Qualified practitioners can offer buprenorphine, a medication ap - proved by the FDA, to treat OUD. The DATA 2000 Act and the Substance Use Disorder Prevention That Promotes Opioid Re- covery and Treatment (SUPPORT) for Patients and Communities Act of 2018 expands the use of medication-assisted treatment
using buprenorphine to additional practitioners in various settings (SAMHSA, 2022c). Qualified practitioners include physicians, NPs, physician assistants (PAs), clinical nurse specialists (CNSs), certi- fied registered nurse anesthetists (CRNAs), and certified nurse- midwives (CNMs).
Table 9: Buprenorphine-Containing Products FDA-Approved for Opioid Use Disorder
Route(s) of Administration
Product Name
Available Strengths
Bunavail buccal films
• 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
Buccal
Probuphine implant
• Buprenorphine 74.2 mg
Subdermal
Sublocade extended-release solution for injection
• Buprenorphine 100mg/0.5 mL • Buprenorphine 300 mg/1.5 mL
Subcutaneous
Subutex sublingual tablets
• Buprenorphine 2 mg • Buprenorphine 8 mg
Sublingual
Suboxone sublingual tablets
• Buprenorphine 2 mg/naloxone 0.5 mg • 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 • 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
Sublingual
Suboxone sublingual films
Sublingual, buccal
Zubsolv sublingual tablets
Sublingual
The John S. McCain Opioid Addiction Prevention Act (S.724, 116) established a new registration requirement for clinicians who are licensed to prescribe controlled substances in schedules II, III, or IV. Specifically, a practitioner must agree to limit the supply of opioids prescribed for the initial treatment of acute pain as a con- dition of obtaining or renewing a registration through the DEA. An opioid approved and prescribed for addiction treatment is not subject to the limit (govtrack.us, 2019). Despite the need and market opportunities for better, safer pain options, a dramatic rise in opioid use still exists and is fueled by a pain epidemic. The National Pain Strategy (2020) is a compre- hensive population-level health strategy to increase recognition of pain as a significant public health problem (IPRCC, 2022). The vision is of timely access to patient care with access to effective approaches for pain self-management. Chronic pain would be recognized as a complex disease process and a threat to public health and productivity (IPRCC, 2022). Evidence-based treatment National Institutes of Health Heal Initiative ® The Helping to End Addiction Long-term® (HEAL) initiative is an effort to stem the national opioid public health crisis (NIH, 2023). NIH is a research program that optimizes the delivery of services for individuals with opioid use disorders, mental health disorders, and suicide risk (NIH, 2023). Long-term solutions for the evolving opioid crisis include: ● Partnering with communities to evaluate implementation strategies. ● Intervening in communities to prevent opioid use for at-risk individuals.
Evidence-based strategies can assist in the prevention of sub- stance use disorder. The goal of 911 Good Samaritan laws is to reduce barriers for individuals who notify authorities about over- doses through limited immunity and other drug charges (CDC, 2022). Syringe programs are community-based programs that provide linkages to access to medical, mental health, and social services, in addition to treatment and injection equipment (CDC, 2022). provided by primary care clinicians moves toward pain preven- tion. These actions are just several in a comprehensive strategy to reduce the dual crises of pain and opioid dependence. Programs to decrease inappropriate prescribing practices and opioid abuse should be balanced with quality pain management. Primary care clinicians are reluctant to prescribe opioids over con- cerns of dependence and opioid use disorder. Safe and effective care is a priority for all clients in preventing chronic pain. ● Understanding ways to help opioid-exposed individuals while uncovering long-term effects. ● Developing innovative treatment in all aspects of opioid ad- diction. ● Testing a range of non-opioid pain treatments for use in clini- cal practice. ● Uncovering early-stage development of non-opioid pain treatment. (NIH, 2023)
NATIONAL PAIN STRATEGY
SUBSTANCE USE AND DRUG DIVERSION
Drug misuse typically refers to prescription drugs and is defined as using them for a purpose other than for which they were pre-
scribed. Examples include taking higher doses than prescribed, taking longer than prescribed, using drugs for purposes other
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