{"id":7,"date":"2021-09-08T18:40:42","date_gmt":"2021-09-08T18:40:42","guid":{"rendered":"https:\/\/wp.media.unc.edu\/bupe\/?page_id=7"},"modified":"2024-06-14T13:43:42","modified_gmt":"2024-06-14T13:43:42","slug":"why-buprenorphine","status":"publish","type":"page","link":"https:\/\/wp.media.unc.edu\/bupe\/why-buprenorphine\/","title":{"rendered":"Buprenorphine Facts"},"content":{"rendered":"\r\n<h2 class=\"wp-block-heading\">What is buprenorphine?<sup id=\"popoverA\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">1<\/sup><\/h2>\r\n\r\n\r\n\r\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-1 wp-block-columns-is-layout-flex\">\r\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:60%\">\r\n<ul>\r\n<li style=\"list-style-type: none;\">&nbsp;<\/li>\r\n<li aria-level=\"1\">Buprenorphine is a partial opioid agonist that binds to opioid receptors in the brain, reducing cravings and withdrawal symptoms when opioids are stopped.<\/li>\r\n<li aria-level=\"1\">Buprenorphine does not have the same effects as full agonist opioids, especially when combined with naloxone.\r\n<div id=\"popoverA-content\" class=\"popover-content hide\">\r\n<div id=\"A\"><button id=\"A\" class=\"close\" type=\"button\">\u00d7<\/button>\r\n<ol start=\"1\">\r\n<li value=\"1\">SAMHSA. TIP 63: Medications for Opioid Use Disorder. Published online 2021. <a href=\"https:\/\/store.samhsa.gov\/product\/TIP-63-Medications-for-Opioid-Use-Disorder-Full-Document\/PEP21-02-01-002\">https:\/\/store.samhsa.gov\/product\/TIP-63-Medications-for-Opioid-Use-Disorder-Full-Document\/PEP21-02-01-002<\/a> Accessed August 1, 2021. <\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<\/li>\r\n<li aria-level=\"1\">Buprenorphine is used to treat both opioid use disorder (OUD) and chronic pain. In this continuing education program, we focus on the use of buprenorphine to treat OUD.<\/li>\r\n<\/ul>\r\n<\/div>\r\n\r\n\r\n\r\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:40%\">\r\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/11\/OUDs_in_Brain-01.png\" alt=\"Full agonists such as Methadone generate full effects on opioid receptors in the brain while partial agonists such as Buprenorphine generate limited effects. \" class=\"wp-image-1271\" width=\"424\" height=\"309\" srcset=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/11\/OUDs_in_Brain-01.png 424w, https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/11\/OUDs_in_Brain-01-300x219.png 300w\" sizes=\"(max-width: 424px) 100vw, 424px\" \/><\/figure><\/div>\r\n<\/div>\r\n<\/div>\r\n\r\n\r\n\r\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-2 wp-block-columns-is-layout-flex\">\r\n<div class=\"wp-block-column top15 is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:35%\">\r\n<h2 class=\"wp-block-heading\">What is buprenorphine&#8217;s role in preventing overdose?<\/h2>\r\n\r\n\r\n\r\n<p>Buprenorphine is a key strategy to prevent overdose. As shown in the table, medications for opioid use disorder, which include buprenorphine, are listed in four of 10 of the CDC\u2019s top recommended evidence-based strategies to prevent overdose.<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"834\" height=\"448\" src=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/11\/bupestrip.png\" alt=\"\" class=\"wp-image-1269\" srcset=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/11\/bupestrip.png 834w, https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/11\/bupestrip-300x161.png 300w, https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/11\/bupestrip-768x413.png 768w\" sizes=\"(max-width: 834px) 100vw, 834px\" \/><\/figure>\r\n<\/div>\r\n\r\n\r\n\r\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:65%\">\r\n<h4 class=\"wp-block-heading\" id=\"block-cd678757-027b-4c06-8526-29e29fe2b4c3\">CDC\u2019s Evidence-Based Strategies for Preventing Opioid Overdose<sup id=\"popoverBB\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">2<\/sup><\/h4>\r\n<div id=\"popoverBB-content\" class=\"popover-content hide\">\r\n<div id=\"BB\"><button id=\"BB\" class=\"close\" type=\"button\">\u00d7<\/button>\r\n<ol start=\"2\">\r\n<li value=\"2\">Carroll J, Green T, Noonan R. <em>Evidence-Based Strategies for Preventing Opioid Overdose: What\u2019s Working in the United States, 2018.<\/em> Centers for Disease Control; 2018:40. Accessed December 2, 2019. https:\/\/www.cdc.gov\/drugoverdose\/pdf\/pubs\/2018-evidence-based-strategies.pdf<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n\r\n\r\n\r\n<div class=\"well\"><figure class=\"wp-block-table is-style-stripes\"><table><tbody><tr><th>Medications for Opioid Use Disorder (MOUD)<\/th><\/tr><tr><td><ul><li>Medications for opioid use disorder<\/li><li>Eliminating prior-authorization requirements for MOUD<\/li><li>Medications for opioid use disorder in criminal justice settings and upon release<\/li><li>Initiating buprenorphine-based MAT (MOUD) in emergency departments<\/li><\/ul><\/td><td><\/td><\/tr><tr><th>Other Strategies<\/th><\/tr><tr><td><ul><li>Targeted naloxone distribution<\/li><li>Academic detailing<\/li><li>Fentanyl screening<\/li><li>Good Samaritan Laws (immunity from prosecution for assisting a person overdosing)<\/li><li>Naloxone distribution in treatment centers and criminal justice settings<\/li><li>Syringe services programs (also known as syringe access programs)<\/li><\/ul><\/td><td><\/td><\/tr><\/tbody><\/table><\/figure><figure class=\"wp-block-embed\">\r\n\r\n<\/figure><\/div>\r\n<\/div>\r\n<\/div>\r\n\r\n\r\n\r\n<h2>How is it prescribed?<\/h2>\r\n<h3>General guidelines<\/h3>\r\n<figure class=\"wp-block-table is-style-regular barriers\">\r\n    <table>\r\n        <thead>\r\n            <tr>\r\n                <th style=\"width: 40%\">Statement<\/th>\r\n                <th style=\"width: 20%\">True or False<\/th>\r\n                <th style=\"width: 40%\">Feedback<\/th>\r\n            <\/tr>\r\n        <\/thead>\r\n        <tbody>\r\n            <tr>\r\n                <td>Buprenorphine is usually prescribed as a short-term medication.<\/td>\r\n                <td>\r\n                    <form action=\"#\" id=\"Q1\">\r\n                        <input type=\"radio\" id=\"t1\" name=\"TF1\" value=\"True\" onclick=\"document.getElementById('fb1').classList.remove('hide');document.getElementById('cross1').classList.remove('hide');document.getElementById('check1').classList.add('hide');\"><label for=\"t1\">True<\/label>\r\n                        <input type=\"radio\" id=\"f1\" name=\"TF1\" value=\"False\" onclick=\"document.getElementById('fb1').classList.remove('hide');document.getElementById('check1').classList.remove('hide');document.getElementById('cross1').classList.add('hide');\"><label for=\"f1\">False<\/label>\r\n                    <\/form>\r\n                <\/td>\r\n                <td>\r\n                    <p id=\"fb1\" class=\"hide\">\r\n                        <span id=\"cross1\" class=\"hide\" style=\"color:#FF0000\">\u2718<\/span>\r\n                        <span id=\"check1\" class=\"hide\" style=\"color:#00CC00\">\u2714<\/span>\r\n                        This statement is false. Buprenorphine is typically prescribed as a long-term medication, sometimes life-long.\r\n                        <sup id=\"popoverAAA\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">1<\/sup>\r\n                    <\/p>\r\n                <\/td>\r\n            <\/tr>\r\n            <tr>\r\n                <td>Providers are required to be registered with the DEA to prescribe buprenorphine.<\/td>\r\n                <td>\r\n                    <form action=\"#\" id=\"Q2\">\r\n                        <input type=\"radio\" id=\"t2\" name=\"TF2\" value=\"True\" onclick=\"document.getElementById('fb2').classList.remove('hide');document.getElementById('check2').classList.remove('hide');document.getElementById('cross2').classList.add('hide');\"><label for=\"t2\">True<\/label>\r\n                        <input type=\"radio\" id=\"f2\" name=\"TF2\" value=\"False\" onclick=\"document.getElementById('fb2').classList.remove('hide');document.getElementById('cross2').classList.remove('hide');document.getElementById('check2').classList.add('hide');\"><label for=\"f2\">False<\/label>\r\n                    <\/form>\r\n                <\/td>\r\n                <td>\r\n                    <p id=\"fb2\" class=\"hide\">\r\n                        <span id=\"cross2\" class=\"hide\" style=\"color:#FF0000\">\u2718<\/span>\r\n                        <span id=\"check2\" class=\"hide\" style=\"color:#00CC00\">\u2714<\/span>\r\n                        This statement is true. Buprenorphine is a schedule III medication. Prescribers must be registered with the DEA to prescribe buprenorphine.\r\n                    <\/p>\r\n                <\/td>\r\n            <\/tr>\r\n            <tr>\r\n                <td>Providers are required to have a DEA X-waiver in order to prescribe buprenorphine.<\/td>\r\n                <td>\r\n                    <form action=\"#\" id=\"Q3\">\r\n                        <input type=\"radio\" id=\"t3\" name=\"TF3\" value=\"True\" onclick=\"document.getElementById('fb3').classList.remove('hide');document.getElementById('cross3').classList.remove('hide');document.getElementById('check3').classList.add('hide');\"><label for=\"t3\">True<\/label>\r\n                        <input type=\"radio\" id=\"f3\" name=\"TF3\" value=\"False\" onclick=\"document.getElementById('fb3').classList.remove('hide');document.getElementById('check3').classList.remove('hide');document.getElementById('cross3').classList.add('hide');\"><label for=\"f3\">False<\/label>\r\n                    <\/form>\r\n                <\/td>\r\n                <td>\r\n                    <p id=\"fb3\" class=\"hide\">\r\n                        <span id=\"cross3\" class=\"hide\" style=\"color:#FF0000\">\u2718<\/span>\r\n                        <span id=\"check3\" class=\"hide\" style=\"color:#00CC00\">\u2714<\/span>\r\n                        This statement is false. After enactment of the Consolidated Appropriations Act of 2023, Congress eliminated the DATA-Waiver program. Going forward, all prescriptions for buprenorphine only require a standard DEA registration number.\r\n                        <sup>27<\/sup>\r\n                    <\/p>\r\n                <\/td>\r\n            <\/tr>\r\n            <tr>\r\n                <td>The DEA places limits on the number of patients that advanced practice providers are able to see and prescribe buprenorphine.<\/td>\r\n                <td>\r\n                    <form action=\"#\" id=\"Q4\">\r\n                        <input type=\"radio\" id=\"t4\" name=\"TF4\" value=\"True\" onclick=\"document.getElementById('fb4').classList.remove('hide');document.getElementById('cross4').classList.remove('hide');document.getElementById('check4').classList.add('hide');\"><label for=\"t4\">True<\/label>\r\n                        <input type=\"radio\" id=\"f4\" name=\"TF4\" value=\"False\" onclick=\"document.getElementById('fb4').classList.remove('hide');document.getElementById('check4').classList.remove('hide');document.getElementById('cross4').classList.add('hide');\"><label for=\"f4\">False<\/label>\r\n                    <\/form>\r\n                <\/td>\r\n                <td>\r\n                    <p id=\"fb4\" class=\"hide\">\r\n                        <span id=\"cross4\" class=\"hide\" style=\"color:#FF0000\">\u2718<\/span>\r\n                        <span id=\"check4\" class=\"hide\" style=\"color:#00CC00\">\u2714<\/span>\r\n                        This statement is false. After enactment of the Consolidated Appropriations Act of 2023, there are no longer limitations, under federal law, on the number of patients with OUD that a practitioner may treat with buprenorphine.\r\n                        <sup>27<\/sup>\r\n                    <\/p>\r\n                <\/td>\r\n            <\/tr>\r\n            <tr>\r\n                <td>Buprenorphine has been shown to be diverted more frequently than oxycodone and hydrocodone.<\/td>\r\n                <td>\r\n                    <form action=\"#\" id=\"Q5\">\r\n                        <input type=\"radio\" id=\"t5\" name=\"TF5\" value=\"True\" onclick=\"document.getElementById('fb5').classList.remove('hide');document.getElementById('cross5').classList.remove('hide');document.getElementById('check5').classList.add('hide');\"><label for=\"t5\">True<\/label>\r\n                        <input type=\"radio\" id=\"f5\" name=\"TF5\" value=\"False\" onclick=\"document.getElementById('fb5').classList.remove('hide');document.getElementById('check5').classList.remove('hide');document.getElementById('cross5').classList.add('hide');\"><label for=\"f5\">False<\/label>\r\n                    <\/form>\r\n                <\/td>\r\n                <td>\r\n                    <p id=\"fb5\" class=\"hide\">\r\n                        <span id=\"cross5\" class=\"hide\" style=\"color:#FF0000\">\u2718<\/span>\r\n                        <span id=\"check5\" class=\"hide\" style=\"color:#00CC00\">\u2714<\/span>\r\n                        This statement is false. Diversion and misuse of buprenorphine products occurs at lower rates than many pharmacists and others assume.\r\n                        <sup id=\"popoverE\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">4,5<\/sup>\r\n                        Buprenorphine has been shown to be diverted less frequently than oxycodone and hydrocodone.\r\n                        <sup id=\"popoverF\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">6<\/sup>\r\n                    <\/p>\r\n                <\/td>\r\n            <\/tr>\r\n        <\/tbody>\r\n    <\/table>\r\n<\/figure>\r\n\r\n\r\n\r\n\r\n<div id=\"popoverAAA-content\" class=\"popover-content hide\">\r\n<div id=\"AAA\"><button id=\"AAA\" class=\"close\" type=\"button\">\u00d7<\/button>\r\n<ol start=\"1\">\r\n<li value=\"1\"> SAMHSA. TIP 63: Medications for Opioid Use Disorder. Published online 2021. Accessed August 1, 2021. https:\/\/www.cdc.gov\/drugoverdose\/pdf\/pubs\/2018-evidence-based-strategies.pdf <\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n\r\n<div id=\"popoverB-content\" class=\"popover-content hide\">\r\n<div id=\"B\"><button id=\"B\" class=\"close\" type=\"button\">\u00d7<\/button>\r\n<ol start=\"3\">\r\n<li value=\"3\"><a href=\"https:\/\/www.samhsa.gov\/medication-assisted-treatment\/become-buprenorphine-waivered-practitioner\/buprenorphine-waiver-faqs\"> https:\/\/www.samhsa.gov\/medication-assisted-treatment\/become-buprenorphine-waivered-practitioner\/buprenorphine-waiver-faqs<\/a><\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<div id=\"popoverBBB-content\" class=\"popover-content hide\">\r\n<div id=\"BBB\"><button id=\"BBB\" class=\"close\" type=\"button\">\u00d7<\/button>\r\n<ol start=\"3\">\r\n<li value=\"3\"><a href=\"https:\/\/www.samhsa.gov\/medication-assisted-treatment\/become-buprenorphine-waivered-practitioner\/buprenorphine-waiver-faqs\"> https:\/\/www.samhsa.gov\/medication-assisted-treatment\/become-buprenorphine-waivered-practitioner\/buprenorphine-waiver-faqs<\/a><\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<div id=\"popoverBBBB-content\" class=\"popover-content hide\">\r\n<div id=\"BBBB\"><button id=\"BBBB\" class=\"close\" type=\"button\">\u00d7<\/button>\r\n<ol start=\"3\">\r\n<li value=\"3\"><a href=\"https:\/\/www.samhsa.gov\/medication-assisted-treatment\/become-buprenorphine-waivered-practitioner\/buprenorphine-waiver-faqs\"> https:\/\/www.samhsa.gov\/medication-assisted-treatment\/become-buprenorphine-waivered-practitioner\/buprenorphine-waiver-faqs<\/a><\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<div id=\"popoverE-content\" class=\"popover-content hide\">\r\n<div id=\"E\"><button id=\"E\" class=\"close\" type=\"button\">\u00d7<\/button>\r\n<ol start=\"4\">\r\n<li value=\"4\">Chilcoat HD, Amick HR, Sherwood MR, Dunn KE. Buprenorphine in the United States: Motives for abuse, misuse, and diversion. <em>Journal of Substance Abuse Treatment.<\/em> 2019;104:148-157. doi:10.1016\/j.jsat.2019.07.005<\/li>\r\n<li>Cicero TJ, Ellis MS, Chilcoat HD. Understanding the use of diverted buprenorphine. <em>Drug and Alcohol Dependence.<\/em> 2018;193:117-123. doi:10.1016\/j.drugalcdep.2018.09.007<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<div id=\"popoverF-content\" class=\"popover-content hide\">\r\n<div id=\"F\"><button id=\"F\" class=\"close\" type=\"button\">\u00d7<\/button>\r\n\r\n<ol start=\"6\">\r\n<li value=\"6\">Dart RC. Per A New Frontier: Prescription Drug Abuse Beyond Opioids. Presented at: Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System 2020 14th Annual Scientific Meeting; n.d. <\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n\r\n\r\n<h3>Reasons for diversion<\/h3>\r\n<div class=\"diversion\">\r\n<p><b>Inability to obtain prescribed buprenorphine can contribute to diversion.<\/b><sup id=\"popoverJ\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">4,5<\/sup><\/p>\r\n<div id=\"popoverJ-content\" class=\"popover-content hide\">\r\n<div id=\"J\"><button id=\"J\" class=\"close\" type=\"button\">\u00d7<\/button><p><\/p>\r\n<p>&nbsp;<\/p>\r\n<ol start=\"4\">\r\n<li value=\"4\">Chilcoat HD, Amick HR, Sherwood MR, Dunn KE. Buprenorphine in the United States: Motives for abuse, misuse, and diversion. <em>Journal of Substance Abuse Treatment.<\/em> 2019;104:148-157. doi:10.1016\/j.jsat.2019.07.005<\/li>\r\n<li value=\"5\">Cicero TJ, Ellis MS, Chilcoat HD. Understanding the use of diverted buprenorphine. <em>Drug and Alcohol Dependence.<\/em> 2018;193:117-123. doi:10.1016\/j.drugalcdep.2018.09.007<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<ul>\r\n<li>Studies indicate that patients take buprenorphine without a prescription for therapeutic reasons, such as to reduce withdrawal symptoms, treat pain, manage psychiatric issues, and to wean off opioids.<sup id=\"popoverK\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">4,7<\/sup><\/li>\r\n<div id=\"popoverK-content\" class=\"popover-content hide\">\r\n<div id=\"K\"><button id=\"K\" class=\"close\" type=\"button\">\u00d7<\/button><p><\/p>\r\n<p>&nbsp;<\/p>\r\n<ol start=\"4\">\r\n<li value=\"4\">Chilcoat HD, Amick HR, Sherwood MR, Dunn KE. Buprenorphine in the United States: Motives for abuse, misuse, and diversion. <em>Journal of Substance Abuse Treatment.<\/em> 2019;104:148-157. doi:10.1016\/j.jsat.2019.07.005<\/li>\r\n<li value=\"7\">Carroll JJ, Rich JD, Green TC. The More Things Change: Buprenorphine\/naloxone Diversion Continues While Treatment Remains Inaccessible. <em>J Addict Med.<\/em> 2018;12(6):459-465. doi:10.1097\/ADM.0000000000000436<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<li aria-level=\"1\">Among people reporting use of diverted buprenorphine, the most common reasons were to prevent withdrawal (79%), maintain abstinence from opioids (67%), or wean off drugs (3%).<\/li>\r\n<li aria-level=\"1\">Among respondents who had used diverted buprenorphine, 33% reported barriers to finding a doctor or obtaining buprenorphine on their own.<\/li>\r\n<li aria-level=\"1\">The majority (81%) indicated they would prefer using prescribed buprenorphine, if available.<sup id=\"popoverJJ\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">5<\/sup>\r\n<div id=\"popoverJJ-content\" class=\"popover-content hide\">\r\n<div id=\"JJ\"><button id=\"JJ\" class=\"close\" type=\"button\">\u00d7<\/button><p><\/p>\r\n<p>&nbsp;<\/p>\r\n<ol start=\"5\">\r\n<li value=\"5\">Cicero TJ, Ellis MS, Chilcoat HD. Understanding the use of diverted buprenorphine. <em>Drug and Alcohol Dependence.<\/em> 2018;193:117-123. doi:10.1016\/j.drugalcdep.2018.09.007<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<\/li>\r\n<li>Previous use of non-prescribed buprenorphine is associated with greater likelihood of subsequent treatment success.<sup id=\"popoverHH\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">8<\/sup><\/li>\r\n<\/ul>\r\n<\/div>\r\n<div id=\"popoverHH-content\" class=\"popover-content hide\">\r\n<div id=\"HH\"><button id=\"HH\" class=\"close\" type=\"button\">\u00d7<\/button><p><\/p>\r\n<p>&nbsp;<\/p>\r\n<ol start=\"8\">\r\n<li value=\"8\">Monico LB, Mitchell SG, Gryczynski J, et al. Prior Experience with Non-Prescribed Buprenorphine: Role in Treatment Entry and Retention. <em>Journal of Substance Abuse Treatment.<\/em> 2015;57:57-62. doi:10.1016\/j.jsat.2015.04.010<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<h3>Combination vs. mono buprenorphine products<\/h3>\r\n<p>As shown in the table below, it may be appropriate for a patient to receive a buprenorphine mono product script for a range of reasons (as opposed to the combination product containing naloxone). The ultimate decision on formulation is the prescriber\u2019s. As of late 2021, the DEA and the Department of Justice demonstrated a preference for pharmacies to document a reason for dispensing mono-product buprenorphine. The prescriber can provide rationale with the script. If not, a pharmacist can inquire and document the response. <b><span style=\"color: #FFA800;\">EXAMPLE RATIONALE:<\/span> \u201cPatient has experienced an adverse reaction to naloxone\u201d<\/b><\/p>\r\n\r\n\r\n<p class=\"has-text-align-center\"><strong>Combination and Mono Product Buprenorphine: Reasons for Each Script<\/strong><\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-table is-style-stripes\"><table><tbody><tr><th><span>Combination product<\/span><span>Buprenorphine\/naloxone<\/span><\/th><th><span>Mono product<\/span><span>Buprenorphine<\/span><\/th><\/tr><tr><td><ul>\r\n<li style=\"text-align: left;\">Preferred for both withdrawal management and treatment of OUD<sup id=\"popoverG\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">9<\/sup><\/li>\r\n<div id=\"popoverG-content\" class=\"popover-content hide\">\r\n<div id=\"G\"><button id=\"G\" class=\"close\" type=\"button\">\u00d7<\/button>\r\n<ol start=\"9\">\r\n<li value=\"9\">The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. <em>Journal of Addiction Medicine.<\/em> 2020;14(2S):1-91. doi:10.1097\/ADM.0000000000000633<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<li style=\"text-align: left;\">Trainings for SUD treatment providers may recommend prescribing combo product.<\/li>\r\n<div id=\"popoverBBBBB-content\" class=\"popover-content hide\">\r\n<div id=\"BBBBB\"><button id=\"BBBBB\" class=\"close\" type=\"button\">\u00d7<\/button>\r\n<ol start=\"3\">\r\n<li value=\"3\"> <a href=\"https:\/\/www.samhsa.gov\/medication-assisted-treatment\/become-buprenorphine-waivered-practitioner\/buprenorphine-waiver-faqs\">https:\/\/www.samhsa.gov\/medication-assisted-treatment\/become-buprenorphine-waivered-practitioner\/buprenorphine-waiver-faqs\/<\/a> <\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<li style=\"text-align: left;\">Reduces risk of overdose<\/li>\r\n<li style=\"text-align: left;\">Proven safe in pregnancy<sup id=\"popoverH\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">10,11<\/sup> and recommended by some perinatal substance use treatment programs<sup id=\"popoverI\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">12<\/sup>\r\n<div id=\"popoverH-content\" class=\"popover-content hide\">\r\n<div id=\"H\"><button id=\"H\" class=\"close\" type=\"button\">\u00d7<\/button>\r\n<ol start=\"10\">\r\n<li value=\"10\">Linke S, Harrison R, Wallace P. A Web-based intervention used in general practice for people with excessive alcohol  consumption.<em> J Telemed Telecare.<\/em> 2005;11 Suppl 1:39-41. doi:10.1258\/1357633054461895<\/li>\r\n<li value=\"11\">Debelak K, Morrone WR, O\u2019grady KE, Jones HE. Buprenorphine+ naloxone in the treatment of opioid dependence during pregnancy\u2014initial patient care and outcome data. <em>The American journal on addictions. <\/em>2013;22(3):252-254.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<div id=\"popoverI-content\" class=\"popover-content hide\">\r\n<div id=\"I\"><button id=\"I\" class=\"close\" type=\"button\">\u00d7<\/button>\r\n<ol start=\"12\">\r\n<li value=\"12\">Project CARA. Use of Buprenorphine -Naloxone in Pregnancy (Project CARA Brief). Published online 2021.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<\/li>\r\n<li style=\"text-align: left;\">Less likely to be used other than as prescribed<\/li>\r\n<\/ul><\/td><td><ul>\r\n<li style=\"text-align: left;\" aria-level=\"1\">Patient has naloxone allergy or intolerance (nausea, vomiting) or sensitivity to buccal film materials<sup id=\"popoverMM\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">13,14<\/sup><\/li>\r\n<div id=\"popoverMM-content\" class=\"popover-content hide\">\r\n<div id=\"MM\"><button id=\"MM\" class=\"close\" type=\"button\">\u00d7<\/button>\r\n<ol start=\"13\">\r\n<li value=\"13\">Strickland DM, Burson JK. Sublingual absorption of naloxone in a large clinical population. <em>J Drug Metab Toxicol.<\/em> 2018;9(02):240. <\/li>\r\n<li value=\"14\">Blazes CK, Morrow JD. Reconsidering the usefulness of adding naloxone to buprenorphine. <em>Frontiers in Psychiatry.<\/em> 2020;11:958. <\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<\/ul><\/td><\/tr>\r\n<tr><td colspan=\"2\" class=\"both\"><h4>Reasons that apply to both combo and mono products<\/h4><ul><li>May be covered by insurance, or require prior authorization when the other product is not<\/li><li>May cost less via a patient assistance program<\/li><li>Patient was stable on mono product and transferred care to new prescriber; new prescriber decides not to change script<\/li><li>Patients may tolerate one better than the other, or vice versa<\/li><\/ul><\/td><\/tr><\/tbody><\/table><\/figure>\r\n\r\n\r\n\r\n\r\n\r\n<p class=\"has-text-align-center nav-text\">For a comprehensive list of buprenorphine product formulations available as of June 2024, <br>please see <a href=\"https:\/\/wp.media.unc.edu\/bupe\/resources\/\" data-type=\"URL\" data-id=\"https:\/\/wp.media.unc.edu\/bupe\/resources\/\">Resources.<\/a><\/p>\r\n\r\n\r\n<div class=\"lowernav\"><a href=\"https:\/\/wp.media.unc.edu\/bupe\/\"><button class=\"navbtn prev\" type=\"button\">\u2190 back<\/button><\/a><a href=\"#\"><button class=\"navbtn top\" type=\"button\">top<\/button><\/a><a href=\"\/bupe\/why-me-role-of-the-pharmacist\/\"><button class=\"navbtn next\" type=\"button\">next \u2192<\/button><\/a><\/div>","protected":false},"excerpt":{"rendered":"What is buprenorphine?1 &nbsp; Buprenorphine is a partial opioid agonist that binds to opioid receptors in the brain, reducing cravings and withdrawal symptoms when opioids are stopped. Buprenorphine does not have the same effects as full agonist opioids, especially when &hellip; <a href=\"https:\/\/wp.media.unc.edu\/bupe\/why-buprenorphine\/\" aria-label=\"Read more about Buprenorphine Facts\">Continued<\/a>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/pages\/7"}],"collection":[{"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/comments?post=7"}],"version-history":[{"count":316,"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/pages\/7\/revisions"}],"predecessor-version":[{"id":1621,"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/pages\/7\/revisions\/1621"}],"wp:attachment":[{"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/media?parent=7"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}