When something is new, its bound to constantly change and adapt until its stabilized...buprenorphine practice and treatment is certainly no exception.
Just last week we got a phone call from a friend whom is also an Emergency Room physician that owns a Buprenorphine practice...a local drug rep had begun to tell him about the "major changes" coming up from the south, and naturally, he was very nervous.
This always confused us ...if your doing everything up to standard, what should you have to be nervous about? And then it occurred to us...that maybe, just maybe...not everyone is as boring as us and scanning the news for these types of things. So...without further interruption, heres a run down of what has already been put into effect in Virginia and Tennessee and what will inevitably make its way across this nation.
On February 16, 2017 the Virginia Board of Medicine adopted regulations entitled “Governing Opioid Prescribing for Pain and Prescribing of Buprenorphine" and it breaks down to the following major points:
Subutex (buprenorphine mono-product) can only be legally prescribed to two VERY specific populations
1) Pregnant women
Notice i did NOT say breastfeeding, and neither did the Board report
2) Methadone transfers
This is NOT to exceed a 7 day supply
3) Dosage Limits
Patients should be treated with buprenorphine mono-product in doses 16mg per day or less
4) No Other Reasoning Considered Valid for Subutex Prescriptions
"Other states also permit the prescription of the buprenorphine mono-product in cases where there is a documented allergy as confirmed by a Board Certified allergist, or in cases where a patient has failed a course of treatment in a category commonly referred to as medical necessity. The Board chose not to adopt either of those exceptions out of concern that they would be abused and be difficult to enforce."
What Else Has Changed?
Screening/Medical Testing Requirements
At the onset of treatment, urine drug screens, pregnancy tests for women of child bearing age and ability, and a check of the PDMP and testing must be performed for HIV, Hepatitis B, Hepatitis C, and TB are required
Mandated Professional counseling/behavioral health services
No, this is not NA/AA or any other form of "community support". This is a professional counselor, social worker, psychologist etc that is specifically trained in MAT treatment or substance abuse treatment.
While this has been a "unwritten law" since the beginning, it is now a state law to have in clients charts
Doses cannot exceed 24mg per day of any combination of buprenorphine product and any dosage above 16mg will require high levels of supporting documentation
Read the full article here: VA Laws
What About The Licensing Rumors?
While this topic doesn't have much to do with Virginia (yet) it is also probably something heading our way.
New to the state of Tennessee for the 2017 year - ALL Buprenorphine based practices will be required to apply for a specific license.
"As of Jan. 1 the currently unregulated clinics have to apply for a license. Requirements include things like a financial statement, an $810 annual licensing fee and proof of a physician." according to wjhl.com.
See the article here: TN Licensing
Be Adaptable - Or Be Left Behind
There couldn't be a better quote to sum up providers working in the MAT industry (or clients seeking treatment in it!). And while all these changes SEEM daunting and frustrating at times, remember that, so is the opioid epidemic that we living in. Good practice owners (those whom are already staying up to date with the new laws and regulations and practicing in accordance) often times feel overwhelmed with the constant changes they need to make and the rat race to stay ahead of the legislation game.
But this isn't a reason to give up. The government isn't fighting to shut down the good practices...they are fighting to set standards so the "not so good" clinics can shape up or ship out.
The doctors that change hundreds per month depending on what medications the clients get (hint: Subutex appointments always cost the most)...the clinics that work on a "pay per prescription basis"that sell prescriptions via secretary or where you don't even see your doctor when your getting medications...the offices that don't mandate counseling services or taper plans that don't care if their clients improve...THESE are the enemy, not the government.
Yes...times are getting more difficult. Someone is finally setting a good standard of care for the clinics and you know what? WE SHOULD BE THRILLED! Someone is finally noticing the poor practices of some of these cash clinics that are giving the rest of the GOOD providers a bad rap. I can name plenty of "licensed facilities" that have crap staff and a very low success rates....just like i can name several cash clinics that have amazing results without being sucked into the insurance "one size fits all routine".
But in the end...none of this should matter. Why does it matter if an office is taking cash or accepting insurance if they have an equal set of standards they have to follow? Isn't the primary goal of ALL of these facilities to get help those in need? Perhaps we should start to judge them on success rates rather than how they pay their bills...
To you doctors/counselors/medical staff out there reading this...I encourage you to continue to adapt with the regulations and be patient. If you are a client reading this...dont panic when you come in for your appointments and there are new changes to your treatment. Everything that these clinics are changing is meant for your own good.
As always....if you have any further questions - feel free to comment below!
Coming Up Next Week: INSURANCE vs. CASH - The Great Debate