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Primary Care Providers Can Prescribe with Confidence

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Screening and Diagnosing Opioid Use Disorder in Primary Care Settings

Prescribing Medications to Treat Opioid Use Disorder

  • Types of medications used to treat opioid use disorder (OUD) and who can prescribe them
  • Why medications for OUD belong in primary care
  • Benefits and risks of medications used to treat OUD 
  • Counseling and medications used to treat opioid use disorder 

Some Practical First Steps to Learn More About Prescribing Medications Used to Treat Opioid Use Disorder

Screening and Diagnosing Opioid Use Disorder in Primary Care Settings

An estimated 6.1 million people over the age of 12 have an opioid use disorder (OUD) in the United States. Based on that prevalence, if you are a primary care provider it is very likely that you already provide medical care to people who also have OUD.  

There are many different resources that may help primary care providers find screening tools to identify people who are at risk for OUD. Some commonly used and often recommended screening tools include:


Prescribing Medication to Treat Opioid Use Disorder

Medications to treat OUD are still underused in the United States, even though there is significant evidence showing their safety and effectiveness. Primary care providers can save lives by treating people using medications for opioid use disorder.

Types of medications used to treat OUD and who can prescribe them

The FDA has approved three medications for treatment of OUD: buprenorphine, naltrexone, and methadone.

The most commonly prescribed medications used to treat OUD in outpatient primary care settings are buprenorphine-containing products, which are available in a film or tablet for sublingual or buccal use. There are also long-acting injectable forms of buprenorphine.

Physicians, physician assistants, and nurse practitioners who have a current Drug Enforcement Administration (DEA) registration with authority to prescribe controlled substances can prescribe buprenorphine for OUD, though some states may have additional requirements to do so. New or renewing DEA registrants must meet DEA requirements to continue prescribing.

A DATA waiver (X-waiver), long considered a barrier preventing health care providers from prescribing buprenorphine, is no longer required. The Substance Abuse and Mental Health Services Administration (SAMHSA) has more information about waiver elimination.

Injectable naltrexone can also be prescribed by any provider with the authority to prescribe medication.

Methadone used to treat OUD can only be dispensed by opioid treatment programs (OTPs), except in very limited circumstances. You can find OTPs and other treatment programs at FindTreatment.gov


A podcast from the American Academy of Addiction Psychiatry discusses how to Navigate the New 8-Hour Training Requirement for SUDs: What Prescribers Should Know.


Why medications for OUD belong in primary care

There are many people who need or want treatment but who have not received any for their OUD. Many may not be able to access specialty care for this purpose. As a primary care prescriber treating other chronic health conditions, you are in a key position to also prescribe medications for OUD.

Benefits and risks of medications used to treat OUD

There is abundant evidence that treatment for OUD is most effective when medications are used. Treatment of OUD with medications reduces opioid misuse and the risks of overdose, return-to-use, and death compared with those receiving no treatment.

People with OUD should be informed of the risks of the medication and the risks of no treatment. Prescribing information for all medications used to treat OUD can be found at Drugs@FDA. Some additional resources include:

  • Buprenorphine: Office-Based Buprenorphine Therapy for Opioid Dependence: Important Information for Prescribers describes important safety information for buprenorphine-containing products, such as safety, protocols for induction and maintenance, preventing diversion and misuse, along with additional information on treating OUD.
    • Dental concerns: Health care professionals should also be aware of dental concerns associated with use of medicines containing buprenorphine that are dissolved in the mouth. The FDA has issued a Drug Safety Communication and provided information for patients and providers about managing this risk. 
    • Safe conditions to prescribe: The Appropriate Use Checklist is a useful reminder of the safe conditions and monitoring recommendations for prescribing buprenorphine-containing transmucosal products for OUD.
  • Secure storage: Instruct people who are prescribed these products to keep them in a secure place, out of the sight and reach of all others, especially children. Ingestion by a child may cause respiratory depression that can result in death. Advise people to seek medical attention immediately if a child is exposed to one of these products. Refer to FDA's Remove the Risk Campaign and the PROTECT Initiative.  
  • Naloxone: Naloxone is a lifesaving emergency treatment that reverses opioid overdose. Discuss the availability of naloxone and strongly consider prescribing it. People receiving medicines to treat OUD have a lower risk of opioid overdose than those with OUD who are not being treated; however, even when being treated with MOUD, there is still a risk of return-to-use and opioid overdose.  
  • Naltrexone: Naltrexone Injection for Opioid Use Disorder – FDA’s Efforts to Reduce Medication Errors is a webinar focused on medication errors identified for naltrexone injectable suspension and actions to mitigate those errors. The session also highlighted the importance of the health care provider's role in drug safety.

Counseling and medications used to treat opioid use disorder

Treatment with medications for OUD should include an offer of counseling or other services, when possible, based on an individual’s stage of change. However, treatment with medication should not be contingent upon someone choosing to participate in these additional services.

With respect to buprenorphine, for example, evidence shows that when counseling or other services are not immediately available, people still benefit from buprenorphine treatment.

It is important to not place treatment engagement conditions or preconditions on someone seeking treatment for OUD. This includes conditions for treatment, for example a requirement to receive multiple services or treatment for co-occurring conditions such as mental disorders.


Some Practical First Steps to Learn More About Prescribing Medications Used to Treat Opioid Use Disorder

There are a few steps to take to become a prescriber of medications to treat OUD.

  1. Read the FDA-approved labeling for the product you are interested in prescribing and consider the risks and benefits of treatment for each person. See FDA-approved products at Information about Medications for Opioid Use Disorder and obtain drug labeling from: Drugs@FDA.
  2. Know the necessary rules, requirements, and options in your state by checking with state medical boards or health departments.  
  3. Complete the 8 hours of training per DEA requirements and review available resources focused on implementation.
  4. Plan ahead for how you and your practice team will screen for OUD and how you will work with your patients to develop a treatment plan that will work for them.
  5. Consider talking with local pharmacies ahead of time to make sure they will carry buprenorphine and/or consider engaging with a pharmacist under a collaborative practice agreement.

Resources for New and Current Prescribers

There are many federal and federally supported resources that provide effective overviews of what to expect and what to plan for when starting to prescribe medications used to treat OUD. If you are a healthcare provider who is considering becoming a prescriber of MOUD, here are two useful publications:

The Substance Abuse and Mental Health Services Administration, the National Institute on Drug Abuse, the Centers for Disease Control and Prevention, and the Agency for Healthcare Research and Quality have all created additional content and resources to help providers understand and take steps to help combat substance use disorders, including OUD.

Education and information for current and future prescribers

More training resources for providers

Other resources that will help primary care providers understand and complete the requirements to become a prescriber of medications for OUD include:  

  • The Centers for Disease Control and Prevention (CDC) offers four training modules about how to help people with substance use disorders (SUDs) and outlines support services within the field of addiction medicine, diagnosing and assessing SUDs, communication strategies to build a collaborative patient relationship, and the role of care coordination in the treatment of SUDs. One hour of continuing education (CE) credit is available after completing all modules.
  • The American Medical Association’s (AMA) Substance Use Disorders continuing medical education (CME) activities also apply toward the one-time 8-hour training requirement in substance use disorders for DEA registration and renewal.

Information to share with people who have OUD

There are also many resources on these topics available for you to share with people who have OUD.

Substance use disorders, opioids and opioid use disorders

Treatment of OUD

Safe storage and disposal

Talking About Opioid Use Disorder and Fighting Stigma

People with OUD often experience the negative consequences of inaccurate assumptions about who they are, which is known as stigma. Stigmatizing assumptions may: 

  • Lower someone’s willingness to seek treatment.
  • Cause feelings of isolation as stereotypes lead other people to feel pity, fear, anger, or a need to keep away from someone who has OUD.
  • Negatively influence health care providers’ perceptions of people with OUD and impact the care they receive.   

The Centers for Disease Control and Prevention (CDC) created a video-based training module about Effective Communication in Treating Substance Use Disorders.

The National Academy of Medicine co-hosted a Stigma of Addiction Summit to discuss the negative impact of stigma on people with substance use disorders.

Effective substance use disorder (SUD) treatment, including treatment for OUD, requires providers to understand what an individual genuinely needs to do to change substance use behaviors. Motivational interviewing is a collaboration between patients and providers to approach change based on a patient’s existing motivations, values, strengths, and resources. Read more in the Using Motivational Interviewing in Substance Use Disorder Treatment advisory (SAMHSA).

What you say matters

The words you choose play a powerful role in how someone perceives your willingness to help them and your perceptions of them. Health care professionals who provide OUD treatment can improve patient experiences and combat stigma by using person-centered, strengths-based language. In other words, choose language that focuses on a person’s unique characteristics rather than on their health condition or disease.

Use Person-Centered Language to Avoid Stigma

Examples of person-centered language:

  • Person with a substance use disorder
  • Person who is in active use or has returned to use
  • Person with OUD

More examples of strengths-based language can be found in the Substance Abuse and Mental Health Services Administration guide Practical Tools for Prescribing and Promoting Buprenorphine in Primary Care Settings and the National Institute on Drug Abuse’s Words Matter - Terms to Use and Avoid When Talking About Addiction.


In Their Own Words: Health Care Providers

Dr. Matthew Hahn on the Importance of Destigmatizing OUD Treatment
Dr. Matthew Hahn, a rural Maryland family physician, discusses why opioid use disorder should be treated the same way as asthma, diabetes, hypertension, or other chronic health conditions.
An MOUD Success Story from Dr. Matthew Hahn
Dr. Matthew Hahn, a rural Maryland family physician, shares a story about using medication to successfully treat a patient with opioid use disorder (OUD). 
Dr. Matthew Hahn on Treating OUD with Medication
Dr. Matthew Hahn, a rural Maryland family physician, shares his success at treating patients with medications for opioid use disorder (MOUD). 

The opinions in these videos reflect the views of individuals, and not necessarily the official position of the FDA's Center for Drug Evaluation and Research. The videos represent accurate information about approved medications and treatments at the time the interviews were conducted.


Free Materials to Spread the Word about the Prescribe with Confidence Campaign

You can save lives by helping more health care providers recognize OUDs and the options to treat them, including medications used to treat OUD.

See campaign materials available for sharing and download on our Partners page.

 
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