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Buprenorphine Training

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Understanding Opioid Medications and Buprenorphine Formulations

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Review Activity Description

Understanding Opioid Medications and Buprenorphine Formulations

1 hr out of up to 8.5 CME/CE

Goal: To prepare the learner to apply an understanding of the biology and pharmacology of opioids and in particular, buprenorphine, when treating patients with opioid use disorder.
To prepare the learner to select the formulation of buprenorphine that is best for each patient and provide relevant education when treating patients with opioid use disorder.

Review Activity Description

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Educational Objectives:

After completing this activity participants will be able to:

  • Relate the structure of opioids to their biological effects
  • Describe the biological actions of opioid agonists, partial agonists, and antagonists
  • Relate pharmacological properties of buprenorphine and naloxone to physiological effects
  • Relate opioid dependence, overdose, tolerance, and withdrawal to buprenorphine treatment
  • Explain how buprenorphine works to reduce opioid craving and physical dependence
  • Distinguish the different forms of buprenorphine, including when and how they are used

Choose Another Module:

Buprenorphine for Opioid Use Disorder: Overview course image
Buprenorphine for Opioid Use Disorder: Overview

0.5 Hrs

30 min

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Screening, Detection, and Diagnosis of Opioid Use Disorder course image
Screening, Detection, and Diagnosis of Opioid Use Disorder

1 Hr

60 min

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Assessing Patients for Buprenorphine Treatment course image
Assessing Patients for Buprenorphine Treatment

1 Hr

60 min

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Buprenorphine Treatment Structure course image
Buprenorphine Treatment Structure

0.5 Hrs

30 min

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Understanding Opioid Medications and Buprenorphine Formulations course image
Understanding Opioid Medications and Buprenorphine Formulations

1 Hr

60 min

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Induction – Initiating Buprenorphine Treatment course image
Induction – Initiating Buprenorphine Treatment

1 Hr

60 min

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Prescribing for Pain with Care: 2 Patients course image
Prescribing for Pain with Care: 2 Patients

1 Hr

60 min

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Opioid Misuse – 1 Patient course image
Opioid Misuse – 1 Patient

0.5 Hrs

30 min

View Activity Outline

 
Opioid Use Disorder and Medication Assisted Treatment – 2 Patients course image
Opioid Use Disorder and Medication Assisted Treatment – 2 Patients

0.5 Hrs

30 min

View Activity Outline

 
Opioids and Acute Pain: When and How – 1 Patient course image
Opioids and Acute Pain: When and How – 1 Patient

0.5 Hrs

30 min

View Activity Outline

 
Maintenance and Discontinuation course image
Maintenance and Discontinuation

1 Hr

60 min

View Activity Outline

 

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Activity Content

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Understanding Opioid Medications and Buprenorphine Formulations
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Understanding Opioid Medications and Buprenorphine Formulations
Test Your Knowledge
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Understanding Opioid Medications and Buprenorphine Formulations Post-Test
Post-Assessments
Funding Information Development of this website was funded by grant #R44DA12066, contract #HHSN271200655304C, contracts #HHSN271200900003C and Grant #1R44DA027245-01, from the National Institute on Drug Abuse (NIDA) at the National Institutes of Health. The website contents are solely the responsibility of the authors and do not necessarily represent the official views of NIDA. Ongoing development and maintenance is funded by the training fee and Clinical Tools, Inc. No commercial support is received.
Clinical Tools is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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Buprenorphine Practice Gaps

Professional practice gaps exist when there is a disparity between educational needs and the ideal or desired level of knowledge, competence, and performance. Despite demonstrated effectiveness of buprenorphine (SAMHSA, 2020), only around 95,000 providers prescribe buprenorphine for office-based treatment of opioid use disorder, which is a small percentage considering that the pool of potential prescribers is well over a million (SAMHSA, 2021). Physicians, nurse practitioners, and physician assistants are likely to encounter patients having this disorder due to the size of the opioid epidemic:

  • 9.5 million people (3.4%) aged 12 or older engaged in misuse of opioids in 2020 (SAMHSA, 2021a). 
  • Many people who need treatment are still not receiving it; in 2019 only 18.1% of those needing it received medication-assisted treatment for opioid use disorder (SAMHSA, 2020a).
  • Practitioners having a DEA registration to prescribe controlled substances can prescribe buprenorphine for opioid use disorder and detoxification (HHS, 2021). Federal law requires practitioners wishing to see more than 30 patients to complete an 8-hour certification training in order to prescribe buprenorphine (SAMHSA, 2020b; HHS, 2021).
  • This training is intended for practitioners who are not required to complete a certification training for a waiver and others who wish to refresh skills or learn more about buprenorphine.

Buprenorphine is a safe and effective treatment for opioid use disorder. Until the exemption for practitioners with DEA registration announced on April 28, 2021 (HHS, 2021), 8 hours of training by an approved organization was required by law in order to prescribe it (SAMHSA, 2020b). Providing information on all aspects of buprenorphine treatment will help address this knowledge need. Moreover, buprenorphine treatment has a protocol for successful outcomes and to minimize risks of overdose, death, and diversion (ASAM, 2020), which validates a need for training for many providers. New, extended-release formulations of buprenorphine have been released over the past several years, resulting in the need to learn new clinic protocols and understanding of patient needs (Compton & Volkow, 2021).

Understanding of clinical protocol and how to apply it will help address this competence need. Experience with interactive case scenarios helps address the performance need of translating competence in following the protocol into actual practice. 

Practice Gap References

ASAM. The ASAM National Practice Guideline For the Treatment of Opioid Use Disorder 2020 Focused Update. 2020.

Compton W & Volkow N. Extended-Release Buprenorphine and Its Evaluation With Patient-Reported Outcomes. JAMA Netw Open. 2021;4(5):e219708. doi:10.1001/jamanetworkopen.2021.9708

Health and Human Services Department. Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder. Fed Regist. April 28, 2021.

Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.; 2020a.

Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.; 2021a.

SAMHSA. Buprenorphine. October 7, 2020b.

SAMHSA. Practitioner and Program Data. SAMHSA.gov. 2021b.

Training Activity References

Understanding Opioid Medications and Buprenorphine Formulations References

  1. SAMHSA/CSAT. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. 2004. PMID: 22514846.

  2. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.

  3. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013.

  4. ASAM. 2020 National Practice Guideline. Am Soc Addict Med. 2020.

  5. Mackey K, Veazie S, Anderson J, Bourne D, Peterson K. Barriers and Facilitators to the Use of Medications for Opioid Use Disorder: A Rapid Review. J Gen Intern Med. December 2020;35(Suppl 3):954-963. doi:10.1007/s11606-020-06257-4. PMCID: PMC7728943. PMID: 33145687.

  6. Trescot A, Datta S, Lee M, Hansen H. Opioid Pharmacology. Pain Physician. 2008;11(2 Suppl):S133-153.

  7. Williams J. Basic Opioid Pharmacology. Rev Pain. March 2008;1(2):2-5. doi:10.1177/204946370800100202. PMCID: PMC4589929. PMID: 26524987.

  8. Pathan H, Williams J. Basic Opioid Pharmacology: An Update. Br J Pain. February 2012;6(1):11-16. doi:10.1177/2049463712438493. PMCID: PMC4590096. PMID: 26516461.

  9. Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. In: Vol Publication No. PEP20-02-01-006. Treatment Improvement Protocol (TIP). Rockville, MD: SAMHSA; 2020.

  10. Richardson MG, Raymond BL. Lack of Evidence for Ceiling Effect for Buprenorphine Analgesia in Humans. Anesth Analg. July 2018;127(1):310-311. doi:10.1213/ANE.0000000000003368. PMID: 29624528.

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  15. Kosten T, George T. The Neurobiology of Opioid Addiction: Implications for Treatment. NIDA Sci Pract Perspect. 2002;1(1):13-20. PMCID: PMC2851054. PMID: 18567959.

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  36. Labelle C, Han S, Bergeron A, et al. Office-Based Opioid Treatment with Buprenorphine (OBOT-B): Statewide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers. J Subst Abuse Treat. 2015;15. PMCID: PMC4682362. PMID: 26233698.

  37. FDA. Medication Guide: ButransTM CIII (buprenorphine) Transdermal System. 2010.

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  39. FDA. Bunavail prescribing information. 2014.

  40. Stanton A, McLoed C, Luckey B, et al. SAMHSA/CSAT Evaluation of the Buprenorphine Waiver Program. 37th Annual Medical- Scientific Conference of the American Society of Addiction Medicine. 2006.

  41. Dahan A, Yassen A, Romberg R, et al. Buprenorphine Induces Ceiling in Respiratory Depression but Not in Analgesia. Br J Anaesth. 2006;96(5):627-632. PMID: 16547090.

  42. Huestis M. High-dose buprenorphine in humans. In: In: Kintz P, Marquet P, Eds. Buprenorphine Therapy of Opiate Addiction. Vol Totowa, NJ: Humana Press, Inc; 2002.

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