Pharmacy

Description: 
Information on how AAA members can save money prescriptions at participating pharmacies.
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Patient Handouts: 

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.

Related Resources: 

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.

Newborn

The safety of buprenorphine use during breastfeeding is promising, but not yet clearly established (Kraus et al. 2011).

View ReferencesHide References
Food and Drug Administration (FDA). Medications Guide. btodrems.com. 2013. Available at: https://www.btodrems.com/SitePages/MedicationGuides.aspx Accessed on: 2013-10-09.
Jones HE. Treating opioid use disorders during pregnancy: historical, current, and future directions. Subst Abus. 2013; 34(2): 89-91. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23577898 Accessed on: 2014-02-05.
Kraus ML, Alford DP, Kotz MM, et al. Statement of the American Society of Addiction Medicine Consensus Panel on the Use of Buprenorphine in Office-Based Treatment of Opioid Addiction.. Journal of Addiction Medicine . 2011; 5(4): 254-263. Available at: https://www.asam.org/docs/advocacy/use-of-buprenorphine-in-office-based-treatment-of-opioid-addiction.pdf Accessed on: 2013-12-12.
O’Connor AB, Collett A, Alto WA, O’Brien LM. Breastfeeding rates and the relationship between breastfeeding and neonatal abstinence syndrome in women maintained on buprenorphine during pregnancy . Journal of Midwifery Women’s Health. 2013; 58(4): 383-8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23931660 Accessed on: 2014-06-18.
Substance Abuse and Mental Health Services Administration (SAMHSA). 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. 2004b. Available at: https://www.ncbi.nlm.nih.gov/books/NBK64245/ Accessed on: 2013-10-08.
Related Resources: 
Description: 
Four-page document discussing treatment of pregnant patients with buprenorphine.
Source: 
Physician Clinical Support System (PCSS)
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Physician stage in practice: 

Buprenorphine and Pregnancy -- What You Need to Know

Description: 
This patient handout sheet explains concerns and risks for buprenorphine treatment of patients who are or wish to become pregnant.

Buprenorphine and Pregnancy -- What You Need to Know

Abusing heroin or prescription painkillers while you are pregnant is very dangerous --both for your own health and for the health of the baby you are carrying. The best action you can take is to get into treatment and stop using drugs.

What happens if you are pregnant (or want to become pregnant) and want to start taking buprenorphine?

Methadone maintenance treatment and buprenorphine monotherapy are both appropriate choices for pregnant women with opioid use disorder.

Drug-free treatments, naltrexone treatment, or "detox" are also good choices if you are just planning a pregnancy, but they are a bad idea if you are already pregnant --these treatments will force you to go into withdrawal, which could cause a miscarriage.

Your provider can advise you about other treatments and help you choose one that it right for you.

What happens if you are already using buprenorphine and want to get pregnant?

If you want to get pregnant, the safest thing to do is switch to another treatment that is safe to use during pregnancy -- methadone, naltrexone, or a drug-free treatment.

Let your provider know in advance if you want to become pregnant so you can work together to plan your change in treatment. Also, use birth control to reduce the chance of having an unplanned pregnancy.

But what happens if you are taking buprenorphine and get pregnant unexpectedly?

In this situation, you have 2 things to consider:
 There is a small chance that buprenorphine will hurt your child, but

If you switch from buprenorphine to any other kind of treatment (except for the buprenorphine only form --see below), you will probably go into withdrawal --and withdrawal could cause a miscarriage.

Miscarriage from withdrawal is the greater of these 2 risks. So, if you are already on buprenorphine and you become pregnant, you should not switch to another treatment.

There is only one change you should make --your provider will probably switch you from buprenorphine/naloxone combination to buprenorphine only form (monotherapy). Monotherapy has the same active ingredient as the buprenorphine/naloxone combination formulation and is used in the same way, but it doesn't have another ingredient (naloxone) which could be dangerous to take during pregnancy.

Remember to talk to your provider if you wish to become pregnant or suspect you are pregnant at any time while taking buprenorphine.

Description: 
This chapter provides information on using buprenorphine in patients who have special circumstances, including patients who have comorbid medical conditions or pain, pregnant patients, and adolescents.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
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Physician stage in practice: 
Description: 
This 2005 randomized controlled study examined transitioning women from short-acting opioids to buprenorphine with respect to safety and withdrawal discomfort.
Source: 
Drug and Alcohol Dependence
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Physician stage in practice: 
Resource Type: 
Description: 
Table of drug Interactions between methadone or buprenorphine and other medications from a review by McCance-Katz, Sullivan, and Nallani (2010).
Source: 
Am J Addict
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Description: 
Zubsolv is a product for the treatment of opioid dependence. In July 2013, Zubsolv was approved for the maintenance treatment of opioid dependence by the U.S. Food and Drug Administration, FDA.
Source: 
Orexo
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Description: 
A forum for sharing on Prescription Monitoring Programs
Source: 
Alliance of States with Prescription Monitoring Programs
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Description: 
The RADARS System is a surveillance system which collects timely product-and geographically-specific data on prescription drug abuse, misuse and diversion.
Source: 
Radars.org
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Description: 
A web based database created by Purdue Pharmaceuticals that collects, collates, and analyzes pharmacy crime data. The site looks for patterns, trends, and similarites in the crimes being commited and dissiminates this information to law enforcement groups to aid in apprehending suspects and also sends it to pharmacies.
Source: 
Purdue Pharmaceuticals
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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)

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Commonly Used Forms: 
Resource Type: 
Description: 
This TIP, Substance Abuse Treatment for Persons With Co-Occurring Disorders, revises TIP 9, Assessment and Treatment of Patients With Coexisting Mental Illness and Alcohol and Other Drug Abuse. The revised TIP provides information about new developments in the rapidly growing field of co-occurring substance use and mental disorders and captures the state-of-the-art in the treatment of people with co-occurring disorders. The TIP focuses on what the substance abuse treatment clinician needs to know and provides that information in an accessible manner. The TIP synthesizes knowledge and grounds it in the practical realities of clinical cases and real situations so the reader will come away with increased knowledge, encouragement, and resourcefulness in working with clients with co-occurring disorders.
Source: 
U.S. Department of Health and Human Services, SAMHSA
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Resource Type: 

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