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

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system to coordinate care. Physicians who wish to participate in the incentive plan must agree to work with a Stateassigned Buprenorphine Coordinator. The Coordinator is to help the office prepare for the treatment of opiateaddicted patients and to assure that every patient obtains all recommended treatment services. The SSA also is planning to develop a set of tools, including screening instruments and patient contracts, for use by the Coordinators. Formal outcome measures will be used to measure the effectiveness of the Coordinators and of the incentive program. Recommendation: This may be an excellent model for other States. Hypothesis 2: Buprenorphine is being widely used for the treatment of pain in Vermont. Relevant Information: A sizeable number of Vermont physicians may be using Subutex and Suboxone offlabel for the treatment of pain. The outside experts consulted for this assessment confirmed that many physicians prefer to use these oral formulation in treating pain patients rather than Buprenex, which is labeled for pain, because Buprenex is available only in an injectable form. The experts also suggested that some physicians may be using the Suboxone formulation in pain management in an effort to avoid drug overdoses. Analysts examined the distribution of buprenorphine within the State, as compared to the distribution of physicians who hold waivers to prescribe the drug for officebased treatment of opioid addiction (Exhibits 2a and 2b). The data not only showed wide variations in distribution of buprenorphine from county to county, they also indicated that Suboxone and Subutex are being dispensed in counties where there are no physicians who hold waivers to prescribe buprenorphine for officebased treatment of opioid addiction. Results of the Vermont Case Study 8
Exhibit 2a. Vermont Data: Distribution by County of Buprenorphine, in Number of Dosage Units and Number of Prescriptions, and Distribution of Waivered Physicians, 2005 # Medicaid Patients Total # DU per Receiving # Waivered Subutex Subutex Suboxone Suboxone Dosage 10,000 Vermont County Buprenorphine Doctors 2.16 DU 8mg DU 2mg DU 8mg DU Units Population ADDISON 18 0 1,320 300 60 9,150 10,830 3,011 BENNINGTON 29 6 960 5,280 3,090 14,370 23,700 6,406 CALEDONIA 24 9 270 1,140 2,550 15,300 19,260 6,484 CHITTENDEN 184 16 5,250 2,370 14,970 80,970 103,560 6,970 FRANKLIN 5 1 0 420 3,600 26,220 30,240 6,658 GRAND ISLE 4 0 0 0 0 90 90 101 LAMOILLE 28 4 1,350 2,100 9,060 26,250 38,760 16,683 ORANGE 18 1 30 690 90 1,650 2,460 872 ORLEANS 33 3 270 990 1,350 9,270 11,880 4,521 RUTLAND 149 13 450 4,770 3,780 61,680 70,680 11,148 WASHINGTON 79 22 2,940 1,860 8,880 57,180 70,860 12,209 WINDHAM 48 18 1,320 450 10,980 34,650 47,400 10,720 WINDSOR 46 8 180 810 1,350 10,920 13,260 2,309 TOTAL 665 101 14,340 21,180 59,760 347,700 442,980 82,948 Sources: U.S. Drug Enforcement Administration: Automation of Reports and Consolidated Orders System; Vermont Medicaid Data; and Vermont SSA Data on Waivers. Results of the Vermont Case Study Exhibit 2b. Map of Vermont Counties 9
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: Vermont Maine Exhibit 1. ARCOS Data
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 and 36: 1 Levels of care range from ambulat
Page 37: ~ BUPRENORPHINE ~ Prior Authorizati

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

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