Buprenorphine Training Program v2.0 (2012 Update)

(Est time: 0.25 hrs) Understand the regulations and requirements of office-based buprenorphine treatment.

Goal: The learner will understand the changing role of addiction treatment in primary care, including recent legislative changes that permit office-based treatment of opioid dependence.

Module Objectives: Discuss the primary care physician's role in addiction treatment, including new responsibilities and opportunities, and integrate these changes in their own patient care practicesUnderstand the recent legislative changes related to office-based addiction treatment and how they may provide their patients with more treatment optionsExplain the requirements and process of becoming certified to prescribe buprenorphine for opioid dependent patientsDescribe basic elements in an office-based buprenorphine practice

Practice Gaps:

Primary care physicians need to better understand their role in addiction treatment and the process of obtaining a waiver to prescribe buprenorphine.

(Est time: 0.5 hrs) Understand the pharmacological basis of opioids and buprenorphine.

Goal: The learner will understand the pharmacological basis of opioids and buprenorphine.

Module Objectives: Identify the functions of opioid receptors and develop a simplified explanation for patientsExplain the difference between opioid agonists, partial agonists, and antagonists and how this impacts buprenorphine treatmentRelate pharmacological properties of buprenorphine and the buprenorphine/naloxone combination to physiological effects on patients

Practice Gaps:

Physicians need to understand the pharmacology of opioids and buprenorphine so they can safely and effectively treat their opioid dependent patients.

(Est time: 1 hr) Understand how to interact with patients and screen for and recognize opioid use problems.

Goal: The learner will understand how to interact with patients and screen for and recognize opioid use problems.

Module Objectives: Describe the physical signs and symptoms that are indicative of opioid use and assess your patients for these signsExplain methods of detecting opioid use through patient interviews and with standardized screening instruments and utilize these methods in your practiceAssess opioid use in adolescent patients in your clinical practiceDescribe and utilize the DSM-IV criteria for diagnosing substance use disorders in your patient population

Practice Gaps:

Physicians need to learn how to screen patients for opioid use so they can identify and begin to treat at-risk substance abusers.

(Est time: 1 hr) Understand which patients are most suitable for office-based buprenorphine treatment.

Goal: The learner will understand which patients are most suitable for office-based buprenorphine treatment.

Module Objectives: Describe common medical and psychiatric problems in opioid abusers that may complicate treatment and watch for signs of these comorbidities in your patients Appraise patients' appropriateness for office-based buprenorphine treatmentIdentify patients who are unlikely candidates for office-based buprenorphine treatmentAdjust treatment protocols for special populations including adolescents, pregnant women, and geriatric patientsExplain the importance of an individualized treatment plan and when referral is appropriate for your patients

Practice Gaps:

In 2004, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that there were 270,000 heroin users and another 1.4 million Americans who were dependent on prescription opioids (SAMSHA 2005). In fact, these figures probably vastly underestimate the true prevalence of opioid use disorders in the United States (SAMHSA 2005). Further, only a small fraction of these users have received treatment for an opioid use disorder (SAMHSA 2005).

Buprenorphine is a safe and effective treatment for opioid dependence that offers patients a more widely available, accessible, convenient treatment option as compared to traditional opioid treatment programs (OTP) (SAMHSA 2001; Johnson et al. 2003; SAMHSA 2004). The Drug Addiction Treatment Act (DATA) of 2000 -- an amendment to the Controlled Substances Act -- allows physicians who are not part of an OTP to prescribe buprenorphine. However, the law requires physicians to complete an 8-hour buprenorphine training conducted by an approved organization in order to prescribe it.

The courses in this training program prepare physicians to prescribe buprenorphine safely and effectively to address needs of the millions of Americans with opioid use problems. In addition, when completed together as a program, the 12 courses comprise a training program that has been developed to meet the DATA 2000 training guidelines as defined in Public Law 106-310-106th Congress and endorsed by the American Society of Addiction Medicine, one of the approved training organizations named in DATA 2000. The course content is based upon SAMHSA’s 2004 publication Treatment Improvement Protocol (TIP) #40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. The courses are regularly reviewed and updated by ASAM members who are experts in the field of addiction medicine and buprenorphine treatment.

The courses in this training program prepare physicians to prescribe buprenorphine safely and effectively to treat opioid dependence. This CME course and the overall buprenorphine training program addresses a performance gap in clinical practice. The course will facilitate physicians to prescribe buprenorphine to their opioid dependent patients, with a long term goal of decreasing opioid problems for these patients.

References:
Johnson RE, Strain EC, Amass L. Buprenorphine: how to use it right. Drug Alcohol Depend. 2003; 70(suppl 2): S59-S77.

Substance Abuse and Mental Health Services Administration. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 40, USDHHS Publication (SMA) 04-3939. 2004.

Substance Abuse and Mental Health Services Administration. Overview of Findings From the 2004 National Survey on Drug Use and Health. Rockville, Md: Office of Applied Studies. 2005. Available at: http://oas.samhsa.gov/NSDUH/2k4NSDUH/2k4Overview/2k4Overview.pdf

Substance Abuse and Mental Health Services Administration. Use of Buprenorphine in the Pharmacologic Management of Opioid Dependence: A Curriculum for Physicians. Substance Abuse and Mental Health Services Administration. 2001.

(Est time: 1.25 hrs) Be able to safely initiate and maintain patients on buprenorphine.

Goal: The learner will be able to safely initiate and maintain patients on buprenorphine.

Module Objectives: Demonstrate a thorough understanding of dosing principles to help your patients succeed in the early phase of buprenorphine treatment: inductionRecognize and anticipate complications of buprenorphine use during induction and prepare to deal with occasional complications in your patients

Practice Gaps:

In 2004, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that there were 270,000 heroin users and another 1.4 million Americans who were dependent on prescription opioids (SAMSHA 2005). In fact, these figures probably vastly underestimate the true prevalence of opioid use disorders in the United States (SAMHSA 2005). Further, only a small fraction of these users have received treatment for an opioid use disorder (SAMHSA 2005).

Buprenorphine is a safe and effective treatment for opioid dependence that offers patients a more widely available, accessible, convenient treatment option as compared to traditional opioid treatment programs (OTP) (SAMHSA 2001; Johnson et al. 2003; SAMHSA 2004). The Drug Addiction Treatment Act (DATA) of 2000 -- an amendment to the Controlled Substances Act -- allows physicians who are not part of an OTP to prescribe buprenorphine. However, the law requires physicians to complete an 8-hour buprenorphine training conducted by an approved organization in order to prescribe it.

The courses in this training program prepare physicians to prescribe buprenorphine safely and effectively to address needs of the millions of Americans with opioid use problems. In addition, when completed together as a program, the 12 courses comprise a training program that has been developed to meet the DATA 2000 training guidelines as defined in Public Law 106-310-106th Congress and endorsed by the American Society of Addiction Medicine, one of the approved training organizations named in DATA 2000. The course content is based upon SAMHSA’s 2004 publication Treatment Improvement Protocol (TIP) #40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. The courses are regularly reviewed and updated by ASAM members who are experts in the field of addiction medicine and buprenorphine treatment.

The courses in this training program prepare physicians to prescribe buprenorphine safely and effectively to treat opioid dependence. This CME course and the overall buprenorphine training program addresses a performance gap in clinical practice. The course will facilitate physicians to prescribe buprenorphine to their opioid dependent patients, with a long term goal of decreasing opioid problems for these patients.

References:
Johnson RE, Strain EC, Amass L. Buprenorphine: how to use it right. Drug Alcohol Depend. 2003; 70(suppl 2): S59-S77.

Substance Abuse and Mental Health Services Administration. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 40, USDHHS Publication (SMA) 04-3939. 2004.

Substance Abuse and Mental Health Services Administration. Overview of Findings From the 2004 National Survey on Drug Use and Health. Rockville, Md: Office of Applied Studies. 2005. Available at: http://oas.samhsa.gov/NSDUH/2k4NSDUH/2k4Overview/2k4Overview.pdf

Substance Abuse and Mental Health Services Administration. Use of Buprenorphine in the Pharmacologic Management of Opioid Dependence: A Curriculum for Physicians. Substance Abuse and Mental Health Services Administration. 2001.

(Est time: 1 hr) Be able to safely initiate and maintain special populations on buprenorphine.

Goal: The learner will be able to safely transfer methadone patients to buprenorphine maintenance and induct and maintain other special populations on buprenorphine.

Module Objectives: Demonstrate an understanding of special precautions required throughout the phases of buprenorphine treatment for patients on methadone and other special populations, including pregnant women, teens, elderly, patients with psychiatric comorbidities, and patients with chronic pain. Recognize and anticipate complications of buprenorphine use and prepare to deal with occasional complications in methadone patients and other special populations

Practice Gaps:

In 2004, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that there were 270,000 heroin users and another 1.4 million Americans who were dependent on prescription opioids (SAMSHA 2005). In fact, these figures probably vastly underestimate the true prevalence of opioid use disorders in the United States (SAMHSA 2005). Further, only a small fraction of these users have received treatment for an opioid use disorder (SAMHSA 2005).

Buprenorphine is a safe and effective treatment for opioid dependence that offers patients a more widely available, accessible, convenient treatment option as compared to traditional opioid treatment programs (OTP) (SAMHSA 2001; Johnson et al. 2003; SAMHSA 2004). The Drug Addiction Treatment Act (DATA) of 2000 -- an amendment to the Controlled Substances Act -- allows physicians who are not part of an OTP to prescribe buprenorphine. However, the law requires physicians to complete an 8-hour buprenorphine training conducted by an approved organization in order to prescribe it.

The courses in this training program prepare physicians to prescribe buprenorphine safely and effectively to address needs of the millions of Americans with opioid use problems. In addition, when completed together as a program, the 12 courses comprise a training program that has been developed to meet the DATA 2000 training guidelines as defined in Public Law 106-310-106th Congress and endorsed by the American Society of Addiction Medicine, one of the approved training organizations named in DATA 2000. The course content is based upon SAMHSA’s 2004 publication Treatment Improvement Protocol (TIP) #40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. The courses are regularly reviewed and updated by ASAM members who are experts in the field of addiction medicine and buprenorphine treatment.

The courses in this training program prepare physicians to prescribe buprenorphine safely and effectively to treat opioid dependence. This CME course and the overall buprenorphine training program addresses a performance gap in clinical practice. The course will facilitate physicians to prescribe buprenorphine to their opioid dependent patients, with a long term goal of decreasing opioid problems for these patients.

References:
Johnson RE, Strain EC, Amass L. Buprenorphine: how to use it right. Drug Alcohol Depend. 2003; 70(suppl 2): S59-S77.

Substance Abuse and Mental Health Services Administration. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 40, USDHHS Publication (SMA) 04-3939. 2004.

Substance Abuse and Mental Health Services Administration. Overview of Findings From the 2004 National Survey on Drug Use and Health. Rockville, Md: Office of Applied Studies. 2005. Available at: http://oas.samhsa.gov/NSDUH/2k4NSDUH/2k4Overview/2k4Overview.pdf

Substance Abuse and Mental Health Services Administration. Use of Buprenorphine in the Pharmacologic Management of Opioid Dependence: A Curriculum for Physicians. Substance Abuse and Mental Health Services Administration. 2001.

(Est time: 0.75 hrs) Be able to maintain patients on buprenorphine, and deal with special situations in buprenorphine treatment.

Goal: The learner will be able to maintain patients on buprenorphine, and deal with special situations in buprenorphine treatment including continued use of drugs during buprenorphine treatment, discontinuation of buprenorphine treatment, and the use of buprenorphine in medically supervised withdrawal from opioids (detoxification).

Module Objectives: Demonstrate a thorough understanding of dosing principles to help your patients succeed throughout the maintenance phase of buprenorphine treatment as well as special situations in buprenorphine treatment: continued use of drugs while on buprenorphine, tapering off of buprenorphine, and use of buprenorphine for medically supervised withdrawal from opioids (detoxification).Recognize and anticipate complications of buprenorphine use during the maintenance phase of treatment and prepare to deal with and minimize complications in your patients when discontinuing buprenorphine or using buprenorphine in medically supervised withdrawal (detoxification).

Practice Gaps:

In 2004, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that there were 270,000 heroin users and another 1.4 million Americans who were dependent on prescription opioids (SAMSHA 2005). In fact, these figures probably vastly underestimate the true prevalence of opioid use disorders in the United States (SAMHSA 2005). Further, only a small fraction of these users have received treatment for an opioid use disorder (SAMHSA 2005).

Buprenorphine is a safe and effective treatment for opioid dependence that offers patients a more widely available, accessible, convenient treatment option as compared to traditional opioid treatment programs (OTP) (SAMHSA 2001; Johnson et al. 2003; SAMHSA 2004). The Drug Addiction Treatment Act (DATA) of 2000 -- an amendment to the Controlled Substances Act -- allows physicians who are not part of an OTP to prescribe buprenorphine. However, the law requires physicians to complete an 8-hour buprenorphine training conducted by an approved organization in order to prescribe it.

The courses in this training program prepare physicians to prescribe buprenorphine safely and effectively to address needs of the millions of Americans with opioid use problems. In addition, when completed together as a program, the 12 courses comprise a training program that has been developed to meet the DATA 2000 training guidelines as defined in Public Law 106-310-106th Congress and endorsed by the American Society of Addiction Medicine, one of the approved training organizations named in DATA 2000. The course content is based upon SAMHSA’s 2004 publication Treatment Improvement Protocol (TIP) #40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. The courses are regularly reviewed and updated by ASAM members who are experts in the field of addiction medicine and buprenorphine treatment.

The courses in this training program prepare physicians to prescribe buprenorphine safely and effectively to treat opioid dependence. This CME course and the overall buprenorphine training program addresses a performance gap in clinical practice. The course will facilitate physicians to prescribe buprenorphine to their opioid dependent patients, with a long term goal of decreasing opioid problems for these patients.

References:
Johnson RE, Strain EC, Amass L. Buprenorphine: how to use it right. Drug Alcohol Depend. 2003; 70(suppl 2): S59-S77.

Substance Abuse and Mental Health Services Administration. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 40, USDHHS Publication (SMA) 04-3939. 2004.

Substance Abuse and Mental Health Services Administration. Overview of Findings From the 2004 National Survey on Drug Use and Health. Rockville, Md: Office of Applied Studies. 2005. Available at: http://oas.samhsa.gov/NSDUH/2k4NSDUH/2k4Overview/2k4Overview.pdf

Substance Abuse and Mental Health Services Administration. Use of Buprenorphine in the Pharmacologic Management of Opioid Dependence: A Curriculum for Physicians. Substance Abuse and Mental Health Services Administration. 2001.

(Est time: 1 hr) Understand how to manage problematic behaviors and how to measure treatment efficacy using urine screening.

Goal: The learner will understand how to manage problematic behaviors common to opioid-dependent patients and how to measure treatment efficacy using urine screening.

Module Objectives: Discuss goals for defining the doctor-patient relationship in buprenorphine treatment and how to achieve them in clinical practiceExplain the rules, regulations, and consequences of problematic behavior in office-based opioid treatment and how to apply them with your patientsDescribe the integral function of urine analysis in substance abuse treatment and an approach for implementing testing with your patients

Practice Gaps:

In 2004, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that there were 270,000 heroin users and another 1.4 million Americans who were dependent on prescription opioids (SAMSHA 2005). In fact, these figures probably vastly underestimate the true prevalence of opioid use disorders in the United States (SAMHSA 2005). Further, only a small fraction of these users have received treatment for an opioid use disorder (SAMHSA 2005).

Buprenorphine is a safe and effective treatment for opioid dependence that offers patients a more widely available, accessible, convenient treatment option as compared to traditional opioid treatment programs (OTP) (SAMHSA 2001; Johnson et al. 2003; SAMHSA 2004). The Drug Addiction Treatment Act (DATA) of 2000 -- an amendment to the Controlled Substances Act -- allows physicians who are not part of an OTP to prescribe buprenorphine. However, the law requires physicians to complete an 8-hour buprenorphine training conducted by an approved organization in order to prescribe it.

The courses in this training program prepare physicians to prescribe buprenorphine safely and effectively to address needs of the millions of Americans with opioid use problems. In addition, when completed together as a program, the 12 courses comprise a training program that has been developed to meet the DATA 2000 training guidelines as defined in Public Law 106-310-106th Congress and endorsed by the American Society of Addiction Medicine, one of the approved training organizations named in DATA 2000. The course content is based upon SAMHSA’s 2004 publication Treatment Improvement Protocol (TIP) #40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. The courses are regularly reviewed and updated by ASAM members who are experts in the field of addiction medicine and buprenorphine treatment.

The courses in this training program prepare physicians to prescribe buprenorphine safely and effectively to treat opioid dependence. This CME course and the overall buprenorphine training program addresses a performance gap in clinical practice. The course will facilitate physicians to prescribe buprenorphine to their opioid dependent patients, with a long term goal of decreasing opioid problems for these patients.

References:
Johnson RE, Strain EC, Amass L. Buprenorphine: how to use it right. Drug Alcohol Depend. 2003; 70(suppl 2): S59-S77.

Substance Abuse and Mental Health Services Administration. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 40, USDHHS Publication (SMA) 04-3939. 2004.

Substance Abuse and Mental Health Services Administration. Overview of Findings From the 2004 National Survey on Drug Use and Health. Rockville, Md: Office of Applied Studies. 2005. Available at: http://oas.samhsa.gov/NSDUH/2k4NSDUH/2k4Overview/2k4Overview.pdf

Substance Abuse and Mental Health Services Administration. Use of Buprenorphine in the Pharmacologic Management of Opioid Dependence: A Curriculum for Physicians. Substance Abuse and Mental Health Services Administration. 2001.

(Est time: 0.75 hrs) Understand the prevalence of opioid misuse and the impact of opioid use on physical and mental health.

Goal: The learner will understand the prevalence of opioid misuse and the impact of opioid use on physical and mental health.

Module Objectives: Realize the scope of the heroin abuse and prescription opioid misuse problem in the United StatesDiscuss mortality and morbidity trends in opioid misusers and how this relates to patient careDescribe the scope of the problem of infectious diseases in opioid misusers and integrate this health information into patient careUnderstand the interrelationships between opioid misuse and mental illness and utilize this information to treat patients with dual diagnosisExplain how treatment for opioid dependence reduces associated negative health effects and educate your patients about this benefit

Practice Gaps:

Physicians need to understand the prevalence, health impact, and implications of opioid misuse and dependence so that they can better treat their substance abuse patients.

(Est time: 0.5 hrs) Understand confidentiality and medical recordkeeping for patients with substance use problems.

Goal: The learner will understand the importance of confidentiality and the principles of medical recordkeeping for patients with substance use problems.

Module Objectives: Discuss the pertinence of confidentiality regulations to substance abuse treatment (and OBOT specifically) and implement these rules in clinical practiceExplain the exceptions to the confidentiality law, including when (and to whom) disclosure of patient information is allowed, and discuss with staff and buprenorphine patientsDescribe the facets of medical recordkeeping for patients with substance use disorders and DEA requirements for medical recordkeeping in OBOT practicesWork with health insurance companies to prepare and submit patient claims for buprenorphine treatmentDiscuss the out-of-pocket costs of OBOT for patients and the logistics of setting up a cash-only buprenophine practice

Practice Gaps:

In 2004, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that there were 270,000 heroin users and another 1.4 million Americans who were dependent on prescription opioids (SAMSHA 2005). In fact, these figures probably vastly underestimate the true prevalence of opioid use disorders in the United States (SAMHSA 2005). Further, only a small fraction of these users have received treatment for an opioid use disorder (SAMHSA 2005).

Buprenorphine is a safe and effective treatment for opioid dependence that offers patients a more widely available, accessible, convenient treatment option as compared to traditional opioid treatment programs (OTP) (SAMHSA 2001; Johnson et al. 2003; SAMHSA 2004). The Drug Addiction Treatment Act (DATA) of 2000 -- an amendment to the Controlled Substances Act -- allows physicians who are not part of an OTP to prescribe buprenorphine. However, the law requires physicians to complete an 8-hour buprenorphine training conducted by an approved organization in order to prescribe it.

The courses in this training program prepare physicians to prescribe buprenorphine safely and effectively to address needs of the millions of Americans with opioid use problems. In addition, when completed together as a program, the 12 courses comprise a training program that has been developed to meet the DATA 2000 training guidelines as defined in Public Law 106-310-106th Congress and endorsed by the American Society of Addiction Medicine, one of the approved training organizations named in DATA 2000. The course content is based upon SAMHSA’s 2004 publication Treatment Improvement Protocol (TIP) #40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. The courses are regularly reviewed and updated by ASAM members who are experts in the field of addiction medicine and buprenorphine treatment.

The courses in this training program prepare physicians to prescribe buprenorphine safely and effectively to treat opioid dependence. This CME course and the overall buprenorphine training program addresses a performance gap in clinical practice. The course will facilitate physicians to prescribe buprenorphine to their opioid dependent patients, with a long term goal of decreasing opioid problems for these patients.

References:
Johnson RE, Strain EC, Amass L. Buprenorphine: how to use it right. Drug Alcohol Depend. 2003; 70(suppl 2): S59-S77.

Substance Abuse and Mental Health Services Administration. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 40, USDHHS Publication (SMA) 04-3939. 2004.

Substance Abuse and Mental Health Services Administration. Overview of Findings From the 2004 National Survey on Drug Use and Health. Rockville, Md: Office of Applied Studies. 2005. Available at: http://oas.samhsa.gov/NSDUH/2k4NSDUH/2k4Overview/2k4Overview.pdf

Substance Abuse and Mental Health Services Administration. Use of Buprenorphine in the Pharmacologic Management of Opioid Dependence: A Curriculum for Physicians. Substance Abuse and Mental Health Services Administration. 2001.