BUPRENORPHINE QUICK POINTS

WHAT             Buprenorphine is a partial opioid agonist recently approved for the treatment of opioid dependency in an office based setting.*  It is available in two sublingual forms – Subutex (plain buprenorphine) and Suboxone. Suboxone is a buprenorphine/naloxone combination created to avoid diversion and IV injection. Treatment consists of Induction which is followed by Detoxification or longer term Maintenance.

WHO               Physicians (not PA’s or NP’s) can prescribe Buprenorphine after satisfying three  requirements: 1) they must obtain a waiver from SAMHSA (Substance Abuse and Mental Health Services Administration) for a special DEA license

2) they must have the capacity to refer patients for appropriate counseling and 3) they (or their group practice if they belong to one) may not treat more than 30 patients at a time

HOW               Licensed Physicians may obtain a waiver by completing 8 hours of training provided by ASAM, AAAP, AMA, or other designated organizations, either in person or online (Web sites www.aaap.org , www.asam.org  or www.apa.org) or possess Certifications in Addiction Medicine by ASAM/ AOA or the ABPN Added Qualification in Addiction Psychiatry.

Physicians then must register at SAMHSA (http://buprenorphine.samhsa.gov/howto.html)

Information on training is available from VMS, VCAT (Vermont Consortium for Addiction Training, 802-651-1572), or ADAP (Vermont Division of Alcohol and Drug Abuse Programs, 802-651-1550)

PRESCRIPTION BENEFITS

                        Coverage by private insurers is variable so patients need to check with their carriers. Patients covered by the State’s Prescription Benefit Programs need to have their physicians submit a Prior Authorization form to First Health Service Corp (the State’s Pharmacy Benefits Manager) for approval. (http://www.dpath.state.vt.us/districts/ovha/requestbuprenorphine.pdf )

*  The State of Vermont has developed a Hub and Spoke Model which would allow evaluation and induction at designated sites state wide These patients could then be referred back to their communities and buprenorphine-licensed physicians for long term maintenance.