Course Readies Psychiatrists for Office-Based Opiate Treatment

At this year’s annual meeting in New Orleans, psychiatrists will be able to complete the minimum eight hours of training required by new federal regulations controlling the use of buprenorphine (Subutex or Suboxone) in the treatment of opiate addiction. With final approval of the drug expected at any time, addiction specialists will be ready to begin the new and revolutionary office-based treatment program.

Buprenorphine, alone in tablet form (Subutex) or in combination with naloxone (Suboxone), is the long-awaited treatment developed by the National Institute on Drug Abuse (NIDA) in collaboration with Rickett and Colman Pharmaceuticals Inc. (Psychiatric News, September 1, 2000). Legislation allowing buprenorphine to be dispensed in an office-based environment, the Drug Addiction Treatment Act of 2000, was signed into law by President Clinton last October.

The act allows qualified office-based physicians and group practices to treat up to 30 patients for opioid addiction at one time, although this cap may be adjusted by the secretary of Health and Human Services (HHS). Physicians who use the drug must be registered with the Drug Enforcement Agency (DEA) and have an existing capacity to refer patients for counseling and any additional treatment that may be necessary. Physicians must then notify the secretary of HHS of their intent to dispense or prescribe buprenorphine under the new law.

Qualifying Criteria

According to the legislation, a “qualified physician” is one who is licensed under state law and meets any one of a list of criteria. Qualifying criteria include holding a subspecialty certification in addiction psychiatry from the American Board of Medical Specialties, addiction certification by the American Society of Addiction Medicine, or subspecialty certification in addiction medicine from the American Osteopathic Association. Physicians who are not formally certified may qualify by completing a minimum of eight hours of training by an organization approved under the act. APA is an approved provider for the eight-hour course.

At press time, however, final approval of buprenorphine had not been granted. As required by law, the DEA must develop regulations categorizing the drug under the Controlled Substances Act, and the Food and Drug Administration (FDA) must approve the drug specifically for use in the treatment of opiate addiction. The DEA is prepared to designate buprenorphine as a Schedule V controlled substance upon FDA approval. In addition, the DEA is preparing regulations that would allow physicians to prescribe buprenorphine rather than dispense it directly, as called for in the original legislation.

The FDA’s approval has been considered imminent for some time now. By completing the training course at the annual meeting, physicians will, upon final approval by the FDA, be ready to notify the secretary of HHS of their intention to begin offering treatment and may begin treating patients no later than 45 days after that notification, unless HHS notified them in writing that they do not qualify.

The Drug Addiction Treatment Act effectively bars states from enacting regulations to restrict the expansion of opiate addiction treatment for a period of three years. After that time, states will be able to choose whether to continue allowing physicians to treat patients with opiate addictions in an office-based setting.

Course Details

APA’s Council on Addiction Psychiatry and the American Academy of Addiction Psychiatry are cosponsoring the CME course (no. 24) titled “Office-Based Treatment of Opiate-Dependent Patients,” which will be held Sunday, May 6, from 8:30 a.m. to 4:30 p.m. It is an intermediate course for physicians who already have a basic knowledge of treating patients with substance abuse disorders.

The course will include lecture, case discussions, and a question-and-answer period. Content will focus on the core information unique to using buprenorphine to manage opioid abuse and dependence.

The course will review the basic aspects of opioid pharmacology as well as nonpharmacological treatments that are necessary to achieve stability in patients with opioid addiction and dependence. In addition, the different levels of treatment services available will be reviewed, as well as the specific types of treatments that may be used in the different levels. Psychiatric and medical comorbidities that the physician must be aware of in this patient population will also be discussed, as will assessment and appropriate selection for office-based opiate dependence treatment.

Seating for this CME course is limited, so advance registration is encouraged.

To register for this or any CME course, use the Advance Registration and Course Enrollment form in the Advance Registration Information Booklet. ▪