Buprenorphine and addiction/pain management Links

 

Extended-Release Naltrexone to Prevent opioid relapse in criminal justioce offenders

Extended-release naltrexone, a sustained-release monthly injectable formulation of the full mu-opioid receptor antagonist, is effective for the prevention of relapse to opioid dependence. Data supporting its effectiveness in U.S. criminal justice populations are limited. METHODS In this five-site, open-label, randomized trial, we compared a 24-week course of extendedrelease naltrexone (Vivitrol) with usual treatment, consisting of brief counseling and referrals for community treatment programs, for the prevention of opioid relapse among adult criminal justice offenders (i.e., persons involved in the U.S. criminal justice system) who had a history of opioid dependence and a preference for opioid-free rather than opioid maintenance treatments and who were abstinent from opioids at the time of randomization. The primary outcome was the time to an opioid-relapse event, which was defined as 10 or more days of opioid use in a 28-day period as assessed by self-report or by testing of urine samples obtained every 2 weeks; a positive or missing sample was computed as 5 days of opioid use. Post-treatment follow-up occurred at weeks 27, 52, and 78. RESULTS A total of 153 participants were assigned to extended-release naltrexone and 155 to usual treatment. During the 24-week treatment phase, participants assigned to extendedrelease naltrexone had a longer median time to relapse than did those assigned to usual treatment (10.5 vs. 5.0 weeks, P<0.001; hazard ratio, 0.49; 95% confidence interval [CI], 0.36 to 0.68), a lower rate of relapse (43% vs. 64% of participants, P<0.001; odds ratio, 0.43; 95% CI, 0.28 to 0.65), and a higher rate of opioid-negative urine samples (74% vs. 56%, P<0.001; odds ratio, 2.30; 95% CI, 1.48 to 3.54). At week 78 (approximately 1 year after the end of the treatment phase), rates of opioid-negative urine samples were equal (46% in each group, P=0.91). The rates of other prespecified secondary outcome measures — self-reported cocaine, alcohol, and intravenous drug use, unsafe sex, and reincarceration — were not significantly lower with extended-release naltrexone than with usual treatment. Over the total 78 weeks observed, there were no overdose events in the extended-release naltrexone group and seven in the usual-treatment group (P=0.02). CONCLUSIONS In this trial involving criminal justice offenders, extended-release naltrexone was associated with a rate of opioid relapse that was lower than that with usual treatment. Opioid-use prevention effects waned after treatment discontinuation.  http://www.nejm.org/doi/pdf/10.1056/NEJMoa1505409

Long-acting injectable naltrexone for the management of patients with opioid dependence

Opioid treatment at release from jail using extended-release naltrexone a pilot proof-of-concept randomized effectiveness trial

Naltrexone extended-release injection an option for the management of opioid abuse

Detoxification and Substance Abuse Treatment Information

DSM-5 Criteria for Opioid Withdrawal

History of Buprenorphine

American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders.

American Society of Addiction Medicine (ASAM). The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use

Gender and Prescription Opioids: Findings from the National Survey on Drug Use and Health

A Risk-Benefit Analysis of Methadone Maintenance Treatment

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919630/

Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States

Mood Disorders and Substance Use Disorder: A Complex Comorbidity

Posttraumatic Stress Disorder and the Incidence of Nicotine, Alcohol, and Other Drug Disorders in Persons Who Have Experienced Trauma

Methadone as HIV Prevention: High Volume Methadone Sites to Decrease HIV Incidence Rates in Resource Limited Settings

CDC overdose data

Center for Disease Control and Prevention (CDC). Opioids drive continued increase in drug overdose deaths

Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain

The development of a comprehensive risk-management program for prescription opioid analgesics: researched abuse, diversion and addiction-related surveillance (RADARS)

Violent traumatic events and drug abuse severity

Adherence to Heroin Dependence Therapies and Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Infection Rates among Drug Abusers

Obstacles to Successful HCV Treatment in Substance Addicted Patients

Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies

Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits

Buprenorphine DEA monolgue

Overdose and prescribed opioids: Associations among chronic non-cancer pain patients

Overdose and prescribed opioids: Associations among chronic non-cancer pain patients

The Role of Opioid Prescription in Incident Opioid Abuse and Dependence Among Individuals with Chronic Non-Cancer Pain: The Role of Opioid Prescription

The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic noncancer pain: the role of opioid prescription.

The Physician Clinical Support System-Buprenorphine (PCSS-B): a Novel Project to Expand/Improve Buprenorphine Treatment

Buprenorphine for Prescription Opioid Addiction in a Patient With Depression and Alcohol Dependence

FDA Buprenorphine

Prescription opioid analgesic use among adults: United States, 1999-2012

Delivery of HIV risk-reduction services in drug treatment programs

Risk correlates of prevalent HIV, hepatitis B virus, and hepatitis C virus infections among noninjecting heroin users.

A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs.

Temporal association between childhood psychopathology and substance use disorders: findings from a sample of adults with opioid or alcohol dependency

Hepatitis C virus infection and needle exchange use among young injection drug users in San Francisco.

The ASRS-6 Has Two Latent Factors: Attention Deficit and Hyperactivity

Substance use disorders in patients with posttraumatic stress disorder: a review of the literature.

Demographic and Substance Use Trends Among Heroin Users — United States, 2002–2013

Renal AA-amyloidosis in intravenous drug users – a role for HIV-infection?

Prevalence of psychiatric and substance use disorders in opioid abusers in a community syringe exchange program.

Statement of the American Society of Addiction Medicine Consensus Panel on the Use of Buprenorphine in Office-Based Treatment of Opioid Addiction

Prescription Drug Abuse: Epidemiology, Regulatory Issues, Chronic Pain Management with Narcotic Analgesics

Indicators of Buprenorphine and Methadone Use and Abuse: What Do We Know?

Liver Disease in Injection Drug Users with Hepatitis C, With and Without HIV Coinfection

Predictors of deterioration among patients with substance-use disorders

National Center for Complementary and Integrative Health. NIH Analysis Shows Americans are in Pain

National Institute on Drug Abuse. Linked Epidemics: Drug Abuse and HIV/AIDS. Topics in Brief. 2005

HIV Heterosexual Sexual Risk From Injecting Drug Users Among HIV-Seronegative Noninjecting Heroin Users

Pharmacological treatment for depression during opioid agonist treatment for opioid dependence

Psychiatrie and Pain Characteristics of Prescription Drug Abusers Entering Drug Rehabilitation

CDC Grand Rounds: Prescription Drug Overdoses — a U.S. Epidemic

Recreational drug use: A neglected risk factor for end-stage renal disease

file://ihsnas1.net.inova.org/LMC1EDR007/Downloads/IPS-Program-Guide%20(1).pdf

Buprenorphine Update and Evolving Standards of Care. IPS: The Mental Health Services Conference

Overview of 5-year followup outcomes in the drug abuse treatment outcome studies (DATOS)

Young adult injection drug users in the United States continue to practice HIV risk behaviors.

Pharmacokinetic drug interactions and adverse consequences between psychotropic medications and pharmacotherapy for the treatment of opioid dependence

Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits

AMHSA. Number of DATA Certified Physicians. SAMHSA Website. 2015. Available at

SAMHSA. Opioid Treatment Program Directory. Medical-Assisted Treatment for Substance Use Disorders. 2011.

Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings

SAMHSA. Substance Use Disorders. SAMHSA website. 2014

The prevalence of borderline personality among buprenorphine patients.

Challenges in Using Opioids to Treat Pain in Persons With Substance Use Disorders

Injection drug use in North America.

Association of Mental Health Disorders With Prescription Opioids and High-Risk Opioid Use in US Veterans of Iraq and Afghanistan

Natural History of Hepatitis C

Trends in Prescribed Outpatient Opioid Use and Expenses in the U.S. Civilian Noninstitutionalized Population, 2002-2012

The SAMHSA Evaluation of the Impact of the DATA Waiver Program

Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction

Buprenorphine curricula

Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings

http://www.buprenorphine.samhsa.gov/Buprenorphine_Curriculum.pdf

Suicidality in opioid-dependent subjects.

http://www.ncbi.nlm.nih.gov/pubmed/18463995

Addressing Prescription Drug Abuse in the United States

U.S. Drug Enforcement Administration (DEA), Office of Diversion Control. National Forensic Laboratory Information System: Year 2009 Annual Report

Co-morbidity of personality disorders in individuals with substance use disorders.

Increase in Fatal Poisonings Involving Opioid Analgesics in the United States, 1999–2006

The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use

Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction

Neural Systems Underlying Opiate Addiction  or Neural Systems Underlying Opiate Addiction

GABAergic MECHANISMS OF OPIATE REINFORCEMENT or  Gaba mechanism of opioid reinforcement

Buprenorphine induces ceiling in respiratory depression but not in analgesia

http://www.buprenorphine.samhsa.gov/Buprenorphine_Curriculum.pdf

Buprenorphine for addiction therapy

Relative bioavailability of different buprenorphine formulations under chronic dosing conditions.

Buprenorphine: how to use it right.

Buprenorphine how to use it right

Clinical and pharmacological evaluation of buprenorphine and naloxone combinations: why the 4:1 ratio for treatment

Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office

Buprenorphine implants for treatment of opioid dependence: a randomized controlled trial

Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) monographs

Buprenorphine products

First and Only FDA-Approved Buccal Film Formulation of Buprenorphine and Naloxone to Compete in the $1.7 Billion and Growing U.S. Opioid Dependence Market

Rx list

Buprenorphine on the streets

FSMB guide for buprenorphine use by patients – office guide

The diversion and injection of a buprenorphine-naloxone soluble film formulation

Relative bioavailability of different buprenorphine formulations under chronic dosing conditions.

Buprenorphine prescribers information

Bunivail prescribers information

Zubsolv prescribers information

Suboxone prescribers information

Buprenorphine prescribers information

Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride)

RADARS® System Fifth Annual Scientific Meeting Abuse Deterrent Formulations of Prescription Drugs

Abuse liability of buprenorphine-naloxone tablets in untreated IV drug users

Buprenorphine implants trial

http://www.fda.gov/downloads/Drugs/DrugSafety/UCM225677.pdf

Side effects treatment of buprenorphine

Sleep disordered breathing in patients receiving therapy with buprenorphine/naloxone.

National clinical guidelines and procedures for the use of buprenorphine in the treatment of opioid dependence

Suboxone prescribing information

Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office

The SAMHSA Evaluation of the Impact of the DATA Waiver Program

Monitoring of Liver function tests in Buprenorphine

Buprenorphine/Naloxone and methadone effects on laboratory indices of liver health: a randomized trial.

Statement of the American Society of Addiction Medicine Consensus Panel on the Use of Buprenorphine in Office-Based Treatment of Opioid Addiction

Acute hepatitis due to buprenorphine administration.

PCSS Guidance Documents

Opiod interactions

Prazosin effects on objective sleep measures and clinical symptoms in civilian trauma posttraumatic stress disorder: a placebo-controlled study.

Pharmacotherapy for post traumatic stress disorder (PTSD)

 

Indicators of Buprenorphine and Methadone Use and Abuse: What Do We Know?

Trends in Benzodiazepine Prescription and Co-Prescription with Opioids in the United States, 2002––2009

merican Society of Addiction Medicine (ASAM). The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use.

Drug Interaction Checker

CYTOCHROME P450 DRUG INTERACTION TABLE [ PDF Format ]

Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction

Pharmacokinetic drug interactions and adverse consequences between psychotropic medications and pharmacotherapy for the treatment of opioid dependence

Buprenorphine-containing Transmucosal products for Opioid Dependence (BTOD)

http://www.asam.org/docs/advocacy/use-of-buprenorphine-in-office-based-treatment-of-opioid-addiction.pdf

Buprenorphine

PCSS Guidance Documents

Mthadone and Buprenorphine interactions/

American Society of Addiction Medicine (ASAM). The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use

Urine specimen detection of concurrent nonprescribed medicinal and illicit drug use in patients prescribed buprenorphine

Drug Abuse Trends in the United States

Buprenorphine Update and Evolving Standards of Care. IPS: The Mental Health Services Conference, New York City. 2015;

Interaction Between Buprenorphine and Atazanavir or Atazanavir/Ritonavir

Treatment of opioid dependence and coinfection with HIV and hepatitis C virus in opioid-dependent patients: the importance of drug interactions between opioids and antiretroviral agents.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272856/

Methadone, buprenorphine, and street drug interactions with antiretroviral medications.

DEA Buprenorphine data

Buprenorphine-containing Transmucosal products for Opioid Dependence (BTOD) Risk Evaluation and Mitigation Strategy (REMS)

Buprenorphine information Canadian

Accidental and Non-Accidental Ingestion of Methadone and Buprenorphine in Childhood: A Single Center Experience, 1999-2009 – See more at: http://www.eurekaselect.com/73173/article#sthash.3dmPOsjT.dpuf

Diversion of Buprenorphine

Naloxone Inforamtion Drugs.com

Substance Abuse and Mental Health Services Administration (SAMHSA). About Buprenorphine Therapy. Substance Abuse and Mental Health Services Administration (SAMHSA). 2011

Opioid overdose toolkit

Harm Reduction Coalition. Naloxone Kit Materials. Harm Reduction Coalition.

Naloxone Questions

Overdose Kit

http://evzio.com/hcp/about-naloxone/samhsa-opioid-overdose-toolkit.php

http://evzio.com/hcp/about-naloxone/samhsa-opioid-overdose-toolkit.php

 

Motivational interviewing book

Motivational Interviewing Website

Motivational interviewing in medical care settings: a systematic review and meta-analysis of randomized controlled trials

Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office

http://archives.drugabuse.gov/pdf/blending/Rounsaville.pdf

Enhancing Motivation for Change in Substance Abuse Treatment

Therapist Focus on Ambivalence and Commitment: A Longitudinal Analysis of Motivational Interviewing Treatment Ingredients

Drug abuse in family practice

Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain.

A Single-Question Screening Test for Drug Use in Primary Care

A Guide to Substance Abuse Services for Primary Care Clinicians

NIDA Quick drug screening test

tics

NIDA drug professionals

Addiction severity index

Assessment and screening instruments

DAST 10 Questionnaire

Screening for alcohol problems in primary care: a systematic review.

The prevalence and detection of substance use disorders among inpatients ages 18 to 49: an opportunity for prevention.

http://www.ncbi.nlm.nih.gov/pubmed/10888972

AUDIT alcohol use disorders test

Alcohol Use by Youth and Adolescents: A Pediatric Concern

Addiction medicine book

http://pediatrics.aappublications.org/content/125/5/1078.abstract

CRAFFT screening tool

Validity of the CRAFFT substance abuse screening test among adolescent clinic patients.

Ceasar adolescent drug center

Risk and Protective Factors in Drug Abuse Prevention NIDA

Risk factor mitigation

Association between prescription drug misuse and injection among runaway and homeless youth.

Clinical evaluation of substance abuse.

Predictors of Treatment Response in Adolescents with Comorbid Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder

Major Depression and Treatment Response in Adolescents with ADHD and Substance Use Disorder

DSM-5 Criteria for Opioid Intoxication

Red Flags

http://www.asam.org/docs/advocacy/use-of-buprenorphine-in-office-based-treatment-of-opioid-addiction.pdf

http://methadone.org/library/samhsa_pr_2001_new_regulations.html

Substance-Related and Addictive Disorders

Screening for problematic prescription opioid use.

College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement.

Opioid use checklist

DSM codes

Substance abuse book

Buprenorphine-containing Transmucosal products for Opioid Dependence (BTOD) Risk Evaluation and Mitigation Strategy (REMS)

Model Policy for the Use of Controlled Substances for the Treatment of Pain Federation of State Medical Boards of the United States, Inc.

DSM5

COWS Clinical opioid withdrawal scale

SOWS opioid withdrawal scale

Objective Opiate Withdrawal Scale (OOWS)

Drug Abuse In Family Practice

NW assist tool screening for alcohol and drugs

The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use

Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 40, USDHHS

Patient assessment checklist

Enhancing Motivation for Change in Substance Abuse Treatment

Principles of Addiction Medicine / Edition 3 Principles of Addiction Medicine / Edition 3

ASAM patient criteria

The ASAM criteria

http://www.buppractice.com/printpdf/patientassessmentchecklist

Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office 2013

Substance Abuse Treatment for Persons With Co-Occurring Disorders

. Supplement to the ASAM Patient Placement Criteriaon the Management of Alcohol Use Disorders

Stages of change model

TIP 54: Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders

Practice Guidance for Buprenorphine for the Treatment of Opioid Use Disorders: Results of an Expert Panel Process

http://www.asam.org/docs/advocacy/use-of-buprenorphine-in-office-based-treatment-of-opioid-addiction.pdf

http://www.asam.org/docs/advocacy/use-of-buprenorphine-in-office-based-treatment-of-opioid-addiction.pdf

Practice Guidance for Buprenorphine for the Treatment of Opioid Use Disorders: Results of an Expert Panel Process

Office-Based Treatment for Opioid Dependence: Reaching New Patient Populations

Substance Abuse Treatment for Persons With Co-Occurring Disorders

Why Buprenorphine Is So Successful in Treating Opiate Addiction in France

Practice guideline for the treatment of patients with major depressive disorder, third edition

http://www.buprenorphine.samhsa.gov/Buprenorphine_Curriculum.pdf

IPS: THE MENTAL HEALTH SERVICES CONFERENCE

Trends in the prevalence of multiple substance use in adolescents in England, 1998-2009.

Prevalence of psychiatric and substance use disorders in opioid abusers in a community syringe exchange program.

Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings

Helping SmokersQuit Helping SmokersQuit A Guide for Clinicians

http://www.sbirttraining.com/sites/sbirttraining.com/files/tobaccoform.pdf

Smoking cessation during substance abuse treatment: what you need to know.

The impact of smoking cessation on drug abuse treatment outcome

Attitudes toward the integration of smoking cessation treatment into drug abuse clinics

Tobacco Cessation Treatment for Alcohol-Dependent Smokers: When Is the Best Time?

Smoking Cessation Treatment at Substance Abuse Rehabilitation Programs

Smoking cessation treatment among office-based buprenorphine treatment patients

Characterizing smoking, cessation services, and quit interest across outpatient substance abuse treatment modalities

A Meta-Analysis of Smoking Cessation Interventions With Individuals in Substance Abuse Treatment or Recovery

Treating Tobacco Use and Dependence: 2008 Update

Tobacco Use Cessation During Substance Abuse Treatment Counseling

Smoking cessation in methadone maintenance.

An acute dose of nicotine enhances cue-induced cocaine craving.

A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery

Tobacco Addiction and Smoking Status in Heroin Addicts under Methadone vs. Buprenorphine Therapy

Co-Morbidity of Smoking in Patients with Psychiatric and Substance Use Disorders

A randomized trial of concurrent versus delayed smoking intervention for patients in alcohol dependence treatment.

http://www.ncbi.nlm.nih.gov/pubmed/15700504

Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and six months

Treatment of acute pain in Buprenorphine/naloxone

Buprenorphine: Considerations for Pain Management

Buprenorphine pain patch

Butrans Information

Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain.

What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review.

The physiology and processing of pain: a review.

http://www.ncbi.nlm.nih.gov/pubmed/19187889

Maternal Opioid Treatment: Human Experimental Research (MOTHER)—approach, issues and lessons learned

Treating opioid use disorders during pregnancy: historical, current, and future directions.

Substance Abuse Among Older Adults

Adolescent heroin use: a review of the descriptive and treatment literature.

Treatment of Adolescents with Substance Use Disorders

Referral and consultation communication between primary care and specialist physicians: finding common ground.

Buprenorphine treatment Locator

Practice Guidance for Buprenorphine for the Treatment of Opioid Use Disorders: Results of an Expert Panel Process

American Society of Addiction Medicine (ASAM). The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use

Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction

Buprenorphine checklist

Product comparison

Buprenorphine tapering schedule and illicit opioid use

Adjunctive Counseling During Brief and Extended Buprenorphine-Naloxone Treatment for Prescription Opioid Dependence

https://www.btodrems.com/Portal/Content%20Library/Appropriate%20Use%20Checklist.pdf

PATIENT handout on Induction and bup

SAMPLE CONSENT FORM

Patient rights form

Buprenorphine policy

http://www.naabt.org/documents/COWS_induction_flow_sheet.pdf

SOWS scale

OOWS scale

Withdrawal Versus Precipitated Withdrawal

http://www.asam.org/docs/advocacy/use-of-buprenorphine-in-office-based-treatment-of-opioid-addiction.pdf

BUPRENORPHINE sublingual tablets.

Suboxone tablet information

Zubsolv tablet information

Bunavail tablet information

Buprenorphine HCl and naloxone HCl prescribing information.

American Society of Addiction Medicine (ASAM). The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use

Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction

Buprenorphine tapering schedule and illicit opioid use

Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office

http://www.asam.org/docs/advocacy/use-of-buprenorphine-in-office-based-treatment-of-opioid-addiction.pdf

Protracted withdrawal

Clinical Pathway for Buprenorphine

Sleep hygiene tips

BEHAVIORAL HEALTH treatment locators

Pharmacological treatments for heroin and cocaine addiction

Treating Opioid Addiction With Buprenorphine-Naloxone in Community-Based Primary Care Settings

Buprenorphine Update and Evolving Standards of Care. IPS: The Mental Health Services Conference

TIP 54: Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders

Clinical Characteristics of Veterans Prescribed High Doses of Opioid Medications for Chronic Non-Cancer Pain

Sublingual buprenorphine is effective in the treatment of chronic pain syndrome.

Maternal Opioid Treatment: Human Experimental Research (MOTHER)—approach, issues and lessons learned

Butrans

Butrans website

Butrans medscape

Management Guidelines – Patient Maintained on Buprenorphine Scheduled for Surgery or other Procedures

Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy

http://www.pcssbuprenorphine.org/pcss/documents2/PCSS_AcutePain_052307.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150159/

Guideline for Physicians Working in California Opioid Treatment Programs Guideline for Physicians Working in California Opioid Treatment Programs

Naltrexone use

http://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement1b630f9472bc604ca5b7ff000030b21a.pdf?sfvrsn=0

Vivitrol Naltrexone Information

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150159/

A comparison of buprenorphine taper outcomes between prescription opioid and heroin users.

 

 

http://www.naabt.org/documents/COWS_induction_flow_sheet.pdf

Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting

The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. .

Buprenorphine mentoring

Side effect management

National clinical guidelines and procedures for the use of buprenorphine in the treatment of opioid dependence

Practice Guidance for Buprenorphine for the Treatment of Opioid Use Disorders: Results of an Expert Panel Process

The association between outpatient buprenorphine detoxification duration and clinical treatment outcomes: a review.

Adjunctive Counseling During Brief and Extended Buprenorphine-Naloxone Treatment for Prescription Opioid Dependence

Bringing Buprenorphine-Naloxone Detoxification to Community Treatment Providers: The NIDA Clinical Trials Network Field Experience

1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial.

The Neurobiology of Opioid Dependence: Implications for Treatment

A double-blind, double-dummy, randomized, prospective pilot study of the partial mu opiate agonist, buprenorphine, for acute detoxification from heroin.

Clinical support

Transfer from Methadone form

http://pcssmat.org/wp-content/uploads/2014/03/PCSS-MATGuidanceTransferMethadonetoBup.Casadonte.pdf

Buprenorphine-Mediated Transition from Opioid Agonist to Antagonist Treatment: State of the Art and New Perspectives

Induction of patients with moderately severe methadone dependence onto buprenorphine.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496559/

http://www.asam.org/docs/advocacy/use-of-buprenorphine-in-office-based-treatment-of-opioid-addiction.pdf

CAGE AID

Diversion and abuse of buprenorphine: findings from national surveys of treatment patients and physicians.

Inability to access buprenorphine treatment as a risk factor for using diverted buprenorphine.

The emerging buprenorphine epidemic in the United States.

Prescription opioid abuse in patients presenting for methadone maintenance treatment.

Office-Based Treatment for Opioid Dependence: Reaching New Patient Populations

USA today heroin use

Primary Care Office-based Buprenorphine Treatment: Comparison of Heroin and Prescription Opioid Dependent Patients

A comparison of buprenorphine taper outcomes between prescription opioid and heroin users.

Buprenorphine/naloxone and methadone maintenance treatment outcomes for opioid analgesic, heroin, and combined users: findings from starting treatment with agonist replacement therapies (START).

AAUDIT questionnaire

Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users: Cochrane Reviewa

Risks, Management, and Monitoring of Combination Opioid, Benzodiazepines, and/or Alcohol Use

Integrating Care for People With Co­Occurring Alcohol and Other Drug, Medical, and Mental Health Conditions

Pregnancy and Buprenorphine Treatment

FDA pregnancy categories for medications

Medication-assisted treatment with buprenorphine: assessing the evidence.

High-dose methadone maintenance in pregnancy: maternal and neonatal outcomes.

Prospective multicenter observational study of 260 infants born to 259 opiate-dependent mothers on methadone or high-dose buprenophine substitution.

Maternal Opioid Treatment: Human Experimental Research (MOTHER)—approach, issues and lessons learned

Food and Drug Administration (FDA). Buprenorphine Drug Label. NDA 20-732, NDA 20-73

Buprenorphine: a safe method for detoxifying pregnant heroin addicts and their unborn.

Treating opioid use disorders during pregnancy: historical, current, and future directions.

Chronic opioid use during pregnancy: maternal and fetal implications.

Consent form to Buprenorphine treatment in pregnancy

Neonatal abstinence syndrome

Neonatal Abstinence Syndrome

Buprenorphine-containing Transmucosal products for Opioid Dependence (BTOD)

http://www.ncbi.nlm.nih.gov/pubmed/23577898

SUBOXONE- buprenorphine hydrochloride and naloxone hydrochloride film, soluble

Major increases in opioid analgesic abuse in the United States: concerns and strategies.

Maintenance treatments for opiate dependent adolescent.

An Introduction to Extended-Release Injectable Naltrexone for the Treatment of People With Opioid Dependence

Withdrawal and dependency symptoms among adolescent alcohol and drug abusers.

Treatment of opioid-dependent adolescents and young adults with buprenorphine

Treatment of Adolescents with Substance Use Disorder

Extended vs Short-term Buprenorphine-Naloxone for Treatment of Opioid-Addicted Youth

Treatment of Opioid-Dependent Adolescents and Young Adults Using Sublingual Buprenorphine

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150159/

http://www.ncbi.nlm.nih.gov/books/NBK64350/

Adolescent heroin use: a review of the descriptive and treatment literature.

http://pcssmat.org/wp-content/uploads/2014/03/PCSS-MATGuidanceTreatmentofOpioidDependantAdolescent-buprenorphine.SubramaniamLevy1.pdf

Substance Abuse Among Older Adults

AMHSA. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-46, HHS Publication No. (SMA)

Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting

Buprenorphine for Prescription Opioid Addiction in a Patient With Depression and Alcohol Dependence

Effects of major depression on remission and relapse of substance dependence

Subtypes of Nonmedical Opioid Users: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

HIV/AIDS

Buprenorphine and HIV

Barriers to Obtaining Waivers to Prescribe Buprenorphine for Opioid Addiction Treatment Among HIV Physicians

http://dpt.samhsa.gov/pdf/HepC_draft_monograph_5-8-2006.pdf

samsha

Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs

PCCS guidance documents

http://www.buppractice.com/sites/buppractice.com/files/resources/transferfrommethadone.pdf

Transfer from Methadone Form

TIP 26: Substance Abuse Among Older Adults

Psychosocial Aspects of Treatment in Patients Receiving Buprenorphine / Naloxone

Physician Clinical Support System – Buprenorphine (PCSS-MAT)

PCSS-MAT Guidance: Treatment of Opioid Dependent Adolescents and Young Adults Using Sublingual Buprenorphine

Transfer from Methadone Form

PCSS-MAT Guidance: Treatment of Opioid Dependent Adolescents and Young Adults Using Sublingual Buprenorphine

PCSS-MAT Guidance: Transfer from Methadone to Buprenorphine

PCSS-MAT Guidance: Pregnancy and Buprenorphine Treatment

PCCS-MAT Mentoring Program

Treating Opioid Addiction With Buprenorphine-Naloxone in Community-Based Primary Care Settings

Buprenorphine maintenance program with contracted work/education and low tolerance for non-prescribed drug use: a cohort study of outcome for women and men after seven years.

https://www.btodrems.com/Portal/Content%20Library/Appropriate%20Use%20Checklist.pdf

Appendix H Sample Treatment Agreement/Contract

http://www.ncbi.nlm.nih.gov/pubmed/19187889

The Trilateral Opioid Contract

Pain physician Journal

Alliance of States with Prescription Monitoring Programs

A Closer Look at State Prescription Monitoring Programs (DEA FAQ’s)

The influence of prescription monitoring programs on chronic pain management.

: Adherence, Diversion and Misuse of Sublingual Buprenorphine

Diversion of buprenorphine/naloxone coformulated tablets in a region with high prescribing prevalence.

Use and misuse of buprenorphine in the management of opioid addiction

Diversion and abuse of buprenorphine: findings from national surveys of treatment patients and physicians.

http://pcssmat.org/wp-content/uploads/2014/02/PCSS-MATGuidanceAdherence-diversion-bup.Martin.pdf

http://pcssmat.org/wp-content/uploads/2014/02/PCSS-MATGuidanceAdherence-diversion-bup.Martin.pdf

Drug Testing As A Component Of Addiction Treatment and Monitoring Programs and in Other Clinical Settings

Urine drug testing in pain medicine.

Urine drug testing in long-term opioid therapy: ethical considerations.

Chapter 9. Drug Testing as a Tool

CLIA – Clinical Laboratory Improvement Amendments – Currently Waived Analytes

Determination of drugs of abuse in hair: evaluation of external heroin contamination and risk of false positives

Mandatory guidelines for federal workplace drug testing programs.

URINE DRUG TESTING IN PRIMARY CARE

Urine specimen detection of concurrent nonprescribed medicinal and illicit drug use in patients prescribed buprenorphine.

Bottros MM, Christo PJ. Urine Drug Testing: An Underused Tool. Pain Management Today® eNewsletter series. 2011; 1(7):

Adler M, Barthwell AG, Brown, LS Jr. The treatment of drug addiction: a review. In: Graham AW, Schultz TK, Mayo-Smith MF, Ries RK, Wilford BB, eds. Principles of Addiction Medicine, Third Edition. Chevy Chase, Md: American Society of Addiction Medicine. 2003. Available at:http://www.barnesandnoble.com/w/principles-of-addiction-medicine-american-society-american-society-of-addiction-medicine/1015772450?ean=9781880425084 Accessed on: 2013-10-09.
American Society of Addiction Medicine (ASAM). Drug Testing As A Component Of Addiction Treatment and Monitoring Programs and in Other Clinical Settings. ASAM.org. 2010. Available at: http://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2011/12/15/drug-testing-as-a-component-of-addiction-treatment-and-monitoring-programs-and-in-other-clinical-settingsAccessed on: 2013-12-31.
American Society of Addiction Medicine (ASAM). The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. . June 1, 2015. Available at: http://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement1b630f9472bc604ca5b7ff000030b21a.pdf?sfvrsn=0 Accessed on: 2015-10-06.
Bottros MM, Christo PJ. Urine Drug Testing: An Underused Tool. Pain Management Today® eNewsletter series. 2011; 1(7): . Available at:http://newsletter.qhc.com/JFP/JFP_pain022311.htm Accessed on: 2014-01-02.
Brushwood DB. Electronic prescription monitoring programs: a data-reporting tool designed to prevent drug diversion. Emerging Solutions in Pain Knowledge Series III. MediCom Worldwide, Inc . 2007.
Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy for chronic non-cancer pain. J of Pain. 2009; 10(2): 113-130. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19187889 Accessed on: 2013-10-08.
Christo PJ, Manchikanti L, Ruan X, Bottros M, Hansen H, Solanki DR, Jordan AE, Colson J. Urine Drug Testing In Chronic Pain. Pain Physician .2011; 14: 123-143. Available at: http://www.painphysicianjournal.com/2011/march/2011;14;123-143.pdf Accessed on: 2014-01-02.
Cicero TJ, Surratt HL, Inciardi J. Use and misuse of buprenorphine in the management of opioid addiction. J Opioid Manag. 2007; 3(6): 302-8. Available at: http://www.naddi.org/aws/NADDI/asset_manager/get_file/2740 Accessed on: 2013-10-10.
Dart R. Evaluation of ADFs Using RADARS System Data. RADARS System. 2011. Available at:http://www.thblack.com/links/RSD/RADARS(R)%20System_2011%20Annual%20Meeting%20Summary.pdf Accessed on: 2013-04-30.
Dasgupta N. RADARS System Subutex & Suboxone: How Much is Prescribed vs. Abuse/Diversion Reports. SAMHSA Meeting on Buprenorphine. 2010. Available at: http://buprenorphine.samhsa.gov/presentations/Dasgupta.pdf Accessed on: 2013-04-30.
Department of Health and Human Services (DHHS). Mandatory guidelines for federal workplace drug testing programs. Federal Register.2008; 73(228): 71858-71907. Available at: http://www.gpo.gov/fdsys/pkg/FR-2008-11-25/html/E8-26726.htm Accessed on: 2014-01-02.
Drug Enforcement Administration. State Prescription Drug Monitoring Programs. U.S. Department of Justice. 2011. Available at:http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm
Farmer CM, Lindsay D, Williams J, Ayers A, Schuster J, Cilia A, Flaherty MT, Mandell T, Gordon AJ, Stein BD. Practice Guidelines for Burprenorphine for the Treatment of Opioid Use Disorders: Results of an Expert Panel Process. Substance Abuse Journal. 2015; 36(2): . Available at: http://www.tandfonline.com/doi/pdf/10.1080/08897077.2015.1012613?redirect=1#.VgWAsMtVhBc Accessed on: 2015-09-25.
Fishman S, Mahajan G. Jung SW, The trilateral opioid contract: bridging the pain clinic and the primary care physician through the opioid contract. J Pain Symptom Manage. 2002; 24(3): 335-344. Available at: http://www.jpsmjournal.com/article/S0885-3924(02)00486-4/abstract
FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website http://www.fsmb.org. 2013. Available at: https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/2013_model_policy_treatment_opioid_addiction.pdf Accessed on: 2013-10-11.
Gourlay D, Heit H, Caplan Y. Urine Drug Testing in Primary Care: Dispelling the Myths & Designing Strategies. California Academy of Family Physicians. 2002. Available at: http://www.alaskaafp.org/udt.pdf Accessed on: 2005-03-15.
Gourlay D. Urine Drug Testing in Chronic Pain: A Patient Centered Approach (AMA) [webinar]. American Medical Association. 2013. Available at: http://www.pcss-o.org/archived-webinar-58 Accessed on: 2013-12-31.
Gourlay DL, Heit HA, Caplan YH. Urine Drug Testing in Clinical Practice: The Art and Science of Patient Care. Johns Hopkins Medicine. 2012; 5: . Available at: http://eo2.commpartners.com/users/ama/downloads/udt5_Copy.pdf Accessed on: 2014-01-02.
Guo AY, Ma JD, Best BM, Atayee RS. Urine specimen detection of concurrent nonprescribed medicinal and illicit drug use in patients prescribed buprenorphine. Journal of Analytical Toxicology. 2013; 37(9): 636-41. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24080973 Accessed on: 2014-01-06.
Heit HA, Gourlay DL. Urine drug testing in pain medicine. J Pain Symptom Manage. 2004; 27: 260-267. Available at:http://www.ncbi.nlm.nih.gov/pubmed/15010104 Accessed on: 2014-01-02.
Johanson CE, Arfken CL, DiMenza S, Schuster CR. Diversion and abuse of buprenorphine: Findings from national surveys of treatment patients and physicians. Drug and Alcohol Dependence. 2012; 120(1-30: 190-195. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21862241Accessed on: 2012-07-19.
Kleber HD. Pharmacologic treatments for heroin and cocaine dependence. Am J Addict. 2003; 12(suppl 2): S5-S18. Available at:http://www.europeanneuropsychopharmacology.com/article/S0924-977X(03)00181-0/abstract Accessed on: 2013-10-09.
Lavonas EJ, Banner W, Bradt P, Bucher-Bartelson B, Brown KR, Rajan P, Murrelle L, Dart RC, Green JL. Root causes, clinical effects, and outcomes of unintentional exposures to buprenorphine by young children. Journal of Pediatrics. 2013; 163(5): 1377-83. Available at:http://www.ncbi.nlm.nih.gov/pubmed/23993129 Accessed on: 2014-01-06.
Manchikanti L, Manchukonda R. Damron KS, Does adherence monitoring reduce controlled substance abuse in chronic pain patients?. Pain Physician. 2006; 9(1): 57-60. Available at: http://www.painphysicianjournal.com/linkout_vw.php?issn=1533-3159&vol=9&page=57 Accessed on: 2014-01-09.
Mintzer IL, Eisenberg M, Terra M, MacVane C, Himmelstein DU, Woolhandler S. Treating opioid addiction with buprenorphine-naloxone in community-based primary care settings. Ann Fam Med. 2007; 5(2): 146-50. Available at:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1838690/ Accessed on: 2013-10-08.
Monte AA, Mandell T, Wilford BB, et al. Diversion of buprenorphine/naloxone coformulated tablets in a region with high prescribing prevalence. J of Addictive Diseases. 2009; 28: 226-231. Available at: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CCAQFjAA&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F20155591&ei=5fQSVPjOAojP8AHbnIDIBQ&usg=AFQjCNFY2Avnj4kWPn6NZlM-DLGnDueyDA&bvm=bv.75097201,d.b2U Accessed on: 2014-09-12.
Reisfield GM, Maschke KJ. Urine drug testing in long-term opioid therapy: ethical considerations. Clinical Journal of Pain. 2013; [Epub ahead of print]: . Available at: http://www.ncbi.nlm.nih.gov/pubmed/24281293 Accessed on: 2014-01-02.
Romano G, Barbera N, Spadaro G, Valenti V. Determination of drugs of abuse in hair: evaluation of external heroin contamination and risk of false positives. Forensic Sci Int. 2003; 131(2-3): 98-102. Available at: http://www.fsijournal.org/article/S0379-0738(02)00413-9/abstractAccessed on: 2013-10-10.
SAMHSA Press Office. Sharp rise in buprenorphine-related emergency department visits from 2005 to 2010. SAMHSA Bulletin. 2013. Available at: http://www.samhsa.gov/newsroom/advisories/1301293122.aspx Accessed on: 2013-04-30.
Substance Abuse and Mental Health Services Administration (SAMHSA). Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 40, USDHHS Publication (SMA) 04-3939. 2004b. Available at: http://buprenorphine.samhsa.gov/Bup_Guidelines.pdf Accessed on: 2013-10-08.
Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network. National estimates of drug-related emergency department visits . Substance Abuse and Mental Health Services Administration website. 2004-2009. Available at:http://www.samhsa.gov/data/DAWN.aspx#Dawn Accessed on: 2012-07-19.
Wang J, Christo PJ. The influence of prescription monitoring programs on chronic pain management. Pain Physician. 2009; 12: 507-515. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19461820 Accessed on: 2014-05-24.
Warner EA. Laboratory diagnosis. In: Graham AW, Schultz TK, Mayo-Smith MF, Ries RK, Wilford BB, eds. Principles of Addiction Medicine, Third Edition. Chevy Chase, Md: American Society of Addiction Medicine. 2003. Available at: http://www.barnesandnoble.com/w/principles-of-addiction-medicine-american-society-american-society-of-addiction-medicine/1015772450?ean=9781880425084 Accessed on: 2013-10-09.
Öhlin L, Fridell M, Nyhlén A. Buprenorphine maintenance program with contracted work/education and low tolerance for non-prescribed drug use: a cohort study of outcome for women and men after seven years. BMC Psychiatry. 2015; 15:56 (ISSN: 1471-244X). 2015; 15(56): ISSN: 1471-244X. Available at: http://www.medscape.com/medline/abstract/25881164 Accessed on: 2015-09-17.

 

Help substance abusers attain and sustain abstinence

Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and six months

Primary medical care and reductions in addiction severity: a prospective cohort study

Office-Based Treatment: Training Your Staff

Five Year Experience with Collaborative Care of Opioid Addicted Patients using Buprenorphine in Primary Care

Frequently Asked Questions Applying the Substance Abuse Confidentiality Regulations to Health Information Exchange (HIE)1

Applying the Substance Abuse Confidentiality Regulations

The Confidentiality of Alcohol and Drug Abuse Patient Records Regulation and the HIPAA Privacy Rule

Confidentiality of Patient Records for Alcohol and Other Drug Treatment Technical Assistance Publication (TAP) Series 13

Treatment for Alcohol and Other Drug Abuse: Opportunities for Coordination

Appendix D Consent to Release of Information Under Title 42, Part 2, Code of Federal Regulation

Intensive Outpatient Treatment for Alcohol and Other Drug Abuse.

http://www.samhsa.gov/about-us/who-we-are/laws/confidentiality-regulations-faqs

www.fsmb.org/

PART 1311 —REQUIREMENTS FOR ELECTRONIC ORDERS AND PRESCRIPTIONS

Medical Recordkeeping

SAMHSA Section II: Guidelines (Medical Records)

Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office

PCSS Guidance Documents    <<<<<<<<<<<<<GREAT source

Drug Enforcement Administration, Justice. § 1301.75 Physical security controls for practitioners. DEA. 2005

PART 1304 — RECORDS AND REPORTS OF REGISTRANTS

.psychiatry.org/

http://www.psychiatry.org/File%20Library/Psychiatrists/Meetings/IPS-TheMentalHealthServicesConference/IPS-Program-Guide.pdf

Advancing access to addiction medications

USA today article addiction treatment shortage

NAABT Coding Grid

 

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-Discussing Payment Prior to Services

Billing

Prior to starting a patient on buprenorphine, you should discuss the issue of payment for services. First determine who should be billed—an insurance agency, the patient, or both.

Health Insurance Coverage

Private insurance companies tend to cover the cost of appointments for buprenorphine treatment. Almost all major insurers also cover at least a portion of the prescription expense. It can be time consuming to determine whether and to what extent insurance covers buprenorphine. Certain factors should be considered:

  • Health insurance plans may classify buprenorphine/naloxone as a “niche” medication, because it is prescribed solely for opioid use disorder, which affects a limited number of individuals.
  • In some insurance plans, buprenorphine treatment is covered, but counseling is uncovered or unavailable (ASAM, 2013).
  • In a minority of insurance plans, buprenorphine may be off-formulary, resulting in higher co-pays.
  • Exorbitant co-pay costs for patients may require planning and foresight regarding dosing and medication refills. For instance, some insurance provider co-pay amounts may be based on the number of pills prescribed.
  • Insurers may also limit their coverage regarding the number of doses received or the duration that a patient may be permitted to receive treatment (Szabo, 2015).
  • Insurance coverage also varies by region and state (ASAM, 2013).

Patients who plan to use insurance coverage for buprenorphine treatment should contact their insurance company, or work with you to contact their insurance if you provide that service, prior to starting treatment to see what expenses are covered.

Ask about patient insurance during the first visit even if they do not plan to file for office visits. Buprenorphine may be covered as a pharmacy benefit. However, some patients may wish not to file insurance, as it is recorded on their permanent health record.

Coding for Induction and Maintenance

There are few specific codes for billing for buprenorphine treatment. Primary care physicians have been successfully using standard evaluation and management outpatient billing codes for both induction and maintenance treatment stages.

Contributing Components

Coding is either based on complexity of service or time, with four contributing components:

  • History
  • Physical exam
  • Complexity of decision-making
  • Contributing factors (eg: time)

In the event of an audit, the documentation for a single visit must stand alone, unless another record is specifically referenced.

Commonly Used Codes

The most commonly used CPT codes by Primary Care Physicians are as follows:

Type of Visit Code
Assessment Visit:
Comprehensive evaluation of new patient or established patient for suitableness for buprenorphine treatment
New Patient: 99205Established Patient: 99215
Induction Visits:
Any of the new patient evaluation and management (E/M) codes might be used for maintenance visits. Codes listed are in order of increasing length of time with patient and/or severity of the problems.Psychiatric outpatient counseling code does not specify minutes.Prolonged visit codes (99354, 99355) may also be added onto E/M codes for services that extend beyond the typical service time, with or without face-to-face patient contact. Time spent need not be continuous.
New Patient E/M: 99201-05

Established Patient E/M: 99211-15

Patient Consult: 99241-45

Psychiatric Outpatient Counseling: 99251-55

Add-on Codes:
30-60 minutes: 99354;
60+ minutes: 99355

Maintenance Visits:
Any of these established patient E/M codes might be used for maintenance visits.Counseling codes are commonly used to bill for maintenance visits. Counseling and coordinating service with addiction specialists comprise the majority of these follow-up visits.See the following page on counseling for more detailed information on how to bill for these visits.
Established Patient:  99211-15

ICD Codes

The current ICD code, ICD-10, for opioid use disorder is F11.2. This code replaces the old ICD-9 codes. The ICD-10 code must be used as of October 1, 2015. The ICD-9 Code for opioid use disorder was 304.0x. The “x” refers to these classifications: 0=unspecified, 1=continuous, 2=episodic, 3=in remission.

Private Health Insurers

Some private health insurers have developed standard billing codes for buprenorphine treatment services. For instance, the Healthcare Common Procedure Coding System (HCPCS) code for “Oral medication administration, direct observation” is H0033. Be sure to check with individual insurers, as they may have different policies.

Counseling and Coordinating with Addiction Specialists

A large portion of maintenance visits consist of counseling and coordinating service with addiction specialists. You can provide counseling and bill for it without conducting a review of systems. In this case, you should use Counseling codes in place of E/M codes (99211-15).

Documenting a Counseling Visit

Documentation for a counseling visit should include:

  • Total visit time
  • Time spent counseling or coordinating care (must be face-to-face)
  • The nature/content of the counseling

You can bill for counseling time rather than complexity in a visit when counseling or coordination of care take up more than 50% of the total visit time. Coding is then based on the total visit time, not just the time spent counseling or coordinating care. A statement such as the following serves as documentation of time spent: “A total of ___ minutes of a _____ minute visit was spent counseling the patient about _____.”

Level New Patient Counseling Established Patient Counseling
1 10-19 minutes: 99201 5-9 minutes: 99211
2 20-29 minutes: 99202 10-14 minutes: 99212
3 30-44 minutes: 99203 15-24 minutes: 99213
4 45-59 minutes: 99204 25-39 minutes: 99214
5 60+ minutes: 99205 40+ minutes: 99215

 

 

 

Screening and Brief Intervention (SBI) codes are in place in most states. These codes, H0049 – Alcohol and Drug Screening, and H0050 – Brief Intervention, enable physicians to be reimbursed for screening Medicaid-eligible patients for substance abuse.

Medicaid licensed providers who live in states where Medicaid pays for buprenorphine treatment should not charge cash for buprenorphine treatment. It is illegal and state attorneys general have been investigating such practices.

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Formulary Finder for Prescription Drug Plans

Links to State Health Department Websites

Opportunities to Use Medicaid In Support of Rural Health Services

SAMHSA Buprenorphine Clinical Discussion WebBoard for Waived Physicians

The National Alliance of Advocates for Buprenorphine Treatment

15 Ways to Save Money on Buprenorphine Treatment

needymeds.org/

freedrugcard.us/

.suboxone.com/treatment-plan/savings-card

A variety of prescription discounts are available for low-income patients, such as Needy Meds and the Free Drug Card Program (see Related Resources). Also, AAA members can save an average of 20% off the retail price of prescriptions at participating pharmacies

 

Narrative Review: Buprenorphine for Opioid-Dependent Patients in Office Practice

Narrative Review Buprenorphine for Opioid-Dependent Patients in Office Practice

Narrative Review Buprenorphine for Opioid-Dependent Patients in Office Practice

 

 

Buprenorphine Treatment: Training for Multidisciplinary Addiction Professionals

Pharmacy consent Buprenorphine


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American Society of Addiction Medicine (ASAM). The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. . June 1, 2015. Available at: http://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement1b630f9472bc604ca5b7ff000030b21a.pdf?sfvrsn=0 Accessed on: 2015-10-06.
ASAM . Advancing access to addiction medications . Advancing access to addiction medications: Implications for opioid addiction treatment .2013. Available at: http://www.asam.org/docs/default-source/advocacy/aaam_implications-for-opioid-addiction-treatment_final Accessed on: 2015-05-29.
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FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website http://www.fsmb.org. 2013. Available at: https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/2013_model_policy_treatment_opioid_addiction.pdf Accessed on: 2013-10-11.
Gallagher C. What Waivered Physicans Need to Understand About DEA Requirements. PCSS-B Web Seminar. 2010. Available at:http://www.psych.org/Share/QIPS/Addictions/DEA-powerpoint-slides.aspx Accessed on: 2011-04-11.
Madras BK, Wilson MC, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and six months. Drug Alcohol Depend. 2010; 99(1-3): 280-295. Available at:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760304/ Accessed on: 2013-10-09.
Renner J (Chair), Saxon A, Levounis P. Buprenorphine Update and Evolving Standards of Care. IPS: The Mental Health Services Conference, New York City. 2015; Oct 8-11: . Available at: http://www.psychiatry.org/File%20Library/Psychiatrists/Meetings/IPS-TheMentalHealthServicesConference/IPS-Program-Guide.pdf Accessed on: 2015-10-15.
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Substance Abuse and Mental Health Services Administration (SAMHSA). Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 40, USDHHS Publication (SMA) 04-3939. 2004b. Available at: http://buprenorphine.samhsa.gov/Bup_Guidelines.pdf Accessed on: 2013-10-08.
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Szabo L. Addiction treatment hard to find, even as overdose deaths soar . USA Today . 2015. Available at:http://www.usatoday.com/story/news/2015/05/24/addiction-treatment-shortage/27181773/ Accessed on: 2015-05-28.
US Department of Justice. Title 21 Code of Federal Regulations: PART 1306 — PRESCRIPTIONS. US Department of Justice – Office of Diversion Control. 2010. Available at: http://www.deadiversion.usdoj.gov/21cfr/cfr/1306/1306_05.htm Accessed on: 2015-05-04.
US Department of Justice. Title 21 Code of Federal Regulations: PART 1311 —REQUIREMENTS FOR ELECTRONIC ORDERS AND PRESCRIPTIONS.US Department of Justice – Office of Diversion Control. 2010. Available at: http://www.deadiversion.usdoj.gov/21cfr/cfr/1311/subpart_c100.htmAccessed on: 2015-05-04.

Our review and meta-analysis has revealed that opioids are commonly prescribed for but may only be efficacious for short-term treatment for chronic back pain (<16 weeks). Limited information also indicates that up to one quarter of patients who are receiving these medications exhibit aberrant medication-taking behaviors that may be interpreted as signs of abuse. Prevalence rates of lifetime or current substance use disorders varied, with estimates up to 56%.

Our findings are not consistent with previous reviews on the efficacy of opioids for chronic back pain. Opioids, in some instances, have been found to be efficacious for treatment for painful conditions (5861). Our review, however, found that the evidence in favor of opioids is not always consistent, and when supportive, only supports this treatment for short periods (for example, <4 months). Long-term trials of opioid efficacy for chronic back pain are lacking, and there is other evidence that indicates that the long-term efficacy of opioids for chronic pain may be limited. Despite the acceptance of opioid treatment as routine care for chronic back pain, this systematic review cannot provide unequivocal evidence that opioids are efficacious for such treatment. In addition, well-designed trials describing the true prevalence of substance use disorders among patients receiving opioids for chronic back pain are lacking.

WHO pain ladder

Management of   Opioid Therapy for Chronic pain

 





 

 

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1255908/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1255908/

 

 

 

 

 

 

 

 

 

 

 

 

 

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