With all the emphasis on treatment for those who have opioid dependency or addiction issues, more physicians are becoming prescribers of buprenorphine
(known as Subutex and Suboxone). This is an area where providers should be careful especially if they are not addiction specialists.
There are over 230 physicians listed on the Suboxone website who are within 20 miles of my office in downtown Los Angeles and are prescribing Suboxone. Family practice and general practice physicians need to be very careful in treating patients with buprenorphine, a Schedule III drug, and in determining when there is legitimate medical necessity to prescribe.
Patients with addiction disorders can be a risky patient pool from a risk management perspective. Physicians should have training and a very strict system of paperwork, patient history, urine testing, CURES reports, consent and education and a process for behavioral and psychological counseling. There is a standard of care for addiction medicine and Suboxone prescribers will be held to that standard.
We are seeing more physicians who are getting Medical Board complaints relating to the prescribing of Suboxone and are blind-sided when they believed they were filling an important need and instead are getting complaints from family members, patients or government agencies when patients are selling Suboxone or using it and contraindicated street or prescription drugs. Make sure you set up a Suboxone program that is compliant with all prescribing laws and regulations and meets the standards of practice for addiction medicine.
(known as Subutex and Suboxone). This is an area where providers should be careful especially if they are not addiction specialists.
There are over 230 physicians listed on the Suboxone website who are within 20 miles of my office in downtown Los Angeles and are prescribing Suboxone. Family practice and general practice physicians need to be very careful in treating patients with buprenorphine, a Schedule III drug, and in determining when there is legitimate medical necessity to prescribe.
Patients with addiction disorders can be a risky patient pool from a risk management perspective. Physicians should have training and a very strict system of paperwork, patient history, urine testing, CURES reports, consent and education and a process for behavioral and psychological counseling. There is a standard of care for addiction medicine and Suboxone prescribers will be held to that standard.
We are seeing more physicians who are getting Medical Board complaints relating to the prescribing of Suboxone and are blind-sided when they believed they were filling an important need and instead are getting complaints from family members, patients or government agencies when patients are selling Suboxone or using it and contraindicated street or prescription drugs. Make sure you set up a Suboxone program that is compliant with all prescribing laws and regulations and meets the standards of practice for addiction medicine.
Case Study On May 3, 2018, an Indictment was filed relating to opioid addiction and the prescribing of Suboxone and shows the potential pitfalls in a practice.
Five physicians were independent contractors at an opioid addiction treatment practice (Redirections Treatment Advocates, LLC) with offices in Pennsylvania and West Virginia. The Indictments allege that the physicians, working as contractors at various locations, created and distributed unlawful prescriptions for buprenorphine. The physicians were are also charged with conspiracy to unlawfully distribute buprenorphine. The office manager of a West Virginia location was indicted in late April 2018.
Finally, the physicians were also charged with health care fraud for allegedly causing fraudulent claims to be submitted to Medicare or Medicaid for payments to cover the costs of the unlawfully prescribed buprenorphine. An indictment is an accusation. A defendant is presumed innocent unless and until proven guilty.
Conclusion.
Physicians who are prescribing buprenorphine in a clinic setting need to be vigilant in their treatment guidelines and record keeping. Prescribing this Schedule III drug without proper recordkeeping on the assessment, diagnosis, dosing, treatment, tapering and consent for the patient can subject themselves to federal or state criminal charges or Board action.
I have seen many files where the physician accepted the patient's representation of being opioid dependent without any documentation or history. There is a system to be followed for this type of treatment and it is critical that physicians and advanced practitioners are thorough.
Five physicians were independent contractors at an opioid addiction treatment practice (Redirections Treatment Advocates, LLC) with offices in Pennsylvania and West Virginia. The Indictments allege that the physicians, working as contractors at various locations, created and distributed unlawful prescriptions for buprenorphine. The physicians were are also charged with conspiracy to unlawfully distribute buprenorphine. The office manager of a West Virginia location was indicted in late April 2018.
Finally, the physicians were also charged with health care fraud for allegedly causing fraudulent claims to be submitted to Medicare or Medicaid for payments to cover the costs of the unlawfully prescribed buprenorphine. An indictment is an accusation. A defendant is presumed innocent unless and until proven guilty.
Conclusion.
Physicians who are prescribing buprenorphine in a clinic setting need to be vigilant in their treatment guidelines and record keeping. Prescribing this Schedule III drug without proper recordkeeping on the assessment, diagnosis, dosing, treatment, tapering and consent for the patient can subject themselves to federal or state criminal charges or Board action.
I have seen many files where the physician accepted the patient's representation of being opioid dependent without any documentation or history. There is a system to be followed for this type of treatment and it is critical that physicians and advanced practitioners are thorough.
