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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