Diversion and Abuse of Buprenorphine: A Brief Assessment of ...

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Appendix DSM-IV Diagnosis of Opiate Dependence -Maladaptive pattern of use, leading to significant impairment or distress, as manifested by 3 or more of the following, occurring at any time in the same 12-month period. 1.Tolerance, as defined by decreased effect with same amount or increased amount needed to achieve same effect. 2.Withdrawal, as defined by characteristic syndrome for the substance when withdrawn or closely related substance taken to relieve the syndrome. 3.An increase in the amount or the duration from what was intended. 4.Persistent desire or unsuccessful attempts to cut down or control use. 5.Spending a great deal of time in activities needed to obtain or use the substance or recover from the effects of it. 6.Giving up social, occupational, or recreational activities because of use. 7.Continuing the use despite knowing that it is causing or worsening a persistent or recurrent psychological or physical problem. Ten Factor Office Based Criteria Check List In general, 10 factors help determine if a patient is appropriate for office-based buprenorphine treatment. Check off “yes” or “no” next to each factor. Factor Yes No Does the patient have a diagnosis of opioid dependence? Is the patient interested in office-based buprenorphine treatment? Is the patient aware of the other treatment options? Does the patient understand the risks and benefits of buprenorphine treatment and that it will address some aspects of the substance abuse, but not all aspects? Is the patient expected to be reasonably compliant? Is the patient expected to follow safety procedures? Is the patient psychiatrically stable? Are the psychosocial circumstances of the patient stable and supportive? Are resources available in the office to provide appropriate treatment? Are there other physicians in the group practice? Are treatment programs available that will accept referral for more intensive levels of service? Is the patient taking other medications that may interact with buprenorphine, such as naltrexone, benzodiazepines, or other sedative-hypnotics? Information for the above guidelines was obtained in part from the following BUPRENORPHINE CLINICAL PRACTICE GUIDELINES FIELD REVIEW DRAFT November 17, 2000 Use of Buprenorphine in Pharmacologic Management of Opioid Dependence Course Director: Elinore F. McCance-Katz, MD. PhD; Medical College of Virginia Thanks to John Ross Brooklyn, MD and Todd Mandell, M.D. 10
~ BUPRENORPHINE ~ Prior Authorization Work Sheet Vermont Medicaid has established criteria for prior authorization of Buprenorphine. These criteria are based on concerns about safety and the potential for abuse and diversion. For beneficiaries to receive coverage for this drug, prescribers must telephone First Health or complete and fax or mail this form to the First Health Services Corp at the address noted at the bottom of this page. Please complete this form in its entirety, sign and date. Incomplete requests will be returned for additional information. Prescribing physician (use stamp or print): Beneficiary (please print): Name: Name: Phone #: Medicaid ID #: Fax #: Date of Birth: Sex: Diagnosis: Dose: Pharmacy (if known): Phone: &/or FAX: QUALIFICATIONS Prescribers must have a special ‘X’ DEA license in order to prescribe. Prescribers must also have the MDs capacity to refer patients to an evidenced-based substance dependency counseling and monitoring program, and have no more than 30 patients on Buprenorphine. Patients must have a diagnosis of opiate dependence confirmed. Patients must also have been advised of Patients other Rx options, and have signed an informed consent form or treatment contract. PROCESS Has MD prescribed Buprenorphine before? Is this a new patient without any special considerations? Yes No (Special considerations include: hepatitis, pregnancy, CAD/ dual diagnosis/ psych med/ Hx suicidal ideation/ continued substance use (Benzo/ETOH)/ Hx of treatment failure, incarceration, or poor psychosocial-supportive environment) Yes No Is this an established patient who has been compliant with MD appointments? Is this an established patient who has been referred to an evidenced-based substance dependency counseling and monitoring program? Yes No Yes No You must page Dr. Strenio (741-7975) for Prior Authorization if any of the above answers is “NO.” If Agent, please print name: Prescriber/Agent Signature: Date of request: FOR FIRST HEALTH USE Approved Changed Denied Pending Add’l Info Comments: MAP RPh/Tech: NDC: Date of Decision: Submit requests via phone, fax or mail to: First Health Services Corp., MAP Dept. 4300 Cox Road, Glen Allen, VA 23060 tel: (866) 435-1199 fax: (888) 603-7696 Faxed requests are responded to within 24 hrs. For urgent requests, please use telephone. OVHA/Buprenorphine 7/17/03 11
Page 1 and 2: Diversion and Abuse of Buprenorphin
Page 3 and 4: CONTENTS Summary 5 Background 5 Fin
Page 5 and 6: Diversion and Abuse of Buprenorphin
Page 7 and 8: Vermont Maine Exhibit 1. ARCOS Data
Page 9 and 10: Exhibit 2a. Vermont Data: Distribut
Page 11 and 12: the prescriptions were dispensed. D
Page 13 and 14: Moreover, an interview with Allan W
Page 15 and 16: Hypothesis 6: Significant levels of
Page 17 and 18: Buprenorphine is not reported separ
Page 19 and 20: Based on all of the information exa
Page 21 and 22: APPENDIX A INFORMATION SOURCES CONS
Page 23 and 24: APPENDIX B STATE OFFICIALS CONSULTE
Page 25 and 26: APPENDIX C OUTSIDE EXPERTS CONSULTE
Page 27 and 28: Results of the Vermont Case Study A
Page 29 and 30: Once training is completed, the phy
Page 31 and 32: Screening/Intake: depending on the
Page 33 and 34: Patients dependent on SHORT ACTING
Page 35: 1 Levels of care range from ambulat

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