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.
Buprenorphine 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 buprenorphine 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 buprenorphine for opioid dependent patients in Alberta must complete an online buprenorphine prescribing course and provide the CPSA with proof of completion. To complete this online course, visit the Centre for Addiction and Mental Health (CAMH) course page.
INITIATION of Buprenorphine in an Unstable Patient
Unstable patients are those with active opioid dependency, withdrawal symptoms that have not yet achieved a stable dose of buprenorphine or other indicators of instability.
To initiate buprenorphine in these patients, physicians will be required to:
- Complete an accredited buprenorphine prescribing course* in opioid dependence (and provide evidence of successful completion).
MAINTENANCE of Buprenorphine in Stable Patient
A patient is considered stable when opioid withdrawal symptoms are controlled by a stable buprenorphine dose for at least 2 months and there are no other indicators of instability. To maintain a stable dose of buprenorphine, physicians will be required to:
- Complete an accredited buprenorphine prescribing course* in opioid dependence (and provisioned evidence of successful completion)
TEMPORARY Prescriber of Buprenorphine
This category would apply to physicians who wish to prescribe buprenorphine 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 buprenorphine prescribing physicians will be permitted to maintain the same buprenorphine dose without completion of a buprenorphine 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 Opioid Dependence Treatment Core Course, or other approved equivalent courses. Physician must provide confirmation of course completion to the CPSA.
**Temporary prescribing for hospitalized/incarcerated patient(s) at the same buprenorphine dose and only for the duration of their hospitalization/incarceration.