Buprenorphine Update: Clinical Support, Legislation on Patient Limits

SAMHSA recently announced the availability of the Physician Clinical Support System (PCSS) to assist physicians who prescribe or dispense the medication buprenorphine to their patients dependent on heroin or prescription drugs containing opioids.

And in late July, Congress passed legislation to adjust the 30-patient limit for physician group practices that dispense buprenorphine in an office-based setting to individuals with opioid dependence. Now, each physician in a group practice will be allowed to treat 30 patients with buprenorphine.

Prior to this new legislation, an entire group practice could treat only 30 patients—no matter how many physicians had waivers and were certified to prescribe buprenorphine.

In addition to assisting physicians in the appropriate use of buprenorphine, the PCSS promotes improved patient care, research, and education. To accomplish this work, the Agency is collaborating with the American Society of Addiction Medicine (ASAM) and other specialty addiction medicine, psychiatric, pain, and general medicine associations.

"The PCSS is oriented towards the needs of primary care physicians, pain specialists, psychiatrists, and other physicians who are often reluctant to treat patients dependent on heroin or prescription pain medication containing opiates," said SAMHSA's Anton C. Bizzell, M.D., a medical officer in the Division of Pharmacologic Therapies at the Center for Substance Abuse Treatment. "This will assist in increasing access to the millions of untreated prescription opioid- and heroin-dependent persons in the country."

A free service, PCSS will offer support on patient selection, induction, dosing and patient monitoring, and treatment of dependence on more than one substance or co-occurring conditions.

The PCSS is designed to increase access to buprenorphine treatment for these patients. Similarly, an amended Controlled Substances Act resulting from the recent legislation should also increase access to treatment for those who need it.

The PCSS is a national network of 45 trained physician mentors with expertise in addiction treatment and skilled in clinical education, who are supported by a PCSS medical director and by 5 physicians who are national experts in the use of buprenorphine. The physicians within the network provide services via telephone, email, and/or at the place of clinical practice, thereby allowing others to observe them providing office-based treatment with buprenorphine.

For more information on the 30-patient-limit legislation, see details in the July 27, 2005, Federal Register.

To find a PCSS clinician in your region, to become a PCSS mentor, or for more information about the project, email the PCSS staff at PCSSproject@asam.org. You can also call the toll-free line at 1-877-630-8812. Visit the PCSS Web site at www.PCSSmentor.org.

For a listing of physicians who can prescribe buprenorphine to patients with addiction to opioids, or a downloadable version of Treatment Improvement Protocol 40—Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, or other information, visit SAMHSA's buprenorphine Web site at www.buprenorphine.samhsa.gov. 

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