Redesigning Opioid Substitution Therapy: Integrating Liaison Nurses Into Primary Care

Opioid substitution therapy (OST) is a foundational component of Australia's harm-minimization framework, yet nursing involvement is underutilized in its delivery. This paper aims to examine the historical, clinical, and policy foundations of OST, critically analyze the role of nurses within Australian OST services, and argue for the systematic integration of clinically active liaison nurses as a means of improving treatment outcomes.

This position paper synthesizes historical literature, policy documents, workforce and epidemiological data, alongside empirical research, to critically examine how regulatory, educational, and funding structures are limiting the role of addiction nurses in Australia's opioid treatment programs.

A selective review of key international and Australian literature informed this position paper, focusing on OST models, nursing scope of practice, harm-minimization outcomes, and workforce governance. International examples from the United Kingdom, Europe, New Zealand, and the United States are used to illustrate structural enablers of clinically active nursing roles. Australian policy frameworks and funding mechanisms are also reviewed to identify barriers to implementation.

International evidence demonstrates that clinically active liaison nurses improve treatment retention, safety, continuity of care, and patient engagement through integrated clinical assessment, dosing support, and evidence-based psychological interventions. In contrast, Australia's OST delivery is characterized by fragmented governance, limited credentialing pathways, restrictive funding models, and inconsistent recognition of nursing expertise, resulting in the marginalization and underutilization of addiction nursing within shared-care arrangements.

Integrating liaison nurses across primary and specialist secondary care treatment services represents a pragmatic, evidence-informed strategy that strengthens harm minimization through consistent clinical assessment and management, ensuring that harm-minimization principles are actively realized rather than being purely symbolic.