Jump to content

Can PAs prescribe suboxone?


Recommended Posts

  • 9 months later...

This is very common misperception. Only a MD/DO can prescribe Suboxone (buprenorphine/naloxone) for narcotic withdrawal. Buprenorphine with naloxone (Suboxone) and buprenorphine alone (Subutex) are DEA Schedule III drugs. Any PA with DEA Schedule III authority can prescribe Suboxone or Subutex off label for pain management. The prescription must say: "FOR PAIN MANAGEMENT ONLY."

Link to comment
Share on other sites

Yes it is available online.

Just go to the ASAM (American Society of Addiction Medicine) or AAAP (American Academy of Addiction Psychiatry) websites.

 

The certification (Data Wavier) is only available to physicians but non-physicians CAN take the class. The cost is $170.

 

I've also "heard" that PAs can prescribe bup/nalox-SUBOXONE for pain... but since its a partial agonist combined with a full antagonist can't really see why someone would.

Especially when it would be simpler to just use Buprenorphine (Butrans), or any of the other dozens of opioids for pain management and avoid the scrutiny and confusion using Subutex and/or Suboxone for pain will generate.

 

YMMV

 

Contrarian

Link to comment
Share on other sites

  • 2 weeks later...

I rotated in a clinic where the MD officially ran the suboxone clinic on paper but the PA did the clinic by himself. At the beginning of the week, the MD would look at the schedule and if there were 15 suboxone patients that week he would sign 15 blank scripts with his special suboxone prescribing number at the top (must be nationally registered MD). The PA actually saw all the patients by himself and then just wrote the dose, quantity etc on the rx. Interestingly there is a loophole that if a patient loses an Rx, a PA can call in a suboxone rx to a pharmacy, and just say it is under Dr. So and so, and effectively the Dr. is not involved with the Rx. Of course at this place I was at, the Dr. got all the suboxone training and he trained his PA on what to do. It was really interesting actually

Link to comment
Share on other sites

... if there were 15 suboxone patients that week he would sign 15 blank scripts with his special suboxone prescribing number at the top (must be nationally registered MD). The PA actually saw all the patients by himself and then just wrote the dose, quantity etc on the rx. Interestingly there is a loophole that if a patient loses an Rx, a PA can call in a suboxone rx to a pharmacy, and just say it is under Dr. So and so, and effectively the Dr. is not involved with the Rx. Of course at this place I was at, the Dr. got all the suboxone training and he trained his PA on what to do. It was really interesting actually

 

What you so freely describe on the open internet (presigned blank scripts) is ILLEGAL...

 

Its NOT about being a "nationally registered MD"... the "Data Waiver" required to prescribe Suboxone/Subutex specifically for addiction issues is simply a 1-2 letter alphabetical prefix attached to the provider's existing DEA#.

 

So if your DEA# is MN9479467... then after taking the class and applying for authorization to treat opiate addiction in a outpatient setting... your "Data Waiver" may be XN9 479467.

 

There is no "loophole" for PAs... ANY "agent" of the physician can legally "call-in"... transmit a script of any sort for the physician. A MA, LPN, RN, etc... can all call in a script for a physician. This is not contingent upon a patient "losing" a script. Its just a accepted practice in medicine.

 

Also, they just recently started letting non-physicians (PAs/NPs/RNs) take the class within the last few yrs... but they still don't get the "Data waiver" (which is essentially- authorization to treat opiate addiction in a outpatient setting with a specific medication) even if they have a DEA #.

 

So the fact that the PA hadn't actually taken the class isn't really unusual at all. The first time I took it was Apr 2011.

 

Thing is... I started working with Buprenorpine in 2008. It was 1 doc and 2 PAs... in 2 clinics on 2 reservations. He (physician) trained us both (he is board certified in addiction and teaches the required class to physicians) and only actually saw patients for 2.5hr 1 Saturday per month (so that we would only have to work every 3rd saturday). We (2 PAs) did EVERYTHING (inductions, stabilizations, tapers, rapid detoxes, discharges, U/As, counseling, inpatient referrals, etc) else.

 

He would also deal with administration and the "poli-tricks." It worked out well.

Link to comment
Share on other sites

  • 3 years later...

I'm a PA at an Addiction Clinic in Sacramento, CA.  We use Buprenorphine ie Suboxone quite a bit coupled with aggressive therapy. I think it’s a wonderful medication to treat addiction. I’m convinced it saves lives. It is much better than Methadone that has been used for years, even though there is still a place for Methadone.  In fact, Suboxone has revolutionized our approach as it relates to addiction recovery. I have seen great results with much less relapse, less overdose,  less ED visits, much less drug seeking behavior that drains resources and drain primary care providers.

Unfortunately, it is only restricted to MD/DO as it relates to addiction treatment. I think it’s probably due to opioid phobia that we are seeing around the country. Perhaps combined with notion that PA’s aren’t qualified or are not equipped to handles something complicated as addiction.

Perhaps it’s time to change this.

Simply, Suboxone saves lives, and it's time to put this opioid phobia behind us, and let PA's treat addiction without silly baseless restrictions.

I would hope that National and State PA organization push to change this restriction.

Link to comment
Share on other sites

I work part-time for an IM practice that does a lot of work with Vivitrol (naltrexone).  PA's can write for that as it isn't a controlled substance.  The general approach is to manage the patient's detox period of 7-10 days with symptomatic management: phenergan for nausea, bentyl for stomach cramps, a muscle relaxer for leg cramps, and clonidine at low dose for palpitations.

Link to comment
Share on other sites

  • 1 year later...
  • 4 weeks later...

Yes...PAs and NPs are now authorized to write for Buprenorphine for addiction.  HOWEVER, lets make sure not to mislead anyone on this.  BEFORE being able to write for this, we must complete an approved 24 hour CME course, then apply for the XDEA number.  Then, it can still take up to 45 days for SAMHSA to review your application.  

Link to comment
Share on other sites

  • 4 weeks later...

Archived

This topic is now archived and is closed to further replies.

×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More