Pubdate: Fri, 27 Feb 2015
Source: Baltimore Sun (MD)
Copyright: 2015 The Baltimore Sun Company
Authors: Bethany DiPaula and Raymond C. Love


Opioid overdose and dependence are enormous public health problems in 
the U.S. As The Sun reported this week, Gov. Larry Hogan has rolled 
out a strategy to fight heroin ("Hogan unveils plan to fight heroin," 
Feb. 24). A Baltimore task force is considering the city's 
heroin-related treatment needs. And City Health Commissioner Dr. 
Leana Wen has written recently in The Sun that naloxone is the key to 
preventing overdose deaths. Studies show that medications like 
Suboxone, a combination of buprenorphine and naloxone, can reduce 
opioid overdoses, drug use, disease transmission and criminal 
activity while increasing the number of patients who remain in 
treatment. Still, there continues to be a limited number of 
physicians offering buprenorphine treatment. We believe pharmacists 
could play a key role in providing patients access to life-saving treatment.

Federal law allows certain physicians to prescribe Suboxone to treat 
opioid dependence in an office-based setting. However, other 
potential prescribers such as pharmacists, physician assistants and 
nurse practitioners cannot prescribe this medication, further 
limiting patient access. Collaboration within the health care team 
could ameliorate some the demands that Suboxone treatment can place 
on a physician, including intensive monitoring of patients and the 
stigma associated with treating patients with substance use 
disorders. Collaborative drug therapy management (CDTM), in which 
specially trained pharmacists order medications in partnership with 
physicians, could be particularly effective in increasing access to 

Maryland law already allows physicians and pharmacists to manage 
patients together using collaborative drug therapy management 
agreements, but current federal law does not permit non-physicians to 
prescribe buprenorphine. As board-certified psychiatric pharmacists 
involved in the treatment of patients with substance use disorders, 
we believe that a critical way to improve access to Suboxone would be 
to change this federal law. Congress should act to allow specially 
trained pharmacists to prescribe buprenorphine. Doing so could expand 
access to this life-saving and lifechanging medication.

Bethany DiPaula and Raymond C. Love, Baltimore

The writers are, respectively, associate professor and professor of 
pharmacy practice and science at the University of Maryland School of Pharmacy.
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