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ANYONE can Rx bupe

Posted by pseudoname on November 4, 2005, at 11:58:39

In reply to Looking for Mr Bupe Doc, posted by pseudoname on November 3, 2005, at 19:50:58

Ignore my post above. I misunderstood the buprenorphine laws. I'll lay out what I now think I understand. Sorry if TMI, but pdocs don't seem to know this.

SHORT VERSION: My pdoc can give me bupe for depression, right now. So can yours.

LONG VERSION:

The Narcotic Addict Treatment Act of 1974 made it a crime for a doctor to "treat" opioid addicts by giving them opioids. The goal of NATA was to put doctors who were little more than methadone mills out of business. Exceptions were made for highly controlled methadone clinics and other progams with special Federal approval. Beginning in 2003, special waivers were given to private-practice doctors to prescribe the Suboxone and Subutex versions of the opioid buprenorphine to opioid addicts in addiction treatment. Only they can give Suboxone to addicts in treatment.
http://www.nap.edu/openbook/0309052408/html/96.html
http://www.usdoj.gov/dea/pubs/csa/823.htm#g

It still was (and is) legal, however, for ordinary private-practice doctors to prescribe opioids to anyone for purposes other than addiction treatment, and doctors do this every day. A DEA registration is required (different from the bupe waiver), but most doctors have this: it's used to prescribe any "controlled substance" on Schedules III-V like Ritalin.
http://www.usdoj.gov/dea/pubs/csa/812.htm

Most prescribed opioids are FDA-approved for pain. It is still legal, however, for any doctor using her clincial judgment to prescribe any medication for an "off-label" use. Even opioid drugs can be prescribed off-label except that opioids cannot be prescribed to treat opioid addiction. (That's the NATA law.)
http://buprenorphine.samhsa.gov/faq.html#21

The buprenorphine "waiver" that a doctor gets from the Feds only applies when she prescribes (a) the Suboxone or Subutex versions of bupe (b) TO AN ADDICT (c) FOR HIS ADDICTION. After she takes the 8-hour class, the Feds *waive* the restrictions in the 1974 NATA laws for her, allowing her to treat opioid addiction with these opioid drugs. She can then treat no more than 30 *ADDICTS* at a time with these drugs. But she is free to use Suboxone with her other patients, for other purposes.
see Pain Medicine 5(3) 303-308; 2004
http://www.doctordeluca.com/Library/WOD/DearDEA04.htm

Any doctor with a Schedule-III registration can prescribe Suboxone and Subutex without further certification as long as he is not using it to treat an opioid addiction. He is as free to write 102 prescriptions for Suboxone as he is for any controlled substance. It's apparently necessary, however, to put the non-addiction treatment on the Suboxone prescription, i.e., "For pain."
http://www.csam-asam.org/pdf/newsletter/summer2003.pdf, pg 6

Also, the special waiver never applies to other forms of buprenorphine, such as the injectable painkiller Buprenex, which is a Schedule V drug. Buprenex CANNOT be given to an addict for addiction treatment even if the doc has a waiver. Buprenex is just as available for off-label uses as Ritalin or Adderall, and virtually any doc can prescribe it. No pharmacy should balk at the script, either, since it never requires a waiver ID#.
http://buprenorphine.samhsa.gov/bwns/about.html

On the drugbuyers forum, someone points out another reason docs may be reluctant to write bupe scripts:
"Doctors with regular DEA #s can use Subutex and Suboxone off-label for pain, depression, whatever they deem fit. They take a risk, though, when they prescribe anything off-label. In addition to the controlled substance concerns, they need to worry about malpractice. When a doctor prescribes according to the label, it's hard to sue them over the outcome. Not so for off-label prescriptions."

He also says that if a doctor uses her Suboxone waiver ID# on your prescription, even if the prescription is for depression, "it's assumed to be for opiate detox or maintenance." (Assumed by whom?)
http://www.drugbuyers.com/freeboard/showflat.php/Cat/0/Number/192041/Main/174995

I don't know if pharmacies are as confused about these rules as pdocs seem to be. That could throw another obstacle up.


I'll try to get in touch with my pdoc this weekend to let her know she doesn't have to take a special class to write the script she wanted to write in the first place.

Why don't pdocs already know this stuff? Why isn't it stated clearly on the FDA / DEA / SAMHSA web sites?


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poster:pseudoname thread:575160
URL: http://www.dr-bob.org/babble/20051031/msgs/575345.html