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    Demystifying Buprenorphine Regulations For Pharmacists and Clinicians

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    lorien86
    This document discusses regulations around buprenorphine treatment and provides evidence for low-barrier treatment approaches. It notes that the DATA waiver is no longer required to prescribe buprenorphine, removing a barrier to treatment. Low-barrier treatment, also called "medication first" approaches, emphasize rapid medication access, harm reduction, and flexible treatment models. Evidence shows low-barrier care improves retention in treatment compared to referral alone. Studies also find office-based buprenorphine without intensive counseling is effective. The document advocates shifting to a medication first approach to take advantage of reachable moments and expand access to life-saving opioid use disorder medications.

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    © All Rights Reserved
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    Demystifying Buprenorphine Regulations For Pharmacists and Clinicians

    Uploaded by

    lorien86
    54 views10 pages
    This document discusses regulations around buprenorphine treatment and provides evidence for low-barrier treatment approaches. It notes that the DATA waiver is no longer required to prescribe buprenorphine, removing a barrier to treatment. Low-barrier treatment, also called "medication first" approaches, emphasize rapid medication access, harm reduction, and flexible treatment models. Evidence shows low-barrier care improves retention in treatment compared to referral alone. Studies also find office-based buprenorphine without intensive counseling is effective. The document advocates shifting to a medication first approach to take advantage of reachable moments and expand access to life-saving opioid use disorder medications.

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    DemystifyingBuprenorphineRegulationsHandout01-19-2023

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    This document discusses regulations around buprenorphine treatment and provides evidence for low-barrier treatment approaches. It notes that the DATA waiver is no longer required to prescribe buprenorphine, removing a barrier to treatment. Low-barrier treatment, also called "medication first" approaches, emphasize rapid medication access, harm reduction, and flexible treatment models. Evidence shows low-barrier care improves retention in treatment compared to referral alone. Studies also find office-based buprenorphine without intensive counseling is effective. The document advocates shifting to a medication first approach to take advantage of reachable moments and expand access to life-saving opioid use disorder medications.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    54 views10 pages

    Demystifying Buprenorphine Regulations For Pharmacists and Clinicians

    Uploaded by

    lorien86
    This document discusses regulations around buprenorphine treatment and provides evidence for low-barrier treatment approaches. It notes that the DATA waiver is no longer required to prescribe buprenorphine, removing a barrier to treatment. Low-barrier treatment, also called "medication first" approaches, emphasize rapid medication access, harm reduction, and flexible treatment models. Evidence shows low-barrier care improves retention in treatment compared to referral alone. Studies also find office-based buprenorphine without intensive counseling is effective. The document advocates shifting to a medication first approach to take advantage of reachable moments and expand access to life-saving opioid use disorder medications.

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    Demystifying Buprenorphine Regulations for Pharmacists and Clinicians

    Demystifying Buprenorphine
    Regulations for Pharmacists and
    Clinicians

    Margaret Gilly Gehri, Al Carter, MS, Heidi Carroll, Matthew Strait,


    Lowenstein, BA PharmD, RPh BS MS
    MD

    Disclosures
    Our speakers, Dr. Margaret Lowenstein, Dr. Al Carter, Heidi Carroll, Matthew Strait, and Gilly Gehri declare
    that they do not have a current affiliation or financial arrangement with any ineligible companies that may
    have a direct interest in the subject matter of this continuing pharmacy education (CPE) activity within the
    past 24 months.

    Additionally, individuals involved in the planning of this activity do not have any current affiliation or
    financial arrangement with any ineligible companies that may have a direct interest in the subject matter of
    this CPE activity within the past 24 months.

    All relevant financial relationships have been mitigated.

    Center for Addiction Medicine and Policy Webinar – January 19, 2023 1
    Demystifying Buprenorphine Regulations for Pharmacists and Clinicians

    Self Assessment Questions


    1. Why is low-barrier care important?

    2. As pharmacy workflow is streamlined, what proactive steps can


    pharmacists take to support this patient population?

    3. How can I be a champion for low barrier MOUD access from the
    pharmacy level?

    Low-Barrier Buprenorphine
    Treatment

    Maggie Lowenstein, MD, MPhil, MSHP


    Penn Division of General Internal Medicine & Center for Addiction Medicine and Policy

    Center for Addiction Medicine and Policy Webinar – January 19, 2023 2
    Demystifying Buprenorphine Regulations for Pharmacists and Clinicians

    X-waiver is X-ed!
    Mainstreaming Addiction Treatment (MAT) Act Passed
    December 29, 2022

    • DATA-Waiver (X-waiver) no longer required


    to treat patients with buprenorphine for
    OUD
    • Buprenorphine prescriptions can be written with
    standard DEA number
    • No limits or caps on patients for buprenorphine
    treatment.

    MOUDs Save Lives


    Opioid agonist therapy reduces all-cause and
    overdose mortality by ~50%

    Also associated with…


    • Improved treatment retention
    • Lower rates of other opioid use
    • Improved social functioning
    • Decreased injection drug use
    • Reduced HIV and HCV transmission
    • Better quality of life

    Source: NASEM, 2019

    Center for Addiction Medicine and Policy Webinar – January 19, 2023 3
    Demystifying Buprenorphine Regulations for Pharmacists and Clinicians

    BUT … Few with OUD receive treatment


    > 2 million Americans with Opioid Use Disorder

    What gets in the way?


    Received OUD
    20% Treatment • Access challenges
    • Programmatic rules and
    requirements
    • Pharmacy barriers
    Did not receive
    OUD treatment
    80%
    • Stigma

    NSDUH

    Disparities in Buprenorphine Care

    Buprenorphine
    prescriptions higher
    among white,
    commercially insured
    patients

    Hansen, 2013; Netherland 2018; Lagisetty, 2019

    Center for Addiction Medicine and Policy Webinar – January 19, 2023 4
    Demystifying Buprenorphine Regulations for Pharmacists and Clinicians

    What gets in the way?


    Patients’ using non-prescribed buprenorphine %
    Didn’t know where to go 64%
    Could not pay 38%
    No transportation 30%
    Treated poorly during OUD treatment 13%
    Didn’t want to be seen at center 13%
    Did not trust physician 5%

    Fox, 2015

    What is Low-Barrier Treatment?


    “Medication First” Approach

    Rapid medication Harm reduction Flexible treatment Non-traditional


    access approach model settings

    Jakubowski and Fox, 2019

    10

    Center for Addiction Medicine and Policy Webinar – January 19, 2023 5
    Demystifying Buprenorphine Regulations for Pharmacists and Clinicians

    Why Low-Barrier Care?

    11

    Take Advantage of Reachable Moments


    • Patients seeking addiction treatment are more likely to be engaged if
    they are seen on the same day compared to waiting 2+ days
    • Starting buprenorphine in the ED in all-comers with OUD more than
    doubles retention in treatment at 30 days compared to referral alone

    Roy, 2021; D’Onofrio, 2015

    12

    Center for Addiction Medicine and Policy Webinar – January 19, 2023 6
    Demystifying Buprenorphine Regulations for Pharmacists and Clinicians

    Office-based buprenorphine without intensive


    counseling is effective

    Brief medically focused counseling vs


    Intensive counseling interventions

    No difference

    Fiellin, 2006 NEJM; Carroll and Weiss, 2017

    13

    Evidence from COVID

    14

    Center for Addiction Medicine and Policy Webinar – January 19, 2023 7
    Demystifying Buprenorphine Regulations for Pharmacists and Clinicians

    Shift towards a “Medication First Approach”


    Benefits of MOUDs are seen even with imperfect abstinence

    Benefits of MOUDs are seen with or without intensive treatment with


    counseling, mutual aid, or other additional treatments

    Start medication whenever and wherever patients touch the health care
    system!

    15

    Low-Barrier Care in Policy

    “A growing body of evidence


    supports ‘low-threshold’
    buprenorphine treatment, an
    approach that embraces the
    harm-reduction philosophy of
    meeting patients where they
    are … Our agencies are
    working to expand funding
    for these services”

    Gupta, 2022

    16

    Center for Addiction Medicine and Policy Webinar – January 19, 2023 8
    Demystifying Buprenorphine Regulations for Pharmacists and Clinicians

    Pilot Trial of Pharmacist-Led Treatment

    Patients in pharmacy-based program 5x more


    likely to to be retained at 1 month
    (89% vs 17%)

    Green, 2023

    17

    18

    Center for Addiction Medicine and Policy Webinar – January 19, 2023 9
    Demystifying Buprenorphine Regulations for Pharmacists and Clinicians

    Wrap-Up
    • With the removal of the X-waiver, we have opportunities to expand
    buprenorphine access
    • Growing evidence for low-barrier approaches
    • How can we work with pharmacy partners to overcome barriers to
    treatment?

    19

    Questions?

    gilly.gehri@pennmedicine.upenn.edu

    https://penncamp.org

    20

    Center for Addiction Medicine and Policy Webinar – January 19, 2023 10

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