Introduction to Suboxone What Family Physicians Can Offer Friday April 15th, 2016 John L Bender, MD, MBA,FAAFP

The Future is Different  If I had asked the people what they wanted, they would have asked for Faster Horses ” - Henry Ford, inventor of the Model T and the assembly line.

 Do you have an XDEA license? 1. Yes 2. No Some Polling…..

 Do you treat opiate addicts in your practice? 1. Yes 2. No Some Polling Continued…..

 Which is more difficult to manage? a. Chronic Pain Patient b. Heroin Addict c. No difference Some Polling Continued…..

 Do you have collocated/integrated behavioral health in your practice setting? 1. Yes 2. No Some Polling Continued…..

 Identify the role of the Family Physician in the care of the opiate dependent patient  Identify the role of buprenorphine and naloxone in the care of the opiate dependent patient.  Review the Federal law and DEA oversite that applies to obtaining and maintaining XDEA licensure. Learning Objectives

 Review the comorbidities that must be addressed when providing buprenorphine and naloxone therapy in the ambulatory environment.  Understand the key components and end points of delivering team based care to opiate dependent patients. Learning Objectives

Why Suboxone? (Buprenorphine/Naloxone)

Why Family Physicians?

 Schedules with physician to get off the opiates and not to increase them  Generally has more insight into their need for compliance  Willing to budget for physician visits and medication  Opens discussion about heroin relapse and “using”  Meds are rarely stolen  Rapidly get better Heroin Addict vs Chronic Pain Patient

 Tachycardia  Diarrhea  Diaphoresis  Tremulous  “Ancy”  Yawns Withdrawal Symptoms

 Suboxone™ Films (2mg,4mg, 8mg) – Buprenorphine/Naloxone  Subutex™ Tablets (2mg) – Buprenorphine

Mechanism of Action

 Family Physicians with a DEA license are eligible to apply for a waiver to prescribe Suboxone and Subutex.  The DEA grants the waiver by issuing a new DEA license to the Family Physician (no extra charge) that includes a second number, known as a “XDEA”. THE PROCESS

THE PROCESS becoming waivered….

Online, 9 hours CME…

Online, 8 hours CME…

 1. Run PDMP reports – mostly initiation/historical  2. Offer in house urine drug testing – 10 or 12 cup panel that includes buprenorphine ($6 cost, CLIA waived test)  3. Co-Signed Drug Contract  4. Behavioral Health integration – same EHR works best  5. Pharmacy Technician – assists with initiation and prior authorizations  6. Scribes assist with documentation  Works great with Direct Primary Care and Medicaid Team Based/PCMH/Integrated Care

Introduction to Suboxone What Family Physicians Can Offer Friday April 15th, 2016 John L Bender, MD, MBA,FAAFP