Table 12. Buprenorphine-Containing Products FDA-Approved for Opioid Use Disorder Product Name Available Strengths
Route(s) of Administration
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 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
Suboxone sublingual films
Sublingual, buccal
Zubsolv sublingual tablets
Sublingual
Naltrexone As mentioned previously, naltrexone is considered first-line therapy for individuals with moderate or severe alcohol use disorder but is also an option for treatment of OUD via its effects on the mu receptor. Efficacy of naltrexone has been mixed in some studies when compared to traditional treatment for opioid use in particular; its use should be customized to the individual. 130 Different in mechanism from methadone or buprenorphine, naltrexone is an opioid antagonist medication available in both PO and IM formulation.
It can be prescribed by any licensed provider without the need for special requirements linked to buprenorphine or methadone. There is no abuse potential. It is currently approved for the treatment of both OUD and for the treatment of alcohol abuse. As opposed to methadone and buprenorphine, naltrexone is not a controlled substance, so it can be prescribed by any healthcare provider who is licensed to prescribe medications. However, as an opioid antagonist, use of naltrexone must be monitored closely to prevent serious acute withdrawal symptoms.
Case study 6 Mrs. Carter brings in her 18-year-old son, Bobby, for evaluation of his SUD. He has been using unprescribed oxycodone and buying pills off the street. She asks for help getting assistance. What are some of the options available for treatment of Bobby’s OUD? Questions 1. What are some of the options available for treatment of Bobby’s OUD? _______________________________________________________________________________________________ 2. Are you authorized to prescribe medications for the treatment of OUD? _______________________________________________________________________________________________ 3. Mrs. Carter is concerned that medications for the treatment of OUD may just be as dangerous as the oxycodone that Bobby is using. What reassurance can you provide? _______________________________________________________________________________________________ PRESCRIBING PRACTICES FOR CONTROLLED SUBSTANCES
● Effective May 11, 2022, DEA now requires all registration applications and renewal forms to be submitted electronically. ● They are an agent or employee of a hospital or other institution acting in the normal course of business or employment under the registration of the hospital or other institution that is registered instead of the individual practitioner being registered, provided additional requirements as outlined in the Code of Federal Regulations . 93 DEA registration grants federal authority to practitioners to handle controlled substances as part of their professional practice or research. A clinician may prescribe controlled substances only under the laws of the state where their practice is located. When
Multiple providers including physicians, dentists, podiatrists, veterinarians, or advanced practice providers (i.e., chiropractor, nurse practitioner, midwife, optometrist, pharmacist) may issue a prescription for a controlled substance. Others may issue a prescription under the following conditions: ● They are authorized to prescribe controlled substances by the jurisdiction of practice. ● They are registered with the DEA or exempted from registration (e.g., U.S. Public Health Service, Federal Bureau of Prisons, or military practitioners); to obtain a DEA registration, the clinician must complete DEA Form 224 (www.DEAdiversion. usdoj.gov).
Book Code: MDCO1025
Page 79
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