Buprenorphine is a partial opioid receptor agonist available in Canada since 2007. It is most commonly prescribed in combination with opioid antagonist naloxone as Suboxone® in sublingual tablet form.
Suboxone® is as effective as methadone for treatment of opioid dependence but with an improved safety profile. The agonist/antagonist action of Suboxone® creates a “ceiling effect” which makes it less likely to result in overdose and less attractive to abuse.
Although Suboxone® has an improved safety profile compared to methadone, opioid dependent patients are high risk and must be managed with appropriate boundaries. Monitor compliance by accessing prescribing databases and consider random urine drug screening.
Physicians who wish to prescribe Suboxone® for opioid dependent patients in Alberta must be registered to prescribe Triplicate Prescription Program listed drugs, and are encouraged to complete an online Suboxone® prescribing course. We recommend the Centre for Addiction and Mental Health (CAMH) Buprenorphine-Assisted Opioid Dependence Treatment course or www.suboxonecme.ca. Contact us at firstname.lastname@example.org to discuss other equivalent course options.
INITIATION of Suboxone® in an Unstable Patient
Unstable patients are those with active opioid dependency, withdrawal symptoms that have not yet achieved a stable dose of Suboxone® or other indicators of instability.
To initiate Suboxone® in these patients, physicians must be registered to prescribe Triplicate Prescription Program listed drugs, and are encouraged to:
- Complete an accredited buprenorphine prescribing course* in opioid dependence.
MAINTENANCE of Suboxone® in Stable Patient
A patient is considered stable when opioid withdrawal symptoms are controlled by a stable Suboxone® dose for at least 2 months and there are no other indicators of instability. To maintain a stable dose of Suboxone®, physicians must be registered to prescribe Triplicate Prescription Program listed drugs, and are encouraged to:
- Complete an accredited Suboxone® prescribing course* in opioid dependence
TEMPORARY Prescriber of Suboxone®
This category would apply to physicians who wish to prescribe Suboxone® for patients admitted to hospitals or other healthcare settings with controlled medication dispensing processes (e.g. nursing homes) or for incarcerated patients for the duration of their admission/incarceration only.
Temporary Suboxone® prescribing physicians will be permitted to maintain the same Suboxone® dose without completion of a Suboxone® prescribing course.* A temporary prescribing physician must consult with a physician experienced in the treatment of opioid dependency for any dose changes. Physicians will be required to:
- Have a relationship with a physician experienced in the treatment of opioid dependency**
*A course considered appropriate is the online CAMH Buprenorphine-Assisted Opioid Dependence Treatment Core Course or www.suboxonecme.ca. Contact us below to discuss other equivalent course options.
**Temporary prescribing for hospitalized/incarcerated patient(s) at the same Suboxone® dose and only for the duration of their hospitalization/incarceration.