Appogie Production.
Hi, my name's beck Woodbine and welcome to Tenderness for Nurses.
Do you need to burn out to have those insights?
While I'm talking about it now?
But you know, came to educate the world about it.
But I didn't want anyone to know that I was so unwell. I don't know when it was ever okay to yell or scream or abuse somebody. We need to have support and know where to look for support, and know how to look after ourselves, not just professionally, but personally as well. It was quite profound and I learned a lot from that one action. Welcome back to Tenderness for Nurses. Today, we are chatting with Jason Harrison, who is also a nurse practitioner based out of Rocky and
works in the drug and alcohol space. Fill us in a little bit on your background.
I've been working in drug and alcohol probably for the past eighteen plus two years. Been a nurse practitioner since about twenty thirteen working in this space. Prior to that, I worked in corrections and basically been living in Central Queensland probably thirty plus years now working in the dragon Ail coll Sector've been providing a lot of things like withdrawal management, opiate treatment programs. Prior to becoming a nurse practitioner, I used to do a lot of counseling and therapy
with patients to address their dragon al cohoal issues. I'm also a member of DANA and I'm currently the chair of the Nurse Practitioner Group within DANA. Previously the Secretary for the Australian College Nurse Practitioners and currently a delegate for the first Nurse Practitioner Queensland Nurses and Midwives Union in Australia.
So you're right in amongst it.
Yes, very much, so very much. A big strong advocate of nurse practitioners.
Can just explain for everyone what DANA is done.
As the Drug and Alcohol Nurses Australasia. It's a peak nursing group for drug and alcohol nurses and so we represent nursing in that drug and alcohol field. What I do now is probably a lot more brief interventions motivational interviewing. I do prescribing of the opiate treatment program. I also do withdrawal management, so if a patient comes in and they're withdrawing and they can do an ambulaitary detox, say for alcohol, not so much methamphetamines and cannabis because they're
sort of long term stuff. But you know, we can do that for those sorts of patients as well as Benzo's sort of just gradually tapering dass and stuff. I'll do the work with that, or I'll work with a GP too with their patients to gradually taper down and do just support them through that. So I work across the Rockhampton, the Capricorn Coast and Gladston, but I also go as far out as Emerald, Blackwater, Marah and Billa Wheeler for clinics as well.
So do you think because they're big mining communities, you know there's typically you know, the money around mining and that sort of thing. Is it classes an epidemic out there? Is it a problem?
Look, it's pretty much the same everywhere. There's drug and alcohol use across Australia. I mean, if you really want to get down to it, and you ask most people what's the most widely used drug Australia, they'll gay things like heroin, alcohol and it's actually caffeine. But look look within Central Queens and we have higher rates of tobacco use than the average for the state alcohol use might be just slightly above the average state and stuff like that.
It's probably no different to some of those communities when you're talking about a lizards. It's across the spectrum. It just varies depending on where you are. But I don't think it's worse than any other part of the state in particular things. But certain communities may have particular issues with a particular substance at any one time, and it's just about how do we build that community resilience to
be better address it in the long term. But look, mining does bring interesting drugs to communities because of money. You do see things that pop up in things like cocaine, heroin and stuff from time to time. Cocaine more prevalent. Definitely, you do see that pop up, and not just because purely that there's people that have money that can afford that type of drug, because it's a rich man's drugg.
My daughter is studying intelligence in the States and she just did a bit assignment on fentanyl and how they lay sing cocaine with fentanyl in the States to get people really cooked. Is that something you're seeing here.
Look, we do see different substances being added to particular drugs, say with the methamphetamines, what we have seen as I have things seen with patients, I'll tell me that they're using inm fhetamines and when we've drug test and it will show up that they've got methamphetamines and fetamines in the system, but also things like ketamine.
We have had fetanyl in regards.
To that, and even sometimes even with the cannabis users, we've seen that where there's been sort of added derivatives, you know, such as ketamine, and that we have had the things with the xenx bars and that floating around in the community. Patients use the dark web and are quite a fae with it, so we do see all those sorts of things popping through, but it varies from.
Place to place.
What I see in Gladstone is different to what I see in rock Hampton, to what I see at the Cap Coast, to what I see out in the mining areas, So there will be similar as yeah, if I talk rock Campton's managed prescription APIs your fentanyls, your ms Cottons, your oxy.
But if I go to your pain I.
May see things like more of the methodone genis staff, the hydromorphone, which is being removed from PBS and stuff like that, and that's related to more prescribing habits and stuff within the sector and stuff down there for treatment of system pain conditions and stuff. And then if I go to Gladston which has a port, then I'll start to see that more of heroin, fentanyl, oxycadine and stuff like that down there. So it varies and it depends
on what populations have come through. So when they did the big curticile and gas stuff, our NSP went through the roof with needles and syringes for inphetamine use and steroid use. It's always interesting when you at different times when certain industries are booming certain things and they've got a big population of people coming through that you may see changes in the substance use within their community.
That is fascinating. Do you think it's becoming more prevalent because there's just so much more stress around, People aren't coping, people aren't as connected as they were.
If I get down to it, most people always think the illicids caused the most amount of harm in Austray.
It's actually alcohol. It's a legal drug.
Why do people use drugs predominantly it's all about feeling good. And I always use the analogy of if you've got a pain in your ear, you take two penetal to get through to the pain, you feel good.
So in regards to that, that's why people use it.
It's about how do you make yourself feel good when you've got particular problems in life or stresses. But there's a number of factors as to why someone may or may not develop a substance use disorder. There's obviously genetics do pay a part. So if you've got the prevalence of someone having a substance use disorder in your family, it does increase your risk. It doesn't mean you will develop one, but there is potential for that. And then if you go back down to it, then there's what's
role modeled within the household. You know, if Dad's coming home and has six peers and he's using that as a stress relief, and that's what you're seeing, you're starting
to learn some of those behaviors. Obviously, Then there's peer you know, when you get out there and as you get older, in engaging with your peers and what's happening around in that space as to what your substance US may look at and obviously there's learned behaviors yourself and what you learn as to how to sell, soothe or make yourself feel better.
So there's number of factors that go into it.
There's no one thing that just causes someone to have a substance USUS order.
Everything comes together at one point and boom.
COVID was probably a big stress and what we could learn out of it. A lot of people we used alcohol to manage stress and anxiety and stuff.
Life is high paced.
Drug use has probably changed from when I was a kid compared to what I see my kids coming into. What's they're exposed to. You know, what's acceptable alcohol? You know, that was a rite of passage and stuff. So cannabis was around and I had plenty of mates that smoked it. Nowadays, what you see is a lot more of MDMA, people experimenting with methan fetter means pills. Then you've got the synthetic stuff that sort of pops out GHB.
It's interesting. A friend of mine went over to Germany for a dance rave things, I don't know.
Whatever, Yeah, raves.
They didn't drink, They took tablets and they had a little machine that tested to make sure that the tablets were pure and that's what everyone over there did.
Ye look, they are looking at it. In Australia, there was some stuff there. It was a little bit difficult to get in. I think that we're looking at some of the raves and stuff because pill testing is really important at those events because sometimes when people buy stuff, what they think they're getting is not what's actually in the tablet, and people actually then make an informed decision.
And that's the big thing, even when you're coming to drugonelk or the biggest thing I'm teaching people, even whether I'm putting on programs or not, or doing motivation anything, is how to make an informed decision. You know, So you're asking them when you're talking about a substance use, you know, what's.
The good things you get out of it?
And I'll give you a list of things and then you'll going to talk about what they're not so good things are and what you'll include. And those sorts of things are the four ls your liver, your lover, your livelihood, and the law. So how does that impact you, know, your life? The good looks at how much is it costing you the liver is looking at what's the impact on your health and your mental health. Your lover is
how is it impacting on those relationships around you? And now that's not just home life, that's your work life, relationships, your social relationships, et cetera.
And obviously the law, whether it's legal or not.
When you take a person through that journey, it's just teaching them because we're not all taught how to make an informed decision about when it comes to substance use.
Well, I stopped drinking. It'll be five years next year, and I kept an app as to like how many days I haven't drunk. I actually looked at the other day because we're having a conversation around you know, drug and alcohol use, and I just put down that I had a bottle of wine a night, five nights a week, so one hundred dollars a week. I didn't take into account ubers. I didn't take into account you know, buying that odd French champagne or you know, having a few
drinks on more drinks on the weekend. And in that time, I've saved thirty five thousand dollars.
Yep, I've had similar eats.
I had one fella that was smoking pot for ten years and when we worked out if you had a not smoke that, I think it's been about one hundred and thirty two thousand dollars in that ten years on cannabis. Ah, And I said, what could you have done with that? And he said, I could have bought a house at that top. You know, it would have been a good deposit on a house. I said, when you put it into that with patients, it does open their eyes out to what that financial impact is having on them.
Tobacco use is a good one at.
The moment because I always discuss that with a lot of my patient because they're still smokers and we're looking at ways to reduce risk.
So how much is that cigarettes? Sound?
I know, pouchs tobacco fifty grams of white ox is about eighty to one hundred sandly two dollars a gram. Cigarettes are about anywhere from thirty dollars for a packet of twenty, so it's over a dollar a cigarette. So you know, I get some patients that still smoke and tailor mades and they're doing twenty or thirty a day.
I always go back and said.
I gave up when it was five bucks a packet, but I was doing two packets a day. I said, I couldn't afford to smoke these days, and they.
Laugh, But it is true. It's just what we thinks.
And it always comes back to when you're talking about a substance use disorder with some patient. I always go back to that Maslow's hierarchy and stuff. And when you're in that throes of using a certain substance, whether it's tobacco, alcohol, and fetamines and that that becomes the number one priority in your life and it is a hard one to
work on and an address and stuff. At that time, say, it's not until someone gives you on tape shody you need to do something about it, or you've sort of come to that your own realization that when you start re examinating, then you can have a look at how it is impacting on your life and stuff and how you get there. But it's not our simple journey. It's a lifelong journey for a lot of people. It's not something I just stop it and that's it and I
can move on with my life. It's always there, and it's always having those skills and tools to be able to manage it.
And I think our culture in Australia is the drinking culture, because when I go to the States to visit my daughter over there, you go and you look at the menu, they've got a whole page or page and a half of mocktails and non alcoholic drinks and that sort of thing,
like it's just the norm. And they think, Australians, you have more than a couple of drinks, I actually think you're an alcoholic, Like they'll have an intervention if you have more than three drinks, whereas you know, most people would do that at nighttime here in Australia and not think twice about it. It's an interesting thing culturally.
It is.
And even when I've trained some of the medicads that have come through AIDS and stuff, especially when they've been from overseas countries your Southeast Asia sort of specific areas and stuff where drinking is not in part of their culture. And I go to him, I said, you know, if you talk to most Austrains and if they drink six beers a day and they turn up to work every day, don't have sickies, and you say that you've got an alcohol use disorder.
Even whether it's mild or moderate or whatever.
They will become quite offended because culturally you don't have a problem because you're turning up to work, you're putting food on the table, you're paying for everything. They do not think they have a problem. But if you go under looking at the DSM five or look at they're actually drinking, especially if you're doing more than six heavy beers or more than four standard drinks, your risk to yourself actually quite increases.
Probably have got a mind alcohol use disorder, and.
It is quite prevalent in nursing as well, because one of my colleagues who works for Danna, they did a survey of nurses and did a paper on it.
We love a drink.
It's within our culture, but also within nursing as well as culture.
Absolutely work hard and party hard. I mean we used to go out between late ship and earlies.
Yes to the nightclubs. Ring in sick from a nightclub, say what's that? Nothing?
Or you turn up the next day if you're an essential in the sense of that you're going to be short if you didn't turn up, so you'd be there.
Honestly, I mean we were tough as back then. But when I think about it. Probably some of the things we did, I don't know if it was that appropriate.
I think when it comes to alcohol within Australia, it's part of our culture. But also we do have a very powerful lobby group in the liquor industry in starts of keeping it going, and that's why there's reluctance to change. Whilst they put things in place, there's a reluctance to ever get rid of it or anything like that. You know, you only have to see the amount of violence that goes with alcohol, and they have done things like curfews and things like that, you know, lockouts and stuff like
that to reduce it. But I know, like on state of origin, it's the amount of assaults that comes up that's related to alcohol, fuel and violence is phenomenal. Yeah, it spikes at those three times the year.
Really, I mean, it doesn't surprise me, but it's interesting that statistics are there.
The funniest thing is that we do big investments in things like methampheta means probably affects less than five percent of the population, yet there's a heavy investment because what we see, what the media portrays is all this negativity around it. And that all these people are causing that problems. But out of that group, there's probably only a small proportion, you know, the twenty percent that caused the problems out
of the one hundred percent that use. But they're the ones you see on the media and stuff and causing
all the dramas. And it's not to say methmphetamans is a safe drug or anything like that, but when you compare it to alcohol, it's small when you look at how much alcohol impacts on driving offenses, fatalities, alcohol related violence, DV and stuff, and all that sort of negative impact that it has because we've got a bigger proportion of the population using it because we don't want to change our culture.
No, it's true. I mean, you can't turn the TV on and watch football without there either being gambling or alcohol.
And that's pretty much what it is now.
Just a couple of questions around nursing and what avenues do nurses have if they think that they've got an alcohol or drug problem.
Look, you're probably going to work with your GP in the first instance. I'm probably going to say to you, go and see a private practicing psychologist or a private practicing service. Sometimes if you come through the public service. The first initial thing was that people will be worried about if you're using alcohol or other substances, that there may be an impact to patient care or something like that,
and there's likely to be a report to OPRA. Now, my experience with dealing with a few people that have been through the opera experience and the impact that it's had on registration, it can be quite an arduous, costly process and it is not affordable and a lot of times you can't gain employment because sometimes the restrictions that they put on your practice is that someone's got to
be there and supervise you. Makes it very hard for people to hold positions little lane try and demonstrate that their use of a particular substance isn't impacting on patient care.
So it's a difficult one.
But look, you know, we have had patients come through and work through it, but most of the time they've either ended up with a psychiatrist looking after him because there was other issues going on, and done it through private services. But the ones that have come through the public service, there has been apper notifications and then it's working with the patients and even when they're on a program appro date.
Look at that as a safety mechanism.
So I've had a patient that had a codeine use disorder that ended up on the program, was doing well, but obviously an APPER notification went in and then the amount of requirements they made, the.
Hoops and the difficulties of it.
You've got to do counseling that you've got to submit to drug testing, and it's all at the cost of the patient. Now whatls the counseling might be through through a drug and apical service. If you're on a program such as the opia treatment program, that's great. That helps with that, but then there's always the barriers to practice that you can't access an say, covert unless there's a
secondary person there that's going to supervise your practice. If you're working in the age care sector, or if you're working in a community nursing sector, no service or agency wants to pick you up. And if you're try and get a job in the public system, even they will make it difficult in providing that level of supervision. Being able to commit to that these days, especially with the
nursing shortages, it really leaves us at a loss. Now, if I talk about medicine, they will do everything to keep that person in the profession, so it's not an issue. They'll find a supervisor, they'll find someone there to assist the person and monitor practice or whatever.
It's not a thing because they see that they've invested a lot.
Of money into the individual to hold that profession, and just because they've got a problem with a particular substance or alcohol doesn't mean that they're not a good person or a good practitioner. It just means that that particular time they may have had a problem and that's what
they've used to cope with. We're nursing. I don't think we value people enough in the sense of that we're not doing enough to look after and retain our skilled staff just because at some point of their life they may have developed a drug and alcohol issue.
And it's not to.
Say, you know that we shouldn't have something that people have got to aspire to or anything like that to make sure that a the individual's being looked after and has options to support rectifying the particular problem within their life, you know, the substance use disorder or anything like that, and be supported to do that. But we shouldn't also make it a financial impediment on them that they can't earn a living, they can't do the job that they've
signed up because they love it as well. So you know, we've got to find that better happy medium. And I think it's too far, it's too punitive the way Apraa looks at at the moment.
But I go back to nursing. Nursing's always ate their young, and this is.
Different where they really eat someone that may have had a little bit of a problem. Now, if you had diabetes and stuff and it was impacting in your care, they do everything to make sure that was fine.
But drug and alcohols always.
Looked at as a self inflicted problem and it's not looked at as like from a disease model law. You know, it's multi factorial as to why someone may develop one and about how are we supporting and they don't take into the pressures of work life that's going on for a lot of people that can end up with that problem, and how we support them to get back onto in their recovery so that they can go out and continue to be a productive member of society like they have been.
If a nurse is off work having to pay for all her or his own drug tests, then counseling as well as seeing psychiatrists psychologists GPS. That's a huge expense.
It is a huge expense, and some of the stuff you can mitigate some of the stuff sometimes, like through mental health care plans and trying to link them into GP services at bulk bill psychiatry. Sometimes some of them if you're in the health profession, may give you a little bit of lenience and stuff like that with billing and stuff like that, but that's not always the case. It is a difficult one in regards to that about how do you support people with those costs, But there's
an expectation you'll just afford it. But most people live on the threshold of day to day, especially when you're nursing, and depending on where you're working, So if you're working in a public system, you're going to probably be better paid than someone that's working in a private hospital or someone working in a non government facility, or if you're working in general practice, and general practice is probably the most poorly paid out of nursing compared to a lot of the others.
There shouldn't even be that disparity, really.
No, they shouldn't be. Look we won't go into the equity stuff, but that's the whole conversation.
Because we talk about this currently within the Union. We're talking about the gender inequity, you know, especially for a lot of females and stuff when you're talking about super payments and stuff, because a lot of female staff have time off for pregnancy and stuff like that, so you lose a lot out of super.
And stuff and they're disadvantaged.
And the thing that I raise, well, if you work in general practice and you do that, you're even more because you're lower paid, so your super is never going to be as good in regard to that. So they're like a third tier when you're talking about gender actuity. Now, nursing is female dominated, don't get me wrong, but when you compare it against other industries on how much is our time valued, it could be done better. I think
it should be more valued. We're undervalued at times. But governments and that always look at us that we're the biggest work force, we cost the most, but they forget the amount of knowledge and skills that we bring to an area. And the humanity side in patient care, touching, looking after people, giving that comfort when people, especially at the end of life and stuff, and sometimes explaining when the medicads have left, explaining well what did the doctor mean by that?
Because you know they're too frightened to ask the question.
You go, well, this is what they want to do to You want to do this, this and this, and you know, speaking in that layman's term to the patient.
So they get it.
Career nurses are getting less and less, you know, nurses instead of nurse like me for thirty five years. There's not a huge number of us surround anymore.
The problem is we're a dying breed. People look at nursing as a stepping stone. Now, I suppose I look at my kids and they're from twenty to sixteen, they'll probably have a minimum three to.
Four jobs in their lifetime.
They say seven.
Now, yeah, so it's even more so, you know, their diversity will be there in regards to it, and they don't stay at anything that long unless it benefits, you know, and suits their needs and purposes. So in some ways they've got some things right. It is all about them, but it's looking after themselves.
Yeah.
I think the gen x's and the baby boomers we really looked at you know, it was a career choice. You're always there for the longevity, and you'd work your way through and you'd start at the bottom work your way up. But it was also about that community benefit, you know, that social benefit to the community and stuff as to why we stayed in employment and stuff, because we could see the benefits to others and other people, especially in nursing.
We're interesting breed, aren't we.
It's always play hard, have fun, but always doing the best that you can for the people that you look after. I think that was always the motto within that generation of nursing. You know, it was always about looking after patients and providing that holistic care to them.
I look at it now and I.
Don't see that same level of care sometimes for the patients and stuff, and even the way people engage with patients and asking the questions, even what to do with patients. I got called to our cancer ward the other day because I worried about a patient withdrawing from cannabis. He's got brain mets and stuff, and they go, what do we do? And I go, well, I'll go and have
ITTI well, I did you know. Look, reality is yes, in the ideal world, you'd say, well, can you have some medicinal cannabis and stuff like that.
Is there any opportunity now?
Obviously with the nose making stuff, the ability to vape or anything like that, probably not likely to happen. But that's where we haven't caught up with some of that stuff, that access to medicinal cannabis for all some patients you know who want to use that as part of their treatment.
But what I did.
Was, he wasn't no regular pain relief, he didn't have anything there just to manke get a little bit of anxiety.
So my thing is I went up to seeing the patient. He's not in withdrawal or anything like that, but.
I just said to the patient, I said, look, in the ideal world, you'd be able to have a cup of cone somewhere and that'll be your nighttime sleep to get you off and you'd be right.
And I said, but unfortunately we don't have that ability.
Now. I'll put in the notes alternatively to see if they could access some CBD oil or something like that from the medicinal cannabis stuff, to see whether that may be an option. But it's probably going to be told may But what I can do is like a news conventional stuff. So let's get you written up for some basic stuff like some ENDO and five miligrams Q ideas or baseline with some PRN and if you want it, you have it. If you don't, you don't, give you a little bit of dias five miligrams Q idea and
if you want it you can have it. If you don't, don't with a bit of PRN stuff there if you need it.
And I said, that's up to you whether you take it or not.
And I said, look, if you do have any cannabis withdrawals, we can symptomatically treat it with these medications. And just fed that back to the team. But I was sort of gone, these are sort of the common things that I see these days, and people don't know what to do if patients got drug and alcohol. But our care in healthcare has become though silid.
No one wants to step out.
And that's why I love being a nurse practitioner because I do a bit of primary healthcare. I do a little bit of min A patient's got an anxiety disorder, I'm not going to be scared to get Oh you've got a socially anxiety, Le's give you an any depression you're willing to try it, yep, let's go bang, start it. Thanks, we'll get your reviewed in seven days to see them. We'll up your days and we'll play with that and get your settle and then we'll get you back to your GP.
Well, you know, we'll start it.
We'll get you back to the GP and he can manage it up and ty trade you up.
It's all those things. But what I'm finding there with patients is they don't.
Especially drug and heal call patients because of past history whatever. There's limitations on access to general practice and stuff. So even in my things, I manage some patients general practice stuff or we're trying to secure a new GPS.
Yeah, it's an issue. Thank you so much. I know how busy you are, and I know you know you move some things around to have a chat with me today. Thank you. I really appreciate it. And if people require any further information or guidance, we can put some information up.
I always get candidates nurse practitioners always wanting to catch up with me or something like that about different things or questions and stuff we're getting in the area.
So definitely haven help. And look, all I'll say is for nurses.
If you have a drug and alcohol is you, I'd probably stee you more towards private practicing areas only because it is less likely to be preferred to Afria in the first instance. They'll probably want to support you and address that for that particular reason.