Reply To: Alcohol and Substance Use

  • Jennifer Tiller

    September 10, 2019 at 1:24 pm

    Hi Elizabeth,

    There was an excellent general session on this very topic at APHON last week. The presenter, a pain management specialist (and an NP), presented her process for this (she called it “Universal Precautions”, wherein everyone signs a treatment agreement, regardless of risk, and also spoke about a risk stratification process that MDAnderson uses. There’s an article that I can send you if you’re interested in reading more. I’m planning to present this information to our manager here to start talking about creating a similar process for our program. If you’re interested, feel free to shoot me an email at and I’ll be happy to share the article and slides (I don’t have them handy right this minute). 

    I was really impressed by her talk and am hopeful this will be the first steps to instituting something similar here in Austin. 


    Jennifer Tiller, MSN APRN, CPNP, CPHON
    Pediatric Nurse Practitioner
    Children’s Blood and Cancer Center
    Dell Children’s Medical Center
    Austin, Texas
    Original Message:
    Sent: 09-10-2019 01:04 PM
    From: Elizabeth Sheldon
    Subject: Alcohol and Substance Use

    We are in the process of developing an Alcohol and Substance Use and Abuse Policy related to eligibility prior to bone marrow transplant and am curious if any centers have something like this in place? We know it will have to be carefully worded and already has conditions in place to proceed with transplant if needed as long as other parameters are met (ie counseling, subsequent negative testing, support system in place, documentation of adherence to previous medication regimens) and that testing that is positive for prescribed medications will not be a contraindication to eligibility for transplant (unless there is concern for abuse). Our goal is to:
    -provide clear expectations that drug testing may be obtained at anytime during work-up, treatment, follow-up
    -to identify patients that may have a more difficulty time adhering to the complexity of medications, precautions, and follow-up post-transplant and ensure a support system is in place as appropriate.
    -to minimize adverse medication interactions

    I would greatly appreciate any experience you have had with this topic!


    Elizabeth Sheldon, CPHON,CPNP-PC,PCNS
    San Diego, CA
    United States