Nuts and Bolts of Prescribing Buprenorphine

[{"selector":"#anim-c6da5fb0-16d8-4330-a12d-abbc76c82593","keyframes":{"opacity":[0,1]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-6590aabc-0dae-4bf3-8a0d-672a8b049098","keyframes":{"transform":["translate3d(-117.95666%, 0px, 0)","translate3d(0px, 0px, 0)"]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-87c1f0ce-cb16-490e-90e4-59bf02393c38","keyframes":{"opacity":[0,1]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-8ad5b1d4-6956-4108-95a6-324b73f26692","keyframes":{"transform":["translate3d(-117.33746%, 0px, 0)","translate3d(0px, 0px, 0)"]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-4a9a77fb-9415-4f88-95bb-41a5175af3ab [data-leaf-element=\"true\"]","keyframes":{"transform":["translate3d(-31.249999886225726%, 0, 0) translate(-25%, 0%) scale(1.5)","translate3d(0%, 0, 0) translate(0%, 0%) scale(1)"]},"delay":0,"duration":2000,"fill":"forwards"}] Federal Requirements for Prescribing Physicians must complete an 8-hour training and NPs/PAs 24 hours of training to apply for a DEA “X-waiver” to prescribe buprenorphine. Circled Dot In 2021, new guidelines allowed providers to skip the training and treat up to 30 patients after submitting a Notice of Intent to SAMHSA. Circled Dot (480) 764 - 2335

[{"selector":"#anim-81b04a92-a434-4f15-8a3b-0a27fa71ccd4 [data-leaf-element=\"true\"]","keyframes":{"transform":["translate3d(-31.249999886225726%, 0, 0) translate(-25%, 0%) scale(1.5)","translate3d(0%, 0, 0) translate(0%, 0%) scale(1)"]},"delay":0,"duration":2000,"fill":"forwards"}] [{"selector":"#anim-a1d34817-1bfc-4d51-91e5-09d25547d1e1","keyframes":{"opacity":[0,1]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-9f38a22e-7bb6-4894-96c9-c7fe799389c0","keyframes":{"transform":["translate3d(-117.95666%, 0px, 0)","translate3d(0px, 0px, 0)"]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] Federal Requirements for Prescribing Limits on the number of patients a practitioner may treat with buprenorphine have been removed, and SAMHSA will no longer accept Notices of Intent for X-waiver registration. Circled Dot (480) 764 - 2335 Know More

[{"selector":"#anim-d722fb63-725a-4044-90f1-6aa73dd5dc38 [data-leaf-element=\"true\"]","keyframes":{"transform":["translate3d(-31.249999886225726%, 0, 0) translate(-25%, 0%) scale(1.5)","translate3d(0%, 0, 0) translate(0%, 0%) scale(1)"]},"delay":0,"duration":2000,"fill":"forwards"}] [{"selector":"#anim-0636984e-abf2-4dc6-a5dd-74fa1da2165d","keyframes":{"opacity":[0,1]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-ab36da2c-98ec-4816-8ce0-8425e09592c1","keyframes":{"transform":["translate3d(-117.95666%, 0px, 0)","translate3d(0px, 0px, 0)"]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-6b030ca5-34ee-496b-8fab-50e1f80b7de8","keyframes":{"opacity":[0,1]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-2e9379bd-67d9-44df-ba42-241e49df80d2","keyframes":{"transform":["translate3d(-118.26626%, 0px, 0)","translate3d(0px, 0px, 0)"]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] The 4 Phases of Buprenorphine Treatment Initiation – Screen using validated tools like the DSM-5 OUD Checklist. Educate patients and obtain consent. Circled Dot (480) 764 - 2335 Induction – Patients abstain from opioids for 12-24 hrs and begin buprenorphine when in moderate withdrawal. Can be done in-office or at home with telehealth guidance. Circled Dot

[{"selector":"#anim-448a84ec-2d87-4e6d-9563-fff13932489e [data-leaf-element=\"true\"]","keyframes":{"transform":["translate3d(-31.249999886225726%, 0, 0) translate(-25%, 0%) scale(1.5)","translate3d(0%, 0, 0) translate(0%, 0%) scale(1)"]},"delay":0,"duration":2000,"fill":"forwards"}] [{"selector":"#anim-8279645c-2731-4e03-be39-5826f0be3868","keyframes":{"opacity":[0,1]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-11671bae-ad42-4158-a04b-5509162bffdc","keyframes":{"transform":["translate3d(-117.95666%, 0px, 0)","translate3d(0px, 0px, 0)"]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-7b1969b8-d345-4cbf-a60f-42a1b4bba591","keyframes":{"opacity":[0,1]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-c300a8d7-71a8-4ff3-9cdb-f1d7c884a9d3","keyframes":{"transform":["translate3d(-118.26626%, 0px, 0)","translate3d(0px, 0px, 0)"]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] The 4 Phases of Buprenorphine Treatment Stabilization – Titrate dose over 1-2 weeks until cravings subside without side effects. Typically 8-24 mg/day. Circled Dot (480) 764 - 2335 Maintenance – Continue stable dose with monthly check-ins. Frequency can decrease over time if the patient is doing well. Pair with counseling. Circled Dot

[{"selector":"#anim-c5b407ef-93aa-43ba-a416-0b3c00165192 [data-leaf-element=\"true\"]","keyframes":{"transform":["translate3d(-31.249999886225726%, 0, 0) translate(-25%, 0%) scale(1.5)","translate3d(0%, 0, 0) translate(0%, 0%) scale(1)"]},"delay":0,"duration":2000,"fill":"forwards"}] [{"selector":"#anim-c8ec1cc8-a7ae-4cae-b425-1ba98d77b95a","keyframes":{"opacity":[0,1]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-71797489-8cb5-4419-865e-77dd3328439c","keyframes":{"transform":["translate3d(-117.10915%, 0px, 0)","translate3d(0px, 0px, 0)"]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-5f6feb27-824b-41a1-9067-43656cd18b09","keyframes":{"opacity":[0,1]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-3bc6eb19-d54b-41c7-9318-62209b7e9a61","keyframes":{"transform":["translate3d(-118.26626%, 0px, 0)","translate3d(0px, 0px, 0)"]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-955b9b98-6302-4fcc-867f-fdc23abcca3c","keyframes":{"opacity":[0,1]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-42f07d47-0974-4279-a6d7-ad6876b1b132","keyframes":{"transform":["translate3d(-117.33746%, 0px, 0)","translate3d(0px, 0px, 0)"]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] Logistical Considerations Identify local behavioral health and social service partners for referrals. Circled Dot (480) 764 - 2335 Establish relationships with pharmacies experienced in dispensing buprenorphine. Circled Dot Utilize team members like nurses to assist with initial screening and ongoing monitoring. Circled Dot

[{"selector":"#anim-1f762439-0c7f-46af-92fe-c6415ddc28ee [data-leaf-element=\"true\"]","keyframes":{"transform":["translate3d(-31.249999886225726%, 0, 0) translate(-25%, 0%) scale(1.5)","translate3d(0%, 0, 0) translate(0%, 0%) scale(1)"]},"delay":0,"duration":2000,"fill":"forwards"}] [{"selector":"#anim-53eb29f3-d1e7-475f-b060-e92237e72eb5","keyframes":{"opacity":[0,1]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-f1a7eeac-17e0-4e6c-83d5-d7b58a859ad0","keyframes":{"transform":["translate3d(-117.10915%, 0px, 0)","translate3d(0px, 0px, 0)"]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-1d7594cf-87aa-4868-bc70-2c431182f060","keyframes":{"opacity":[0,1]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-209b30e7-072c-4a96-a795-52f24ea49003","keyframes":{"transform":["translate3d(-118.26626%, 0px, 0)","translate3d(0px, 0px, 0)"]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-4e4cc5d3-c17d-4bf0-ad17-eab39126c699","keyframes":{"opacity":[0,1]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] [{"selector":"#anim-b47d8559-2f0f-4fbb-9a57-778282fb93c7","keyframes":{"transform":["translate3d(-117.33746%, 0px, 0)","translate3d(0px, 0px, 0)"]},"delay":0,"duration":3000,"easing":"cubic-bezier(0.2, 0.6, 0.0, 1)","fill":"both"}] Logistical Considerations EHRs can be customized for buprenorphine treatment notes and state PDMP queries. Circled Dot (480) 764 - 2335 Designate time slots for OUD visits and start with a small number of patients. Circled Dot Arizona Medicaid (AHCCCS) and most private insurers cover buprenorphine with prior authorization. Circled Dot

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Nuts and Bolts of Prescribing Buprenorphine

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