New guidelines from the U.S. Health and Human Services Department (HHS) will make it easier for health providers to prescribe buprenorphine to treat opioid use disorder (OUD). As the U.S. faces an increase in drug overdose-related deaths during the COVID-19 pandemic, this change will help more patients gain access to necessary treatment, and expand the number of providers available to prescribe buprenorphine.
As of April 28, 2021, eligible healthcare providers will not need extra hours of training to prescribe buprenorphine, and they will no longer be required to refer patients to counseling services. The providers can also treat up to 30 patients at a time with buprenorphine. Prescribers who want to treat more than 30 patients at a time must continue to follow the stricter requirements.
Addiction treatment providers should be aware that the exemption applies only to the prescription of Schedule III, IV, and V drugs, and does not apply to Schedule II medications, such as methadone.
Before prescribing buprenorphine for OUD, providers must first obtain a waiver under the Controlled Substances Act and submit a Notice of Intent to the Substance Abuse and Mental Health Services Administration (SAMHSA), following current protocols. Providers must be state licensed and registered by the U.S. Drug Enforcement Administration to prescribe controlled substances. For the full list of eligible prescribers, see the official HHS notice.
Although the American Medical Association has praised the change, it has called for Congress to further loosen restrictions to buprenorphine prescriptions. Few providers have been willing to fulfill the requirements for prescribing the drug, restricting the number of prescribers available and limiting treatment access for patients struggling with OUD.
Buprenorphine (also known by the brand name Suboxone) has been approved by the FDA as a medication-assisted treatment (MAT). It is the first medication to treat OUD that can be prescribed or dispensed in physician offices, which can make it more available to those who need it most.
Buprenorphine is available as a pill or a sublingual film for about $100 a month. It helps reduce opioid withdrawal symptoms and cravings. As an opioid partial agonist, buprenorphine produces effects such as euphoria or respiratory depression. These effects are weaker compared to stronger drugs, such as methadone and heroin, making it less likely to be misused. This helps a patient taper from powerful drugs to lower doses of more mild opioids.
SAMHSA offers numerous resources for prescribers interested in MAT, and buprenorphine specifically. Recommendations for prescribing buprenorphine for OUD include:
Patient must abstain from opioid use 12-24 hours and be in the early stages of withdrawal.
The prescriber should adjust the buprenorphine dose once the patient is seeing fewer (or no) side effects or cravings, and has significantly reduced other opioid use.
Depending on the patient’s individual needs, OUD treatment with buprenorphine may go on indefinitely.
Besides buprenorphine, providers treating OUD should prescribe additional behavioral therapies, such as counseling, for the best treatment outcomes.
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