DEA schedule drugs

[sujalneuro]

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Hi I will be working as CL psychiatrist. Need to finish DEA application, which schedule drugs should I choose from 1-5?
Definitely have no experience with buprenorphine and methadone. Thanks for your input!!

 

[VA Hopeful Dr]

Hi I will be working as CL psychiatrist. Need to finish DEA application, which schedule drugs should I choose from 1-5?
Definitely have no experience with buprenorphine and methadone. Thanks for your input!!

2, 2N, 3, 3N, 4, 5

 

[NickNaylor]

Everything but 1. Your experience with ORT is someone irrelevant since you'll need to get an X number if you plan on using buprenorphine, and you won't be prescribing methadone unless you're working in a methadone clinic.

 

[splik]

Everything but 1. Your experience with ORT is someone irrelevant since you'll need to get an X number if you plan on using buprenorphine, and you won't be prescribing methadone unless you're working in a methadone clinic.

BTW bupe is a schedule 3 drug and methadone is schedule 2. Sometimes people use methadone for inpatients to take the edge of withdrawal and occasionally start someone on methadone...

 

[NickNaylor]

BTW bupe is a schedule 3 drug and methadone is schedule 2. Sometimes people use methadone for inpatients to take the edge of withdrawal and occasionally start someone on methadone...

Fair enough. I've never worked with an attending bold enough to start methadone in the inpatient setting, but I guess it's an option...

 

[hamstergang]

BTW bupe is a schedule 3 drug and methadone is schedule 2. Sometimes people use methadone for inpatients to take the edge of withdrawal and occasionally start someone on methadone...

The hospitals I've been in have not allowed starting methadone for ORT. We could continue it from outpatient or use it for pain. I thought this was due to legal requirements, but you're saying this was instead hospital policy?

 

[michaelrack]

At a hospital i have moonlighted at, methadone is often used for several days for opioid detox

 

[675015]

At a hospital i have moonlighted at, methadone is often used for several days for opioid detox

We also use methadone frequently for detox but have a strict "If you didn't come in on methadone, you don't leave on methadone" policy. I believe its mostly due to the fact that since we don't have a methadone program its hard to ensure someone has follow-up with a program and that its not nice to send them out on methadone if they aren't going to be able to continue to getting it filled.

 

[HarryMTieboutMD]

The hospitals I've been in have not allowed starting methadone for ORT. We could continue it from outpatient or use it for pain. I thought this was due to legal requirements, but you're saying this was instead hospital policy?

It's both. At my hospital we can use methadone (or buprenorphine) to detox patients provided that they are admitted for another reason and *happen* to be in opioid withdrawal. If we decide to not only treat the wtihdrawal but initiate OMT we can do that, but then we have to arrange for the patient to go to a methadone clinic (but it's up to the patient to actually show up, we obviously can't write an RX for MTD at DC) or in the case of Bup the attending/resident needs to be Bup certified to Rx upon DC, and the patient needs to be set up with a Bup provider

 

[SeniorWrangler]

The law says you can't continue a methadone prescription at discharge *for opioid use disorder* unless it is a bridging prescription to a patient's follow up with a methadone clinic and even then it has to be administered one day at a time for no more than 3 days and someone has to observe the patient taking it. It is funny that you can prescribe, say, dilaudid, until the cows come home but methadone for addiction falls under a very strict law.
There have been some interesting studies about very permissive prescribing of buprenorphine during short term jail stays or hospitalizations as a way to get patients into MAT when they may be more open to it and maybe more likely to continue in treatment, but it is not the standard of care.

 

[DD214_DOC]

I say dream big and go for I as well!


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[Armadillos]

This may be common knowledge, but I recently realized you don't need a Xnumber/Bup waiver to detox someone (even as outpatient!) with Bup so long as it's less than 72hrs and you don't provide them more than a day supply at a time.

The top rule on this page (the incidental detox for someone's admitted for something else) seems more commonly known and was mentioned above, but I didn't know about the 72hr rule.

Special Circumstances for Providing Buprenorphine | SAMHSA - Substance Abuse and Mental Health Services Administration

 

[SeniorWrangler]

I would really encourage docs doing this to get the waiver, in this environment it is a poor idea to put yourself on the radar of the DEA in any way.

 

[Shikima]

I would really encourage docs doing this to get the waiver, in this environment it is a poor idea to put yourself on the radar of the DEA in any way.

Or elect not to do it.