Suboxone prescribing requirements

[Deja]

A doctor just told me that you do not need provide the special DEA number that starts with a X on certain diagnosis with suboxone; he also said he treats a lot of people with suboxone (over the limit) because of this

is this true? I was under the impression that you are only allowed to treat 30 patients and pharmacies need to make sure they are specially certified with X... or do we just need to make sure that they are certified and doesn't necessarily have to bill the insurance under the special DEA?

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[naseuy]

They do not need XDEA if they are treating pain.

 

[Deja]

They do not need XDEA if they are treating pain.

do we need to document? I could've sworn I read somewhere you needed X for all lol pain is off label use

 

[BidingMyTime]

Ummm, I'm not sure about this. I think it's OK for doctors to prescribe it for pain (not for addiction) without a X number, but it should be documented on the RX (it's needs to say for pain or have their ID-10 code or whatever.)

 

[Deja]

Ummm, I'm not sure about this. I think it's OK for doctors to prescribe it for pain (not for addiction) without a X number, but it should be documented on the RX (it's needs to say for pain or have their ID-10 code or whatever.)

Doctor has to write it on there or can we add it on? No one here encountered this situation before?

I'm going to assume I will get a lot of suboxone patients in the near future

 

[zelman]

It can be prescribed for anything besides addiction without an NADEAN. Commonly pain, but could be used for diarrhea or whatever. Some states have more specific regulations, however.

 

[ChalupaBatman86]

Sounds sketchy to me!


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[Sine Cura]

It's one of those things you should check "just in case," like idiot prescribers writing for methadone for maintenance (a psych doctor no less) because the customer doesn't want to go to his methadone clinic.

In my lovely Medicaid-dominant store, pretty much all scripts for Suboxone are written by those with the DATA waiver and Medicaid will cover Suboxone only for opioid dependence anyway

 

[Deja]

This doctor has the special DEA, he just separate his patient in to 2 groups, ones that need the X and the ones that doesn't

I guess we will just have to ask him to specifically write out the diagnosis code on each script if its not prescribed with a X

 

[CetiAlphaFive]

A doctor just told me that you do not need provide the special DEA number that starts with a X on certain diagnosis with suboxone; he also said he treats a lot of people with suboxone (over the limit) because of this

is this true? I was under the impression that you are only allowed to treat 30 patients and pharmacies need to make sure they are specially certified with X... or do we just need to make sure that they are certified and doesn't necessarily have to bill the insurance under the special DEA?

If it were me:
I would be extremely leery of this and probably reject them outright no matter what. There are much better options than suboxone for pain management.

I'd probably respectfully tell the M.D. to send his patients elsewhere.

SPECIAL NOTE:

You can check to see if a prescriber had an active NADEAN using the DEA validation website. Pull up the DEA.

( https://apps.deadiversion.usdoj.gov/webforms/validateLogin.jsp )

THEN:

Check the prescriber's info.
There should be a letter (a W?) followed by a number. The number is the amount of patients the prescriber is allowed to treat.

I've had one clown who thought he could just call and say the x in front of the regular dea without being registered.


EDIT:

This doctor has the special DEA, he just separate his patient in to 2 groups, ones that need the X and the ones that doesn't

I guess we will just have to ask him to specifically write out the diagnosis code on each script if its not prescribed with a X

Nnnnaaahhh... this stinks to high heaven.
For me, there are red flags raising, red warning lights flashing, and a guy with a red banana dancing.
It seems obvious to me that he's treating more patients than he's allowed.

 

[Rukn]

If you work at a crackhouse where they call in fake Rxs for even test strips then who cares

Just fill it!

 

[ldiot]

You can prescribe it without the XDEA if it's for pain but considering the fact that this doctor has the XDEA and is writing it for pain in order to get around the patient limit I wouldn't fill it and would probably not take any new suboxone patients from that doctor at all. In fact I would consider blacklisting him and reporting him to the DEA. How many of his patients are actively tapering off? Probably zero

 

[CetiAlphaFive]

OK:

Here's exactly what I meant:

....
DEA Number: GG1234567


This DEA Number is ACTIVE

Name (Last, First): Fielgudpilz, Gieme da

Business Activity: PRACTITIONER-DW/100

Business Address 1: 101 Fibro-mylan-only-alga street
i
....

If a prescriber has an active NADEAN, it'll have the DW/__ part, where the number is the number of patients they can treat.

If they don't have the NADEAN (special X DEA number) it'll just say Practitioner.

 

[Deja]

What I don't understand is why is there a restriction on this drug in the first place? yes, some argue you are just replacing one addicted drug with another since most people do not taper off... but suboxone doesn't give you the high effect and it's not more dangerous than other pain meds that doesn't have restrictions.... or am I missing something?

PS, I should know this lol but does all buprenorphine products require X-DEA?

 

[zelman]

What I don't understand is why is there a restriction on this drug in the first place? yes, some argue you are just replacing one addicted drug with another since most people do not taper off... but suboxone doesn't give you the high effect and it's not more dangerous than other pain meds that doesn't have restrictions.... or am I missing something?

PS, I should know this lol but does all buprenorphine products require X-DEA?

Because the DEA regulates controlled substances in an attempt to prevent addiction. If they allow practitioners to give opiates to opiate addicts to feed that addiction, it needs to be more tightly regulated as it flies in the face of their mission. They want to make sure it is being done responsibly, so they require some level of training/education on the topic and limit the number of patients to make sure they can be monitored appropriately.

And yes. This applies to all buprenorphine products used to prevent opiate withdrawal.

 

[npage148]

They are not restricting suboxone's use. They are restricting the clinical practice of addiction management due to the issues involving purposefully maintaining a clinical addiction. Same with methadone. Use it for toe pain all day

 

[ldiot]

It's probably restricted in part due to crackhead doctors who charge patients hundreds of dollars a month to write a script and never taper them off. In the three years that I've worked (right next to one of these clinics) I have NEVER seen a patient being tapered down and every patient who has got off ended up going cold turkey. As a matter of fact I've seen patients being tapered UP to doses exceeding 30mg/day. The doctor the OP is dealing with sounds like one of these. In what circumstance is buprenorphine the best option for pain? What are the chances that a doctor who treats opiate addiction coincidentally has multiple patients in pain who fall under the rare circumstance where buprenorphine is the best option? Give me a break

 

[CetiAlphaFive]

It's probably restricted in part due to crackhead doctors who charge patients hundreds of dollars a month to write a script and never taper them off. In the three years that I've worked (right next to one of these clinics) I have NEVER seen a patient being tapered down and every patient who has got off ended up going cold turkey. As a matter of fact I've seen patients being tapered UP to doses exceeding 30mg/day. The doctor the OP is dealing with sounds like one of these. In what circumstance is buprenorphine the best option for pain? What are the chances that a doctor who treats opiate addiction coincidentally has multiple patients in pain who fall under the rare circumstance where buprenorphine is the best option? Give me a break

+1.

OP's doctor needs a visit from their local DEA office.

 

[Sine Cura]

Just require a copy of a chart. Reputable offices understand. Pill mills will bitch and moan probably because they don't even keep records.

When was the last time any pharmacist even saw a Suboxone Rx for pain? What a joke.

 

[Deja]

So why isn't buprenorphine being used more for pain management?

I think it's better than a lot of the full opioids if it can control the patients pain adequately

 

[ldiot]

So why isn't buprenorphine being used more for pain management?

I think it's better than a lot of the full opioids if it can control the patients pain adequately

One reason may be because technically only the patch and injection are approved for pain by the FDA. In some states generic Subutex can actually only be prescribed to pregnant women and Suboxone and Zubsolv are expensive and often not on formulary. Even the SL buprenorphine tablets often require prior auth.