Methadone/Buprenorphine Prescriptions

Transcription

1 Methadone/Buprenorphine Prescriptions From office to pharmacy to patient Joy Bhimji BSP Methadone/Buprenorphine 101 Workshop December 10, 2016

2 Which prescription (Rx)? Suboxone write in DWI, carry info Analgesia Suboxone OUD (Methadose ) MG NOT UNITS UNITS NOT MG College of Physicians and Surgeons of British Columbia 2

3 Writing the Rx Yes, you can write more than one strength on the same form, just be clear (ideal to use dates) e.g. Suboxone 2mg i sl qd Aug 1-7 then 4mg sl qd Aug 8-28 e.g. 1) Metadol 25mg bid Sep 1-30, and 2) Metadol 3mg tid Sep 1-30 College of Physicians and Surgeons of British Columbia 3

4 Refill vs. part-fill No refills allowed, but part-fills ok e.g. Suboxone 8mg SL qd x 84 days (Jan 4 Mar 21), dispense 7 tablets/week; use this when patients are stable College of Physicians and Surgeons of British Columbia 4

5 Tapers Tapers may be done on the same Rx as well, as long as total quantity = dates of Rx e.g. Methadone 10mg qd x 7d then 9mg qd x 7d Total quantity = 385mg and dates Aug 2-Oct 10 inclusive College of Physicians and Surgeons of British Columbia 5

6 Writing the Rx For methadone Rxs, start and stop dates should exactly match total quantity authorized (audit) Even for Suboxone it is ideal to match the dates of dispensing to the quantity authorized write in start/stop dates and if DWI Make sure the Rx does not end on a weekend Discuss safe storage Discuss naloxone THN and pharmacy supply Pharmacists cannot independently alter the Rx; if any alterations must be made (in rare cases) then the prescriber must initial to confirm Border towns or regular patients from out of province? Register with the respective college in the other province as well College of Physicians and Surgeons of British Columbia 6

7 What do CPBC and Pharmacare require? Only a pharmacist can witness Nurses can only witness inside correctional facilities Prescription requirements: All fields on the Rx must be filled out ud is not acceptable from audit standpoint CPSID, not MSP number Correct contact information for pharmacist in case of issues, especially if you practice at multiple sites Technically, faxing the Rx does not legalize it if you must fax it to the pharmacy, you must send the original to them as well (mail next day, courier, drop it off in person, etc.) College of Physicians and Surgeons of British Columbia 7

8 Who can witness? College of Physicians and Surgeons of British Columbia 8

9 Faxing Rxs PPP66_Policy_Guide_MMT.pdf College of Physicians and Surgeons of British Columbia 9

10 Appendix 4 College of Physicians and Surgeons of British Columbia 10

11 Changing the Rx College of Physicians and Surgeons of British Columbia 11

12 Why not the care aide or grandmother? College of Physicians and Surgeons of British Columbia 12

13 PPP-71 delivery of MMT College of Physicians and Surgeons of British Columbia 13

14 Filling the Rx If it is post-dated then it cannot be filled until the date indicated, and witnessing of first dose for that Rx must still occur First dose must always be witnessed if for OUD DWI (if more than once a week) should be staggered, not consecutive days Start and stop dates should match total quantity, no extras Discuss your policy for missed doses, incomplete ingestion, loss/theft and pharmacy closures, with the pharmacies that dispense for your patients College of Physicians and Surgeons of British Columbia 14

15 Special circumstances Air travel tablets may be more appropriate but not covered. Provide documentation for patient Extended travel rudt before and after? be judicious with quantities do a count before and after Snowbirds many come back for Christmas Work situations patient should find a pharmacy nearby that can do the witnessing, and you can send Rx to them. Also advisable to find a lab nearby for rudt Remote work document document document College of Physicians and Surgeons of British Columbia 15

16 CATSA exemptions College of Physicians and Surgeons of British Columbia 16

17 Naloxone On March 22, 2016, naloxone was changed to Schedule II in BC available without a prescription at pharmacies On September 16, 2016, emergency-use naloxone was removed from Drugs Schedules Regulation it is now unscheduled Training is still important! Toward the Heart (BCCDC) CPBC resources: Checklist for Naloxone Training Naloxone brochure Naloxone FAQs College of Physicians and Surgeons of British Columbia 17

18 Questions? Methadone Maintenance Program Phone: ext Fax: College of Physicians and Surgeons of British Columbia 18