amela Posted December 8, 2010 Share Posted December 8, 2010 Do any of you dispense/prescribe suboxone? Also, what is your experience like doing this? Thanks Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 8, 2010 Moderator Share Posted December 8, 2010 pa's can but you have to take a special course first. doesn't really make sense to do so unless you work in a detox ctr. Link to comment Share on other sites More sharing options...
lingeringmind Posted September 25, 2011 Share Posted September 25, 2011 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 More sharing options...
alleycat Posted September 25, 2011 Share Posted September 25, 2011 where please can i find the reference that differentiates between the "use for" as it applied to PA/NP vs MD/DO?? thanks. and the course is, I've heard, available online. Link to comment Share on other sites More sharing options...
Contrarian Posted September 29, 2011 Share Posted September 29, 2011 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 More sharing options...
kd4029 Posted October 13, 2011 Share Posted October 13, 2011 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 More sharing options...
Contrarian Posted October 14, 2011 Share Posted October 14, 2011 ... 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 More sharing options...
vitaliyjdt Posted April 22, 2015 Share Posted April 22, 2015 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 More sharing options...
ohiovolffemtp Posted April 27, 2015 Share Posted April 27, 2015 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 More sharing options...
Contrarian Posted February 3, 2017 Share Posted February 3, 2017 PAs and NPs can now prescribe buprenorphine (Suboxone/Subutex) using their own DEA number. Link to comment Share on other sites More sharing options...
PAsoldier Posted March 2, 2017 Share Posted March 2, 2017 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 More sharing options...
Moderator ventana Posted March 4, 2017 Moderator Share Posted March 4, 2017 Already took the 8 hour course (the same one doc's take) now slogging my way through the 16 hour additional.... lots of good info but akin to going to the dentist - good overall but painful! Link to comment Share on other sites More sharing options...
d2305 Posted March 10, 2017 Share Posted March 10, 2017 Has anyone got their DEA 'X" license? Link to comment Share on other sites More sharing options...
marktheshark89 Posted March 10, 2017 Share Posted March 10, 2017 Almost there...about to submit the waiver today Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 10, 2017 Moderator Share Posted March 10, 2017 should be done by end of weekend Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 11, 2017 Moderator Share Posted March 11, 2017 DONE!!!!!!!!!!! Waiver applied for not overly enjoyable, but in the process I got 24 hours of CME! Now the hurry up and wait till my # comes in.... Link to comment Share on other sites More sharing options...
d2305 Posted March 11, 2017 Share Posted March 11, 2017 I'm just getting started. Florida just approved controlled prescribing. Link to comment Share on other sites More sharing options...
C.CruzPA Posted April 7, 2017 Share Posted April 7, 2017 I received my X number today. Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 7, 2017 Moderator Share Posted April 7, 2017 still waiting, waiting, waiting.... crickets..... Link to comment Share on other sites More sharing options...
marktheshark89 Posted April 7, 2017 Share Posted April 7, 2017 Same ^ Link to comment Share on other sites More sharing options...
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