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PostPosted: Mon May 11, 2015 10:00 am 
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Suboxone may be used for pain management. Can a medical provider including NP's prescribe suboxone without having the addition DEA requirement of class as this med is being prescribed for pain only. In California, NPs cannot get training to rx suboxone for addiction. The same is true for methadone unless it is being prescribed for pain. I believe suboxone is a great alternative for chronic and acute pain management and should often times be used as a first line treatment over other narcotics. Studies have shown that there are far fewer dosing adjustments required and likely hood of OD is much less than methadone. Any thoughts?


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PostPosted: Mon May 11, 2015 12:40 pm 
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Suboxone can be used 'off label' by anyone with a class III DEA registration. That would include most PA's and NP's that cannot get a DEA waiver for using Suboxone for opiate addiction.
Like any opiate used for chronic pain, they should have a patient agreement, multiple therapies* in play and a way to show functional improvement. The prescriber must use their regular DEA and state on the prescription "For Pain."
There is a for pain buprenorphine product, the Butrans patch.
It gets sticky when their is a substance use disorder as well as pain.
*Cognitive Behavior therapy, Physical, occupational therapy, acupuncture, chiropractic or osteopathic manipulation or interventional techniques.

In California, NPs cannot get training to rx suboxone for addiction.
That is true nation wide, not just California.


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PostPosted: Tue May 12, 2015 3:41 pm 
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docm2, I agree with almost everything you wrote--- I have heard it repeated, the part about needing to write 'for pain' on the script... but I have never seen that requirement written in any law or DEA rule. I can see why some regulators might want to see it written on the script, but I'm reluctant to do one more extra bit of paperwork that discloses details about patient care unless it is truly required by law or rule. Is that a DEA rule? It is not written into DATA 2000... do you know if it is truly required? Or is it 'medical urban myth'?


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PostPosted: Tue May 12, 2015 5:47 pm 
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... do you know if it is truly required?

No, I do not. However, if I don't I will get a call from the pharmacy requesting me to clarify if I meant to use my X... or my B...
Takes less than two seconds to put on the script if I use my BM... 'for pain,' and not hassle with the phone calls. I already have a signed consent that I may communicate with their pharmacist and other providers and a discerning reader would know my intent by which # is used. Locally, the pharmacists are not discerning. Geographically my patients are quite dispersed so we deal with a couple dozen pharmacies.
I reviewed a Webinar last week (from Oct 14, 2014) sponsored by PCSS-MAT and the presenter was a DEA investigator. She was asked a question about the cap and she clarified that pain patients do not count against the cap but we should be documenting quite will in the chart what we are doing. The moderator thought it was a good idea to include it on the script as well.
Another webinar from that site reviewed a N.P. practice for using Suboxone for pain and they routinely write 'for pain,' as well. Turned out later in the presentation their supervisor, a waivered physician actually completes the script.
In a different vein, Walmart has required clarification if a prescription has a preprinted XM #. They will call to clarify 'for addiction' or it must be written on the Rx before they will fill it. I found out because an overzealous tech called for the clarification. When I balked they told me my script was fine. Has not been a problem for me as I don't use preprinted prescriptions.
Myth vs. rule I know that it has saved several phone calls if I do clarify my intent with the pharmacists.
PAX


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PostPosted: Mon Jul 06, 2015 4:08 am 
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This is such a useful article for me! Actually I have been suffering from leg pain and looking for best possible treatments for overcoming this pain. Someone suggested going to a person who does acupuncture. I wonder if it will work or not!!






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