PROVIDER ADVISORY - The Office of Alcoholism and Substance Abuse Services (OASAS) is working diligently to insure that Buprenorphine will be used to treat opiate-dependent persons in the manner that the Federal government intended: in a physician office setting with streamlined, easy access to addiction treatment or in a methadone maintenance treatment program. OASAS is sending physicians information regarding the new medication, as well as the OASAS Provider Directory. We will ask them to access the OASAS-certified treatment network. You might be asked by a local primary care physician to provide treatment for their buprenorphine patient. We are hoping that this will open up new avenues of communication between primary care physicians and our provider network.
Buprenorphine is a partial opiate agonist (agonist and antagonist properties.). Like most partial agonists, it has a safer profile than that of a full agonist. It exhibits a ceiling effect, which means that once a certain receptor occupancy desired dosage level has been achieved, additional dosing does not produce additional effects, including eliminating the typical possible opiate overdose effects of respiratory depression and/or death. By combining it with Naloxone, in a 4:1 ratio, it is hoped that it will prevent both diversion of the drug and intravenous injection. The withdrawal syndrome seen with buprenorphine is much milder than that of other full agonist opiates.
Buprenorphine has been approved by the FDA for use in the United States as an opiate detoxification and opiate maintenance agent. There are two forms of the medication (available in 2 mg and 8 mg sublingual (under the tongue) tablets: Subutex - buprenorphine alone and Suboxone, which is Buprenorphine combined with Naloxone. This combination form prevents intravenous use of the tablet after crushing; in which the user would get an antagonist effect of the naloxone, or at the least, a diminished opiate effect. Doses for opioid dependence range from 2 mg to 32 mg, with the average being approximately 16 mg. and the medication can be used for detoxification or maintenance treatment.
The Drug Addiction Treatment Act of 2000 revised the legislation allowing physicians to prescribe narcotic drugs in schedule III, IV,V or combinations of such drugs, for the treatment of opioid dependence. Qualified physicians in New York State are those who:
- have a subspecialty certification in Addiction Psychiatry from the American Board of Medical Specialties; or
- are certified in Addiction Medicine by the American Society of Addiction Medicine (ASAM) or by the American Osteopathic Academy of Addiction Medicine (AOAAM); or
- have completed not less than 8 hours of approved training or have participated as an investigator in a clinical trial of buprenorphine.
The physician must have the capacity to refer patients for appropriate counseling and other ancillary services.
Methadone maintenance, a very successful effective and safe treatment medication, has been the most commonly utilized intervention treatment for opiate dependence. The approval of Buprenorphine by the FDA increases the options for physicians and methadone maintenance treatment programs for those who are addicted to opiates.
It is hoped that approval of Buprenorphine will increase access to opiate treatment, particularly for younger users and individuals who have used opiates for a shorter duration (these groups are not eligible for methadone maintenance.)
Physicians are no longer required to register with the New York State Office of Alcoholism & Substance Abuse Services (OASAS) to obtain certification to prescribe, administer and dispense buprenorphine for the treatment of chemical dependence.
- Review OASAS Regulations Regarding Controlled Substances
Buprenorphine Office Flow Sheet
Treating opiate dependent patients can be complicated, especially when trying to manage their buprenorphine and linkages to behavioral treatment. The Buprenorphine Office Flow Sheet was put together to help expedite this complicated and comprehensive visit .
SAMHSA Physician Locater (Buprenorphine Approved):