Buprenorphine Interactive Treatment Agreement

• The original guide for prescribing buprenorphine, SAMHSA's Treatment Improvement Protocol (TIP) on the use of buprenorphine in the treatment of opioid addiction, TIP Number 40 [1]
• The updated policies on buprenorpine treatment produced by the Federation of State Medical Boards' Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office [2]
• An update and expansion of these guideline developed by an expert panel of expert consultants and intended to provide guidance based on accumulated experience and expert consensus based on 14 years since DATA 2000 was first enacted [3]
• ASAM's National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use [4].

1. How to communicate with patients
2. Policies for broken appointments
3. Expectations regarding payment for treatment
4. Responses to patient behaviors that could interfere with their treatment or your practice (such as referral to a higher level of care or dismissal from the practice)

1. Patients are required to participate in urine drug tests. The FSMB model policy on buprenorphine treatment recommends that treatment agreements obtain permission from patients for drug screens.
2. Patients are required to disclose the use of any psychoactive substance(s) to the physician. Use of psychoactive substances may be discovered through urine drug testing or review of the patients record in a Prescription Drug Monitoring Report and a policy is needed for when the patient did not disclose their use.

Risks/Benefits

Potential Benefits:

1. Control of withdrawal symptoms when quitting opioid use.
2. Supports patients with opioid use disorder in quitting other opioid use.
3. Compared to other treatments for opioid use disorder, allows more freedom to continue usual daily living routine.

Potential Disadvantages and Risks:

1. Patients become physically dependent on buprenorphine.
2. May experience some opioid-related side effects including mild sedation or impairment of psychomotor function initially and after dose increases or constipation.
3. Potential drug interactions with other substances, especially sedating drugs and alcohol.

1. Describing the criteria for treatment success
2. Behaviors that may result in immediate dismissal from treatment
3. Policy for relapse to opioid use

1. No intoxication from any substance use
2. Physical, psychosocial, and work-related functioning improved
3. No suffering from withdrawal
4. No experience of drug cravings
5. Following treatment protocol
6. Adherence to treatment agreement and treatment plan

Patient Conduct

Relapse Policies