Getting a waiver/setting up your practice

Description: 
Slides describe the process of applying to prescribe buprenorphine for 275 patients by submitting a Waiver Notification form to SAMHSA.
Source: 
Synectics for Management Decisions, Inc. © 2016
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Physician stage in practice: 
Description: 
SAMHSA information page on obtaining a waiver with links to further information and the Notification of Intent form to apply for a waiver.
Source: 
SAMHSA
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Physician stage in practice: 

DSM 5 Opioid Use Disorder Checklist

Patient’s Name:

Date of Birth:

Worksheet for DSM-5 criteria for diagnosis of Opioid Use Disorder

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Final Step

A final step should be preparing your office, including staff members, to begin office-based opioid treatment (OBOT). These tasks should include:

Related Resources: 
Description: 
This clinical guidance from the PCSS-MAT provides a list of commonly used CPT codes for buprenorphine induction and maintenance. Information is includes for both psychiatrists and non-psychiatrist physicians.
Source: 
PCSS-MAT
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Office-Based Treatment: Training Your Staff

Description: 
Your staff will be assisting you with many of the tasks essential to conducting in-office buprenorphine treatment. Therefore, staff members need a firm grasp of the principles of addiction treatment and corresponding clinical skills and an attitude conducive to working with this patient population. The staff's attitudes will affect the way they treat patients, thus influencing the outcome of treatment. Before starting office-based buprenorphine treatment, you may wish to conduct formal training with your staff. The brief guidelines below can help you structure your training.

Information to Convey

In the course of your staff trainings, try to cover the following topics:

  • Addiction is a chronic medical illness, not a character flaw or weakness of will, and can be treated successfully
  • The treatment philosophy your practice espouses Substance abuse screening skills
  • Proper record keeping and compliance with confidentiality legislation
  • Appropriate interaction with patients and how to handle negative situations that may arise
  • Knowledge of other services and referral options

Principles of Staff Training

The setting and tone of the trainings and the methods of information delivery will influence learning. Keep the following principles in mind:

  • Design hands-on activities that stress experience. Focus on skills by using role-playing, for example. This will be more effective for staff than simply being lectured. Start the training with a participatory activity and intersperse these activities throughout the training to keep attention levels high.
  • Notice how the staff members learn, and try to do more things that enhance their learning.
  • Provide additional resources so that learning can continue after training is complete.

Description: 
This is a training package developed by the Buprenorphine Awareness Blending Team to create awareness about buprenorphine among non-physician addiction professionals.
Source: 
National Institute on Drug Abuse (NIDA) and The Addiction Technology Transfer Center (ATTC)
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Before starting to prescribe buprenorphine, you may want to contact a more experienced buprenorphine provider in your area to act as a mentor. A mentor can walk you through your first few patients and advise about any special issues that arise.

CSAT has developed a mentoring system specifically for new buprenorphine prescribers. The Physician Clinical Support System, or PCSS (see link below) can connect you with more experienced buprenorphine providers and local addiction specialists. The program is administered by the American Academy of Addiction Psychiatrists.

Related Resources: 
Description: 
This website is designed to support physicians who prescribe buprenorphine by linking them up with a national network of trained physician mentors.
Source: 
Physician Clinical Support System (PCSS)
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Tags: 
Description: 
This article gives advice on the practical aspects of setting up a buprenorphine clinic based on one hospital's experience.
Source: 
Addictive Disorders and Their Treatment, September 2005
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Physician stage in practice: 
Resource Type: 
Description: 
PCSS-MAT provides ongoing mentoring programs aimed at improving providers confidence in treating opioid use disorder. The PCSS-MAT program is designed to assist providers in incorporating the use of medications for prescription opioid addicted patients in their practices. The mentoring program is available, at no cost to providers. PCSS-MAT mentors are a national network of trained providers with expertise in medication-assisted treatment and skilled in clinical education. Mentors provide support by telephone, email, or in person if logistically possible. (From the website.)
Source: 
SAMHSA
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Physician stage in practice: 
Description: 
This webpage on the PCSS-MAT website links to list of modules, webinars, waiver eligibility training, and a calendar of events. The monthly webinars are sponsored by several professional societies and are archived. Physicians can register for the webinars online. Experienced mentors can be requested through this website. Resources and Clinical Tools including forms and clinical guidance are also available.
Source: 
PCSS-MAT
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Ensuring Your Patients Have Access to Medication

You should establish a relationship with at least one local pharmacy before starting a buprenorphine practice to ensure that they can stock adequate supplies of buprenorphine.

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Pharmacy Consent Form for Buprenorphine Treatment

Description: 
By signing this Appointed Pharmacy Consent Form, the patient authorizes a provider to disclose to the pharmacy that he or she is being treated for opioid dependence; the pharmacy is also authorized to contact the provider to discuss treatment.

Name/Practice Name: ____________________________
Address: _____________________________________________
Address: _____________________________________________
City, State, ZIP: ________________________________________
Phone: _______________________________________________
Fax: _________________________________________________

APPOINTED PHARMACY CONSENT

I, ______________________________________________[Patient Name- Print], do hereby:

(MD check all that apply)

1) __ Authorize ________________________________[Provider Name- Print] at the above address to disclose my treatment for opioid

dependence to employees of the pharmacy specified below. Treatment disclosure most often includes, but may not be limited to, discussing my medications with the pharmacist, and faxing/calling in my buprenorphine prescriptions directly to the
pharmacy.

2) __ Agree to allow pharmacist to contact provider listed above to discuss my treatment if necessary so that my buprenorphine prescriptions can be filled and either delivered to the office addressed given above or picked-up by employees of the same.

I understand that I may withdraw this consent at any time, either verbally or in writing except to the extent that action has been taken on reliance on it. This consent will last while I am being treated for opioid dependence by the provider specified above unless I withdraw my consent during treatment. This consent will expire 365 days after I complete my treatment, unless the provider specified above is otherwise notified by me.

I understand that the records to be released may contain information pertaining to psychiatric treatment and/or treatment for alcohol and/or drug dependence. These records may also contain confidential information about communicable diseases including HIV (AIDS) or related illness. I understand that these records are protected by the Code of Federal Regulations Title 42 Part 2 (42 CFR Part 2) which prohibits the recipient of these records from making any further disclosures to third parties without the express written consent of the patient.

I acknowledge that I have been notified of my rights pertaining to the confidentiality of my treatment information/records under 42 CFR Part 2, and I further acknowledge that I understand those rights.

_____________________ _________________________ __________
Patient Signature Patient Name (Print) Date

______________________ ___________________________ _________
Parent/Guardian Signature Parent/Guardian Name (Print) Date

______________________ ______________________________ _________
Witness Signature Witness Name (Print) Date

Appointed Pharmacy: Name: _____________________________Phone: ___________
Address: _____________________________________________

Confidentiality of Alcohol- and Drug-Dependence Patient Records

The confidentiality of alcohol- and drug-dependence patient records maintained by this practice/program is protected by federal law and regulations. Generally, the practice/program may not say to a person outside the practice/program that a patient attends the practice/program, or disclose any information identifying a patient
as being alcohol- or drug-dependent unless:
1. The patient consents in writing;
2. The disclosure is allowed by a court order; or
3. The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or practice/program evaluation.

Violation of the federal law and regulations by a practice/program is a crime. Suspected violations may be reported to appropriate authorities in accordance with federal regulations.

Federal law and regulations do not protect any information about a crime committed by a patient either at the practice/program or against any person who works for the practice/program or about any threat to commit
such a crime.

Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under state law to appropriate state or local authorities.

Routine Labwork is a Part of All Buprenorphine Practices

Related Resources: 
Description: 
The following is a list of currently waived analytes that are used in laboratory test systems. The list provides the analyte name as well as a link to the waived test system.
Source: 
Food and Drug Administration (FDA)
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Description: 
Comprehensive document detailing the HIPAA Privacy Rule and its implications for alcohol and substance abuse programs.
Source: 
Department of Health and Human Services (DHHS)
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Before Starting a Practice

DATA 2000 requires buprenorphine prescribers to be capable of referring patients to supportive services for psychosocial therapy. Psychosocial services are a crucial component in successful addiction treatment.

View ReferencesHide References
Meier, BR, Patkar, AA. Buprenorphine treatment: factors and first-hand experiences for providers to consider. Journal of Addictive Diseases. 2007; 26(1): 3-14. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17439863
Related Resources: 
Description: 
Search tool where a patient or physician can enter their zipcode and receive a listing of the closest buprenorphine counselors, pharmacies, treatment facilities, and support groups.
Source: 
The National Alliance of Advocates for Buprenorphine Treatment (NAABT)
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Description: 
This is the American Society of Addiction Medicine's member directory which allows users to search by physician first name, last name, city, state, and specialty.
Source: 
American Society of Addiction Medicine (ASAM)
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If you've successfully requested the required credit for your buprenorphine training activity and obtained your training certificate(s) (one 8 hour certificate for physicians, and two certificates for NPs and PAs - one 8 hour BupPractice certificate and one 16 hour SBIRT+OpioidRisk certificate), the next step is to request your waiver!

Related Resources: 
Description: 
Find information for providers on the waiver application and management process to prescribe or dispense buprenorphine for opioid dependency treatment.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
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Physician stage in practice: 
Description: 
This page provides links to the full text, summary, and physician waiver requirements under DATA 2000.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
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Physician stage in practice: 
Description: 
This webpage provides answers to frequently asked questions from physicians about buprenorphine and the Drug Addiction Treatment Act of 2000 (DATA 2000).
Source: 
CSAT Buprenorphine Information Center
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