The current Nurse Practitioner position: based on a medical model.

In this regional/rural health service, the current Nurse Practitioner (NP) position to treat SUDs with pharmacotherapy or withdrawal management in the community is based on a medical model. This process is lengthy, involving multiple steps before patients are seen to be treated. It can take weeks to months before patients are seen by a doctor or NP.

Overview of the intake and assessment process.

Currently the model of care in this health service for people to access treatment for SUDs includes:

1. Referral (either self or from another health care provider)

2. Intake assessment, which involves substance use history, physical and mental health history and current psychosocial circumstances

3. Allocation to an appropriate service

4. Team multidisciplinary meeting within the allocated service, for prioritisation and clinician allocation

5. Formal intake assessment, involving substance use history, physical and mental health history and current psychosocial circumstances

6. Appointment allocation with a clinician (usually a doctor or NP), which initially outlines reported history.

Figure 2.1: A visual representation of the current intake process.

Francia et al. (2022) notes that complex intake processes, much like the above example, is not trauma informed as patients have to discuss sensitive information, only to be added to a long waitlists without support in the meantime. Trauma informed care, a principle that involves understanding the impacts of trauma in people's lives to deliver safe and effective care, is essential in AOD service provision to prevent retraumatising patients (Fisher et al., 2022). Not only is the current process convoluted, the repeated assessments means patients are having to recall their SU, mental health and physical health history several times.

What AOD NPs can offer in rapid-access treatment clinics.

AOD NPs in Australia have realised the potential of NP-led models of care to increase access to AOD treatment in the community. Results of a qualitative study by Searby et al. (2024) on client perceptions of an ambulatory withdrawal service led by NPs was received positively, noting the increased time NPs spend with patients and preference of a rapid-access model, as it supports clients while they are ready to make changes.

In the opioid dependence treatment (ODT) realm, Victorian based NP-led clinics have seen positive outcomes in people with opioid use disorder:

• Strike et al. (2021): NP-led long-acting injectable buprenorphine (LAIB) treatment clinic saw a reduction in the dispensing of needles and syringes in a community clinic

• McKenzie & Mu (2025): NP-led opioid dependence treatment in a medically supervised injecting room initiated >1000 new patients on treatment from 2019-2024.

Though AOD NP-led models of care are evolving in Australia, these preliminary initiatives highlight the versatility and value of NP-led models of care in engaging Australians with SUDs into treatment, which this project proposal plans to expand on.

Success of rapid-access treatment clinics for SUDs in North America.

In Canada, Rapid Access Addiction Medicine (RAAM) clinics exist, where clients can self-refer via telephone or an online form for same-day assessment for ODT and medication assisted treatment for other SUDs (RAAM, 2025). A 2023 study (Corace et al.) found this model of care reduced hospitalisations and mortality for people with OUD. Another study (Srivastava et al., 2021) had similar results, with the added finding of better engagement in the rapid-access model.

While these studies were not specifically NP-led, the discussed Australian studies show the promise of NP-led rapid access clinics to transform the way treatment is provided to people with SUDs.