Preparations for Treating Opioid Use Disorder in the Office
Use this guide to plan for offering medication-assisted treatment with buprenorphine.
Fam Pract Manag. 2018 Nov-Dec;25(6):21-26.
Author disclosures: no relevant financial affiliations disclosed.
- MEDICATION-ASSISTED TREATMENT: WHY BUPRENORPHINE?
- 1. IDENTIFY A PRACTICE CHAMPION
- 2. ASSESS YOUR PRACTICE
- 3. OBTAIN A WAIVER TO TREAT OUD WITH BUPRENORPHINE
- 4. SET UP OFFICE PROTOCOLS
- 5. SECURE PHARMACY, LABORATORY, AND COUNSELING SERVICES
- 6. ESTABLISH A CLINICAL WORKFLOW, AND GO LIVE
- NEXT STEPS
Opioid use disorder (OUD) affects all segments of the U.S. population.1,2 The impacts of OUD and opiate misuse are severe, leading to dramatic declines in public health and quality of life, including increased rates of overdose and death. In 2016, more than 11.5 million people in the United States age 12 or older misused opiates in the past year, and approximately 2.1 million people age 12 or older had an opioid use disorder.2 From 1999 to 2016, approximately 632,000 Americans died of drug overdose, and more than half of those deaths were due to opioid overdose.3 From 2015 to 2016, opioid overdoses accounted for two-thirds of all drug overdose deaths.3
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013 updated the diagnostic criteria and terminology for OUD4 and replaced the more stigmatizing terms of “opioid abuse” and “opioid dependence” with “opioid use disorder.” Describing the problem as a disorder empowers patients, providers, and payers to focus on treatment options in the clinical domain.
Prescription opioids are a key contributing factor to the rise of OUD in the United States. The Centers for Disease Control and Prevention (CDC) estimates that physicians wrote 259 million opioid prescriptions in 2012, enough for each U.S. adult to have a prescription.5 Additionally, the emergence of synthetic opioids such as illicit fentanyl has resulted in a recent and dramatic surge of overdose deaths.6,7
The opioid crisis calls for physicians not only to follow best practices for the responsible prescribing of opioid painkillers5 but also to provide treatment options where prevention has failed. Medication-assisted treatment (MAT) is an important part of the solution. MAT improves outcomes, reducing OUD morbidity and mortality, as well as societal problems associated with untreated OUD.8 Family physicians write more opioid prescriptions by volume than any other specialty,9 yet most family physicians don't prescribe MAT and feel ill equipped to address OUD.10 Recent policy developments and advances in MAT offer family physicians the opportunity to rise to the challenge of treating OUD in the office. The authors collectively have more than 14 years of experience providing OUD MAT treatment services with buprenorphine in practice and, along with other family physicians,11 have found this work to be humbling, gratifying, and an antidote to burnout. This article will present a guide to integrating MAT with buprenorphine into your practice.
Family physicians write more opioid prescriptions by volume than any other specialty, yet most family physicians don't provide medication-assisted treatment (MAT) for patients with opioid use disorder.
MAT with buprenorphine is an effective alternative to methadone that can be provided in primary care practices by family physicians who complete eight hours
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2. Key Substance Use and Mental Health Indicators in the United States: Results From the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17–5044, NSDUH Series H-52) Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2017. https://www.samhsa.gov/data/sites/default/files/NSDUHFFR1-2016/NSDUH-FFR1-2016.htm. Accessed September 3, 2018.
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20. Olson Y, Sharfstein JM. Confronting the stigma of opioid use disorder – and its treatment. JAMA. 2014;311(14):1393–1394.
21. Qualify for a physician waiver. Substance Abuse and Mental Health Services Administration website. https://www.samhsa.gov/medication-assisted-treatment/buprenorphine-waiver-management/qualify-for-physician-waiver. November 21, 2016. Accessed September 4, 2018.
22. Billing and coding: medication assisted treatment. IT MATTTRS Colorado website. https://www.asam.org/docs/default-source/education-docs/billing-and-coding-format_it-matttrs_8-28-2017.pdf. August 28, 2017. Accessed September 26, 2018.
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