Methadone/Buprenorphine 101

Transcription

1 Methadone/Buprenorphine 101 October 1, 2016 Joy Bhimji, BSP Manager, Drug Programs

2 College of Physicians and Surgeons of British Columbia 2

3 College of Physicians and Surgeons of British Columbia 3

4 Regulatory framework The College s goal is to ensure an adequate, well-trained methadone maintenance workforce in BC College of Physicians and Surgeons of British Columbia 4

5 Overview of presentation Understand the regulatory framework for methadone Identify the types of methadone authorizations Know the process to obtain an authorization Methadone Practice Assessments College of Physicians and Surgeons of British Columbia 5

6 Regulatory framework Health Canada Ministry of Health College of Physicians and Surgeons of BC College of Physicians and Surgeons of British Columbia 6

7 Regulatory framework College s role Set standards Recommendations/physician roster Provide education Not to punish or micromanage No patient registry College of Physicians and Surgeons of British Columbia 7

8 Methadone and buprenorphine maintenance is more than just a script Analgesia Suboxone OUD College of Physicians and Surgeons of British Columbia 8

9 Authorization types Methadone authorizations 1. Methadone for opioid use disorder 2. Methadone for analgesia 3. Methadone for hospitalists 4. Temporary authorizations for methadone Locum in clinic or correctional centre Hospital (patient-specific) College of Physicians and Surgeons of British Columbia 9

10 Methadone authorization for opioid use disorder Obtaining an an authorization exemption Attendance at Methadone 101 Workshop sponsored by the College Familiarization with the Methadone and Buprenorphine: Clinical Practice Guideline for Opioid Use Disorder Familiarization with the Safe Prescribing of Drugs with Potential for Misuse/Diversion document Preceptorship satisfactory to the Methadone Maintenance Program Commitment to regularly review the PharmaNet profile of your patient(s) Commitment to prescribe methadone dispensed as daily witnessed ingestion until the patient has sufficient clinical stability and is able to safely store methadone carries Commitment to discussing the availability of take-home naloxone with any patient being discharged on methadone Agreement to undertake a minimum of 12 hours of continuing medical education (CME) in addiction medicine each year Agreement to undergo regular assessments of your methadone maintenance practice College of Physicians and Surgeons of British Columbia 10

11 Obtaining an authorization Methadone authorization for analgesia Familiarization with the recommended key articles on methadone for analgesia Familiarization with the Recommendations for the Use of Methadone for Pain handbook Familiarization with the Safe Prescribing of Drugs with Potential for Misuse/Diversion document Completion of the Methadone for Pain in Palliative Care online course ( Commitment to regularly review the PharmaNet profile of your patient(s) College of Physicians and Surgeons of British Columbia 11

12 Methadone authorization for hospitalists Obtaining an an authorization exemption Attendance at Methadone 101 Workshop sponsored by the College Familiarization with the Methadone and Buprenorphine: Clinical Practice Guideline for Opioid Use Disorder Familiarization with key articles on methadone for analgesia Familiarization with the Recommendations for the Use of Methadone for Pain handbook Familiarization with the Safe Prescribing of Drugs with Potential for Misuse/Diversion document Commitment to regularly review the PharmaNet profile of your patient(s) Commitment to prescribe methadone dispensed as daily witnessed ingestion until the patient has sufficient clinical stability and is able to safely store methadone carries College of Physicians and Surgeons of British Columbia 12

13 Methadone authorization for hospitalists Obtaining an an authorization exemption Commitment to discussing the availability of take-home naloxone with any patient being discharged on methadone Understanding that this dual authorization allows you to prescribe methadone both for analgesia and opioid use disorder but agreement not to initiate methadone treatment without consultation with a physician who has a full authorization to prescribe methadone (either for analgesia or opioid use disorder, as appropriate) Understanding that your application for a federal authorization to prescribe methadone both for analgesia and opioid use disorder refers to in-hospital patients but includes the provision of appropriate discharge prescriptions Commitment to ensuring that any patient for whom you prescribe methadone in hospital has an identified community prescriber and that I will communicate with that prescriber prior to the patient's discharge College of Physicians and Surgeons of British Columbia 13

14 Temporary authorizations for methadone Valid for a maximum of 60 days (maximum two back-to-back) Allow prescriptions at a patient s current dose, or at a lower dose if clinically indicated Must have prior approval by a fully authorized physician to increase the methadone dose Not able to register (initiate) patients in the Methadone Maintenance Program Must contact the College to confirm the temporary authorization has been processed and to order prescription pad Good standing with the College Obtaining an an authorization exemption Satisfactory review of PharmaNet practitioner prescription profile College of Physicians and Surgeons of British Columbia 14

15 METHADONE PRACTICE ASSESSMENT (MPA) College of Physicians and Surgeons of British Columbia 15

16 What happens? The methadone practice assessment is a regular evaluation of methadone practice. The intention is to continually improve quality of methadone maintenance treatment in BC and make it more accessible, while maintaining patient safety and enabling successful outcomes. Assessments can be documentary or office, and assessors provide support and guidance throughout the process. Once an assessment is completed, the College welcomes feedback through the Peer Practice Assessment Evaluation. A copy of the completed MPA will be sent to you with recommendations as necessary. College of Physicians and Surgeons of British Columbia 16 16

17 Methadone practice assessments When starting out, don t wait to ask questions! We are here to support you. Within the first year, College will request charts for documentary practice assessment by medical consultant. What are we looking for? Complete workup Good documentation Use of PharmaNet Dosing Policies: UDT, missed dose, carries Discussion regarding naloxone Based on score, we will: review again when authorization is up for renewal arrange on-site assessment College of Physicians and Surgeons of British Columbia 17

18 To prepare Keep current and review the following: Methadone and Buprenorphine: Clinical Practice Guideline for Opioid Use Disorder Methadone peer practice assessment form Checklist for Methadone or Buprenorphine Maintenance Prescriber Methadone and Buprenorphine Prescribers Tool Kit Check website: Methadone Maintenance Program College of Pharmacists of BC, Professional Practice Policy #6: Policy Guide Methadone Maintenance Treatment in advance College of Physicians and Surgeons of British Columbia 18

19 Questions? Methadone Maintenance Program Phone: ext Fax: College of Physicians and Surgeons of British Columbia 19