In opioid substitution treatment, nursing builds and provides
the primary and main therapeutic relationship and care with patients.
Despite its essential contribution to the treatment of drugdependent
patients, nursing in substitution treatment tends to be
Also, little is known about their work in heroin substitution
in particular. The aim of this article is to describe the nursing
actions provided in the care of patients in the PEPSA (experimental
drug prescription program in Andalusia, Spain) trial, mainly
concerned with patients receiving intravenous diacetylmorphine.
The study was conducted in the Centre for diacetylmorphine prescription
within the context of a heroin clinical trial, Virgen de las
Nieves University Hospital, Granada, Spain.
The nursing team was responsible for overall care for the patient,
focusing on his/her needs. Care provided to each patient
was individualized, with verbal communication being the main
tool to facilitate a two-way exchange of information between the
patient and the nurse providing care.
The protocol for nursing
performance comprised the administration and supervision of the
treatment and other actions aimed at reducing harm, encouraging
healthy habits, monitoring the patient and counseling.
The general process included: admission of the patient; assessment of
his/her general health status; delivery of the treatment; and assessment
of the patient’s response receiving injected diacetylmorphine.
The care of patients who are addicted to drugs provided
calls for a relationship that ensure seamless care. This relationship
should be aimed at fostering and maintaining therapeutic communication.
This relationship involves nurses providing empathy,
active listening, assertiveness, acceptance, respect, offering consistent
information and avoiding a judgmental approach.
In this trial, the nurses attempted to motivate change, detecting and providing
positive reinforcement of any changes made, while always
respecting the patient‘s choices. The fundamental aim was harm
reduction, which involves reducing any adverse consequences aris-
All authors on behalf of the PEPSA Team (Experimental Drug Prescription
Program in Andalusia)