Massachusetts Nursing Substance Abuse Alternative to Discipline Program

Like most states, Massachusetts has a voluntary program in place focused on helping licensed nurses receive treatment for substance abuse. The Substance Addiction Recovery Program (SARP) is an intense treatment and monitoring program administered by the state's Board of Registration in Nursing. It is a “confidential, voluntary, abstinence-based, alternative to discipline program for nurses” that operates by “monitoring participants' ongoing recovery and their return to safe nursing practice.” SARP, however, is not for everyone and is not for every situation where a nurse has been accused of substance abuse. The Lento Law Firm Professional License Defense Team can help you learn more about your rights and your options – including SARP – if you're a licensed nurse who has been accused of substance abuse. Call us today at 888.535.3686 or use our contact form to schedule a confidential consultation.

What is SARP?

As noted, Massachusetts' Substance Abuse Recovery Program is administered by the state's Board of Registration in Nursing (BON). It is a rigorous alternative-to-discipline program that provides a structured and monitored way for nurses with admitted substance abuse problems to receive treatment for those problems while ultimately keeping their nursing licenses. Established by a Massachusetts law, SARP is supposed to “assist nurses, whose competency has been impaired because of substance abuse disorders, to return to practice.”

SARP is a voluntary program. No nurse can be required to enroll, and once enrolled, no participant is required to remain in the program. That said, if a nurse leaves the SARP program before completing it, or is terminated from the program, SARP staff may notify the BON and prosecutors of that status. In addition, leaving the program for any reason before it's completed will result in the nurse having to surrender their license for at least three years.

Enrolling in SARP

A nurse must apply and be accepted into SARP. While in some cases, a nurse's application may be prompted by a disciplinary complaint or a criminal charge, there is no requirement that there be any disciplinary or legal allegations or charges against a nurse who asks to enroll in SARP. There are a number of initial enrollment requirements, however:

  • The nurse must have a valid Massachusetts nursing license that is not expired, surrendered, suspended, revoked, or in a disciplinary probation status.
  • The nurse must admit to having a substance abuse disorder. In most cases, the nurse must also be a first-time applicant, though there are procedures for accepting applicants who have previously completed a SARP program.
  • The nurse must not be suffering from a medical or mental health condition that would prevent the nurse from complying with the SARP requirements or from practicing nursing in a “safe and competent manner.”
  • The nurse must not be being treated with “a medication that is a substance of abuse,” except in situations where the nurse can satisfy certain SARP requirements relating to that treatment.
  • The nurse must be “of good moral character.” A nurse will still be considered to be “of good moral character” even if they have been charged with a crime if that crime is “a result of the applicant's admitted substance use disorder” and is not one of a number of violent or sex-related crimes that would ordinarily result in a determination by the Board of Registration in Nursing to evaluate whether a nursing applicant is of good moral character.
  • The nurse must be in good standing and eligible to be licensed by all licensing bodies that have issued a license to the nurse, except that the nurse may have an active disciplinary proceeding against them filed by any licensing body (such as one in another state) that is related to substance abuse, and where the BON has declined to “take reciprocal disciplinary action.”

In addition, the nurse needs to have an assessment and recommendation from a BON-designated “substance abuse specialist,” which the nurse must pay for. The nurse must also “attend and complete a SARP admission orientation,” but not before enrolling in a BON-approved urine testing program, which is also at the nurse's expense.

The nurse must also complete a Consent Agreement for SARP Participation (CASP), which sets forth all of the requirements that the nurse is expected to follow as a SARP program participant. The entire application process can take anywhere from one to three months; once admitted, the nurse is part of the SARP program for at least three years.

Participating in the SARP Program

Once enrolled in the SARP program, the nurse will be expected to follow a rigorous set of counseling, testing, and reporting requirements. These include:

  • Daily check-ins with SARP staff
  • Random urine toxicology tests (a minimum of 15)
  • Additional hair and blood toxicology testing, as required by SARP staff
  • Attendance at three or more AA/NA meetings each week and 1 “group meeting of choice per SARP approval”
  • Therapy sessions at least once every two weeks
  • Submission of quarterly reports that include a self-assessment, a therapist report, an employer report (if the nurse is employed), and attendance logs from required group meetings

The nurse must also work for at least one year with “basic medication handling” privileges enabled as part of the SARP process before the nurse may exit the program. The nurse must not allow their license to expire and must respond to and communicate with SARP staff.

Employment While Participating in the SARP Program

One important aspect of the SARP process is that from the point at which a nurse applies to enroll in the SARP program through at least the first six months of the program, the nurse is expected to “refrain from working.” After that, the nurse may only work if they've been in “full compliance” with the requirements of their SARP program, and if they receive approval from the SARP program to return to work. Even then, their return to work happens in stages.

  • First stage (called CA1): they may practice as a nurse but may not dispense medication
  • Second stage (called CA2): they may practice as a nurse and may dispense “basic medication,” meaning “non-controlled substances”
  • Third stage (called CA3): they may practice as a nurse with full medication-dispensing privileges.

A SARP participant may only request permission for CA1 or CA2 work approval after six months of “full compliance” with their SARP program. Then, after another six months of full compliance, they may request permission for the next level of work approval (CA2 if they've been in a CA1 position, or CA3 if they've been in a CA2 position).

The Employment Process While Participating in SARP

Assuming the nurse has received approval to work at the CA1/CA2/CA3 level, the nurse must still receive SARP staff approval before beginning to work again as a nurse. The employment process includes the following steps:

  • The nurse must inform prospective employers that they are participating in the SARP program and have SARP approval to work in the particular position they're applying for
  • The nurse must give SARP staff a copy of the job description and a release allowing SARP staff to contact individuals the nurse has interviewed with
  • SARP will review the job description to make sure it is consistent with the conditions that may apply to the nurse's ability to practice and will speak with hiring personnel at the prospective employer to make sure the job meets the nurse's practice conditions. SARP staff will also discuss the supervision requirements that apply to the nurse with the prospective employer.
  • The prospective employer must provide SARP with a job description that includes the specific practice conditions that apply to that nurse
  • Every supervisor that works with the nurse must submit a Supervisor Verification Form to SARP staff
  • Once the SARP staff has all of the information and the supervisor form, they will conduct a final review of the nurse's employment request
  • If approved, the nurse may begin working in the new position. If refused, the nurse may request a hearing before the BON

It can take anywhere from a week to months to secure approval (or denial) of an employment review request.

Travel While Participating in SARP

Because of the ongoing testing requirement for SARP participants, a nurse who is in the SARP program must notify SARP staff in advance of any domestic or foreign travel. For domestic travel, the nurse must identify several possible testing sites in the areas where they will be traveling in case they are required to submit to a random toxicology test while they are away. The nurse must also submit a “monitoring interruption request” for the duration of their travel, including in that request their “times of travel, method of travel (plane, automobile, bus, etc.), and total length of travel.”

The nurse must also inform SARP staff of their travel plans and must continue to check in daily unless SARP staff allows otherwise.

International travel is more complicated. Travel to Alaska, Hawaii, and Puerto Rico is treated as international travel. The nurse must submit an International Travel Request Form that provides detailed information about the trip length, dates, and locations, including plane or other transport reservations. The travel period can be for no more than 14 days. International travel will only be approved if the nurse has been “fully compliant” with their SARP program requirements for 12 months before submitting the request, and if they are working as a nurse, their employer evaluations for the past 12 months have provided acceptable feedback on their work. Finally, the nurse must agree to submit to urine, blood, and hair follicle testing upon their return to the US.

Medical Waivers

When a medical condition or procedure related to “an acute medical or mental health condition” will prevent the nurse from complying with all of their SARP program requirements, the nurse may request a waiver of those conditions for up to 30 days. This may be extended, in certain circumstances, for up to 90 days. Waiver requests must include:

  • A waiver request with a medical release form authorizing SARP staff to get “all pertinent medical records” related to the medical or mental health condition that is the subject of the request
  • A “letter of necessity” from the nurse's medical or mental health provider that states “the diagnosis, treatment, and rationale” for the requested waiver
  • An agreement that the length of the nurse's SARP program will be extended for the amount of waiver time granted
  • An agreement that the nurse won't work as a nurse during the waiver period

If treatment for an acute medical or mental health condition would require a waiver of more than 90 days, the nurse will be terminated from the SARP program.

Prescription Waivers

A nurse participating in the SARP program must receive SARP authorization for all prescribed medication. Certain prescription medications, such as Methadone, used to help treat drug addiction are generally permitted when deemed necessary to help with the nurse's substance abuse treatment while in the SARP program. SARP staff must approve each prescribed medication before the nurse can use it.

Exiting the SARP Program

Participation in the SARP program is intended to be temporary and designed to help the nurse with their drug dependency issues. In order to leave the program, the nurse must submit a petition to the BON to be formally discharged from SARP. There are particular requirements for this petition.

  • It must be in writing and include a sworn statement that there are “no pending actions or obligations, criminal or administrative,” against the nurse before any court or administrative body in any other jurisdiction
  • It must authorize the BON to obtain a Criminal Offender Record Information Report about the nurse from the Massachusetts Criminal History Systems Board
  • The nurse must be able to show three consecutive years of “full and sustained recovery from substance abuse,” based on “complete compliance” with the terms of their SARP program
  • The nurse must have at least one year of “safe and competent monitored nursing practice,” including “medication management,” based on reports submitted by their nursing supervisor

Once submitted, the BON must approve the discharge request before the nurse is discharged from the SARP program. Any complaint that prompted the nurse's enrollment in the SARP program will be sealed upon the nurse's discharge.

Challenges of the SARP Program

As you can see, the SARP program expects a lot from its participants. That is why if you are a nurse who has been accused of substance abuse, diversion of medications, or other drug- or substance-related misconduct, you need the help of an experienced professional license defense attorney. The Lento Law Firm Professional License Defense Team can help you understand the allegations made against you and will work with you to help you protect your rights.

There are a number of consequences of enrolling in SARP that are important to consider before you agree to make the commitments it requires. In particular:

  • Loss of employment. You are not allowed to work as a nurse from the point at which you submit your application until at least six months after you have been accepted and enrolled in the SARP program.
  • Testing fees. As a SARP participant, you agree to submit to random drug tests. You are responsible for paying for those tests. The BON estimates that over a three-year testing period, a SARP participant can expect to spend “at least $4500” on drug testing alone.
  • Therapy fees. You will be responsible for your bi-weekly therapy session fees, which can vary considerably depending on the therapist.
  • Intense counseling schedule. In addition to bi-weekly therapy, you will be required to attend at least 4 group sessions (3 AA/NA, 1 other approved group) per week.
  • Travel restrictions. You will need to secure advance approval for all long-distance travel.
  • Employment hurdles. Getting a new job after your first six months requires a lot of back-and-forth between you, your potential employer, and SARP staff. In addition, once employed, your supervisor must regularly submit reports on your work to SARP.

These challenges may explain why, according to one report, relatively few nurses have enrolled in SARP in Massachusetts.

Reasons to Enroll in SARP

If you are suffering from a serious drug or alcohol dependency issue, the SARP program's intense requirements may be what you need to help you control the problems you're facing on a daily basis. The daily check-ins, the weekly meeting requirements, the bi-weekly therapy obligations, and the focus on your recovery may provide you with the kind of focused treatment that will allow you to understand and overcome your dependency issues.

Alternatives to SARP

There are, of course, alternatives to SARP. There are many drug and alcohol treatment programs available to the general public, and many employers provide confidential treatment options for employees who are suffering from a drug or alcohol dependency. The Lento Law Firm Professional License Defense Team can help you explore your alternatives in situations where your nursing license is in jeopardy because of allegations of drug or alcohol misuse or abuse.

How the Lento Law Firm Professional License Defense Team Can Help

Being accused of misusing or abusing drugs or alcohol on the job can lead to disciplinary proceedings that can result in the loss or suspension of your nursing license. While enrolling in the SARP program can be one way to resolve an outstanding disciplinary proceeding based on these kinds of allegations, it's far from your only option. The Lento Law Firm Professional License Defense Team helps healthcare professionals, including nurses, defend their rights in disciplinary proceedings all over the US, including in Massachusetts. We understand how BON disciplinary investigations and proceedings work, and we are here to help you protect your rights when it feels as though it's just you against your employer and the Massachusetts Board of Registration in Nursing.

There are a number of steps we regularly take on behalf of our nursing clients who have been accused of misconduct. We can conduct our own investigation of the allegations; very often, there is more than one side to the story, and BON investigators fail to uncover information that can be used in our client's defense.

We can also be with you when you're interviewed by a BON investigator. If the investigator asks an unclear question, we can help clarify it before you answer. If you don't understand the question, we can help you and the investigator make sure that you do so before you answer it, because nobody benefits if you provide an answer to a question that you don't understand. And if you provide an answer that isn't clear, we can help make sure you actually said what you meant to say. Misconduct interviews are stressful situations, and while we and the BON investigator have experience with them, you don't – which is why it's a good idea to have one of our professional license defense attorneys with you when you're interviewed.

We can also negotiate with the BON to resolve misconduct allegations without a hearing. How misconduct allegations are resolved will depend very heavily on the facts of the particular case; no two cases are alike. But our goal is always to do everything we can to protect your rights and to keep you on the job with as little impact on your license and your career as possible. That said, in situations where you believe you would benefit from drug or alcohol counseling, we can help you and the BON explore acceptable options that may include SARP, but may also include other types of effective treatment.

If your misconduct case proceeds to the hearing phase, we will represent you at the hearing, protecting your rights throughout the process.

Contact the Lento Law Firm Professional License Defense Team Today

If you are a nurse in Massachusetts who has been accused of substance abuse, medication diversion, or any other form of nursing misconduct, contact the Lento Law Firm Professional License Defense Team today to learn more about how we can help you protect your license, your job, your reputation, and your rights. Call us today at 888.535.3686, or use our contact form to schedule a confidential consultation. We understand how difficult it can be to deal with misconduct allegations, and we are here to help.


Attorney Joseph D. Lento and the Lento Law Firm are committed to answering your questions about Physician License Defense, Nursing License Defense, Pharmacist License Defense, Psychologist and Psychiatrist License Defense, Dental License Defense, Chiropractic License Defense, Real Estate License Defense, Professional Counseling License Defense, and Other Professional Licenses law issues nationwide.
The Lento Law Firm will gladly discuss your case with you at your convenience. Contact us today to schedule an appointment.

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