keep their license and do not have their entry into the program reported to their state’s licensing board. The exact rules the nurses have to follow in order to maintain their confidentiality and license are clearly laid out in a contract that is signed before treatment begins. 

Programs like ISNAP and resources such as medication management are specifically designed to guide nurses through treatment and recovery in a confident, safe, and effective way—all while helping them continue to work, if possible. 

“Opioid Use Disorder is a difficult disease that impacts people in every occupation. Patients must not be forced to choose between medically approved treatments and their livelihoods,” added U.S. Attorney Zachary A. Myers for the Southern District of Indiana in a statement issued Friday. “We will work closely with our partners in the Civil Rights Division to ensure that the Americans with Disabilities Act is appropriately enforced.”

“Recovery and monitoring programs must allow individuals to use proven medications that support their recovery, including prescribed medications that treat Opioid Use Disorder,” Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division said in a statement, according to WishTV.com. “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. Removing discriminatory barriers to employment is an important priority of the Civil Rights Division.”

The case is an important reminder that nurses who struggle with substance abuse are suffering from a disorder, deserve appropriate and effective treatment for that disorder, and have the right to legal protections while undergoing treatment. If you are a nurse who needs help with a substance abuse disorder, you can find a recovery program in your state through the NCSBN.