Healthcare Consideration: While the laws vary from state to state, no prescribers, including nurse practitioners, should prescribe controlled substances for themselves or a family member. Prescribing for family members may have legal and ethical implications. Pharmacists will likely question a prescription written for the same-named individual who signs the prescription. Patients may attempt to fill prescriptions in a different state for various reasons. A pharmacist who receives an out-of-state prescription from a nurse practitioner may refuse to fill the prescription if unsure of the rules in another state. alone or in combination) that the FDA has approved for this indication (SAMHSA, 2022b). Qualified practitioners can offer buprenorphine, a medication approved by the Food and Drug Administration (FDA), to treat opioid use disorders (OUD). The Drug Addiction Treatment Act of 2000 (DATA 2000) and the Substance Use Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities or SUPPORT for Patients and Communities Act of 2018 (SUPPORT Act) expands the use of medication-assisted treatment using buprenorphine to additional practitioners in various settings (SAMHSA, 2022c).
Self-Assessment Quiz Question #4 What is the purpose of Prescription Drug Monitoring Programs (PDMPs)? a. To track all prescription medications dispensed in hospitals and long-term care facilities. b. To promote safe prescribing and dispensing practices for controlled substances. c. To monitor the dispensing of Schedule I substances. d. To collect data on pseudoephedrine sales. Medication-assisted treatment (MAT) for opioid addiction The Substance Abuse and Mental Health Services Administration (SAMHSA) oversees the accreditation and standards for opioid treatment programs (OTP). Many medication-assisted treatments (MAT) medications for opioid addiction are regulated under the CSA (SAMHSA, 2022a). The Drug Addiction Treatment Act of 2000 (DATA 2000 ACT) permits physicians who meet set qualifications to manage opioid dependency with FDA-approved medications, such as buprenorphine, in treatment settings other than OTPs (see Table 4). The DATA 2000 Act allows physicians to obtain a waiver (i.e., DEA-X) to treat opioid use disorder with Schedules III, IV, and V medications (such as buprenorphine
Table 4. Buprenorphine-Containing Products FDA-Approved for Opioid Use Disorder Product Name Available Strengths
Route(s) of Administration
Buprenorphine 1 mg/naloxone 0.2 mg
Buprenorphine 2.1 mg/naloxone 0.3 mg Buprenorphine 4.2 mg/naloxone 0.7 mg Buprenorphine 6.3 mg/naloxone 1 mg
Bunavail buccal films
Buccal
Probuphine implant
Buprenorphine 74.2 mg
Subdermal
Sublocade extended-release solution for injection
Buprenorphine 100 mg/0.5 mL Buprenorphine 300 mg/1.5 mL
Subcutaneous
Buprenorphine 2 mg
Subutex sublingual tablets
Sublingual
Buprenorphine 8 mg
Buprenorphine 2 mg/naloxone 0.5 mg
Suboxone sublingual tablets
Sublingual
Buprenorphine 8 mg/naloxone 2 mg
Buprenorphine 2 mg/naloxone 0.5 mg
Buprenorphine 4 mg/naloxone 1 mg Buprenorphine 8 mg/naloxone 2 mg Buprenorphine 12 mg/naloxone 3 mg
Suboxone sublingual films
Sublingual, buccal
Buprenorphine 0.7 mg/naloxone 0.18 mg
Buprenorphine 1.4 mg/naloxone 0.36 mg Buprenorphine 2.9 mg/naloxone 0.71 mg Buprenorphine 5.7 mg/naloxone 1.4 mg Buprenorphine 8.6 mg/naloxone 2.1 mg Buprenorphine 11.4 mg/naloxone 2.9 mg
Zubsolv sublingual tablets
Sublingual
Morphine milligram equivalent (MME) Morphine milligram equivalent (MME) thresholds guide the risk of overdose when prescribing opioids for pain. Morphine milligram conversion factor analyzes and normalizes opioid prescription data to determine a daily MME value (see Table 5). MME defines limits for the total amount of opioid analgesics prescribed to the patient as part of state legislation, Medicare/
Medicaid, and other payers. The CDC recommends calculating the total daily dose of opioids (as MMEs) to identify patients who may benefit from closer monitoring, reduction, or tapering of opioids, prescribing naloxone (Narcan), or other measures to reduce the risk of overdose. MME calculations
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Book Code: AUS3024
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